Feeling all sneezy and sniffly and downright achoo-y? Yes, it's spring allergy season — and in some areas, it's hitting earlier because of climate change, experts say. And that means it's lasting longer as well. For any of us hit by this seasonal misery, the first questions may well be: What are the best over-the-counter medications to ease the ickies? Should I use a decongestant or an antihistamine, a spray or a pill? Here, some expert answers to what medications are out there — and why with certain meds, it's best to start taking them early.
Common brand names: Benadryl, Claritin, Allegra, and Zyrtec
An antihistamine could be a good medication option if your allergies come and go. These meds are generally fast-acting, and work by blocking histamines, the chemicals in your body that turn you into a sneezy, dripping mess. They come in several different forms: pills, liquids, eyedrops, and nasal sprays.
According to the Allergy and Asthma Foundation of America, antihistamines can ease sneezing and itchy nose and eyes. But you should think about potential side effects when choosing which anti-histamine to take, says Anita Sivam, DO, a board-certified allergist/immunologist in Indianapolis.
“Benadryl is considered a sedating, or first-generation, antihistamine,” Dr. Sivam says. “We know from research studies that after patients took Benadryl, driving performance was the poorest — in fact, it had a greater impact on driving than alcohol did! Also, Benadryl is much shorter acting, only about 4-6 hours. Claritin, Allegra, and Zyrtec are considered non-sedating or second-generation anti-histamines. Thus, we recommend using these type of anti-histamines because they work just as fast as Benadryl, don’t cause drowsiness, and last a lot longer.” Side effects for Claritin and Allegra may include headaches, nausea, and dry mouth.
Common brand names: Sudafed, Afrin
Decongestants, like antihistamines, also come in pill, liquid, eye drop, and nasal spray form. “They’re commonly used when people have a stuffy nose or sinus pain or pressure,” says Dr. Sivam. “These medications work by narrowing the blood vessels to decrease swelling and congestion.” And that makes it easier to breathe (aaaah!).
“Decongestants are really for symptom relief, not to treat the underlying issues of allergies, cold, or sinus infection,” Dr. Sivam explains. And again, people should consider the side effects and, she says, not use them on a regular basis. “In the form of oral medications, taken by mouth, decongestants can cause systemic side effects including increase in blood pressure, high heart rate, and palpitations,” she says. “Topical decongestants, like Afrin [oxymetazoline], are fine if they are used for just a few days. However, prolonged use can cause ‘rhinitis medicamentosa,’ which is basically worsening nasal congestion because your nose almost becomes ‘addicted’ to the medications.”
Common brand names: Allegra-D, Claritin-D
These are medicines that combine both decongestants and antihistamines — which can give you a double-whammy of relief from allergy symptoms. But again, says Dr. Sivam, “I don’t recommend decongestants to be used on a regular basis due to the possible side effects. If you’re having persistent symptoms that aren't relieved by a nasal spray or oral anti-histamine, then it’s probably time to see a board-certified allergist for further evaluation.”
Common brand names: Flonase, Nasacort AQ, Sensimist, Rhinocort
These nasal sprays are a good option if you have symptoms, well, pretty much every day, or all year long. They block reactions to allergens and bring down inflammation in the nose. “Intranasal steroids are probably the most effective OTC medication for the treatment of nasal allergy symptoms,” says Dr. Sivam. “Most are interchangeable — people may prefer the smell or taste of one brand over another. The most important thing to remember is that you can’t just spray them and feel immediate relief — you get that from Afrin, which is why people love it. Intranasal steroids take time to work. You may not notice a benefit until two to four weeks of consistent use.”
How you use these sprays is important too, says Dr. Sivam. Here's her advice for the best technique:
- Look straight ahead, or slightly downward (Not upward!)
- Place the tip of the nasal spray bottle at the opening of one nostril, angled slightly outward.
- Aim spray "up and out" towards the outer corner of your eye.
- Hold your breath or very gently inhale while spraying. (Do not inhale sharply — this will just direct the flow of liquid medication down the back of your throat, where it will be annoying and not help your nasal congestion!)
- Repeat on the other side.
- If there is excess liquid medication in your nose after this, let gravity help it reach the swollen areas. Lean forward until the top of your head is directed toward the ground, then tip your head to the right and hold for about 10 seconds, then to the left and hold again.
- After a minute or two, or if fluid is draining down your throat, you may blow your nose to get rid of excess fluid.
With proper technique, nasal steroid sprays can be used for a prolonged time. The most common side effect is nose bleeds or dry nose, Dr. Sivam says. “If this happens, back off for few days and then resume.”
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