Over-the-Counter Allergy Medications: The Complete Guide

The majority of allergy medications are now available without a prescription. This is obviously a good thing if you are an allergy sufferer, as you do not have to see your doctor get a prescription for simple treatment.
However, you should be careful. Over-the-counter allergy medications can be tricky if you don’t know all of the benefits or risks of using them.

This is where I come in:

The complete guide to the best over-the-counter allergy medication for allergy relief explains everything that an allergy sufferer needs to know when choosing an OTC allergy medicine for their allergy symptoms or allergy relief.

Let’s get started.

Oral Over-the-Counter Antihistamines

Benadryl

Benadryl (which has the generic name diphenhydramine) is a common oral over-the-counter antihistamine. It has been around the longest and is the most widely used, but it shouldn’t be:

Benadryl may be beneficial for an acute allergic reaction to a food, but as a chronic medication, it has too many drawbacks.

Benadryl is a short-acting antihistamine, so it’s protection is limited to a few hours. The other well-known adverse reaction is that it crosses into the brain and makes users tired. Pharmaceutical companies have taken advantage of this drawback by adding diphenhydramine to pain medications, like Tylenol PM or Advil PM, in their nighttime formulas.

A Better Alternative to Benadryl

A much better choice of oral antihistamines is the newer products: Claritin (loratadine), Allegra (fexofenadine) and Zyrtec (cetirizine).

These antihistamines act for a much longer period of time, varying from 24 hours to 3 days with just one pill and tend to be much less sedating than the older antihistamines, with few drug interactions or side-effects.

Advantages of Oral Over-the-Counter Antihistamines

There are advantages to taking an oral antihistamine for allergic symptoms such as sneezing, runny nose, and eye itching.

These medications can block each one of these reactions and are easy to administer. There is no difficult technique involved in taking these types of antihistamines, which include eye drops or nose sprays.

Therefore, you would probably think these antihistamines are the perfect allergy medication.

However, in reality, they are good, but not great! Let’s learn more.

Topical Medications

For the tougher allergy symptoms, such as severe nasal congestion, red eyes, and throat itching, topical medications trump the oral antihistamines:

By administering the topical solution to the nose and/or eye, the tissue gets an immediate and deeper absorption of medicine to block the allergic reaction.

Afrin Nasal Spray

This nasal decongestant works immediately for colds or allergic rhinitis. My patients continually talk about their confusion when choosing over-the-counter nasal sprays. Many are aware of Afrin but are afraid to use it.

They have heard it is addictive – and they are right!

The problem with Afrin is that you get “hooked” on its benefit and with chronic use, you end up more symptomatic than before. Afrin is not a good medication to use to treat nasal allergies on a long-term basis. It does not block allergic inflammation and you can get a rebound effect where, after you stop using it, you become even more congested, hence the addictive quality.

Today there are many excellent prescription choices to help ease nasal symptoms: Patanase, Astelin, Flonase, etc… Remember antihistamines don’t give relief for nasal congestion except for the ones that have a “D” in them. Be warned that constant use of decongestants can raise your blood pressure and cause heartburn and insomnia.

Primatene

The final product which is over-the-counter, but not really safe for asthma is mist-this is inhaled epinephrine. I rarely see any patients in my practice with asthma who use it, but it is still available in many drug stores. Sadly, if a patient with asthma constantly uses this medicine they are not properly treating the inflammatory component of asthma and can be at risk of dying if their airways shut down and get filled with mucus.

Cortisone Nasal Sprays

Additionally, many patients are aware that nasal sprays can contain cortisone and have concerns about whether it is dangerous. Cortisone nasal sprays, such as Flonase (fluticasone) or Nasacort is steroid sprays that are available over-the-counter. They can work wonderfully in relieving symptoms within an hour and last for a full day.

These nasal sprays tend to be very safe since they mainly work locally in the nasal tissue without significant absorption by the rest of the body. This avoids the concern of a drug-drug interaction, which can happen with an oral antihistamine. However, like with all nasal sprays, I tell my patients that technique is critical, so it is important that you are using them in the right way.

The Importance of Technique

When using nasal sprays, it is essential that you have the right technique. You should aim the spray to the side of the nose, not to the middle! If you aim to the middle of your nose you can irritate your nasal septum or, in the worst-case scenario, perforate or make a hole in the septum. If you have been using a cortisone nasal spray for over a month, I would advise checking with your doctor to see if have been using the right technique.

Over-the-Counter Allergy Eye Drops

Ophthalmic eye drops are an excellent way to relieve severe eye itching and redness. There are many different OTC allergy eye drops, and of course, some are good and some are bad.

The Bad: Visine Allergy Eye Drops

It’s advertised to “get the red out” of your eyes. It accomplishes this by constricting your blood vessels in the eye. However, if this medicine is used on a regular basis for allergy or cosmetic reasons, you can end up with chronic red eyes. Why? Your eyes become used to the medicine.

Visine‘s over-the-counter allergy eye drops are a bad choice for allergy sufferers with itchy or swollen eyes. The decongestant in the Visine may “Get the Red Out” as they advertise in the commercials, but like Afrin, it can be addicting and cause more long-term problems.

The only antihistamine eye drops available are older version type antihistamines and I do not recommend them!

The Best Eye Allergy Drops: Prescription

There are many good prescription antihistamine eyes drops such as Patanol, Pataday, Elestat, and Optivar. Be sure to check with your doctor to see which one would be best for you. Also, check with your insurance coverage. Many of these eye drops can be very expensive so make sure you are covered.

These are MUCH better options than Visine.

Why Do You Need An Allergist?

At this point, you may be wondering: “Who needs an allergist when all of these over-the-counter allergy medications are available?”

I thought about this question long and hard, and surprisingly there are still many allergy sufferers who need the help of a certified allergist or immunologist.

One important service I provide to my patients is allergy desensitization or immunotherapy. I have treated thousands of patients effectively with sublingual allergy drops to environmental allergens, like tree and grass pollen, cats and dogs and dust and mold.

Sublingual allergy immunotherapy is a natural way to get lasting protection against airborne allergens. The only key factor is that a patient has to build up high levels several months before the beginning of their allergy season.

If allergies slow you down, consider these medications available at your local pharmacy. If they paralyze your golf game or jogging, consider sublingual allergy drops – beating allergies has never been easier! Why mask the symptoms when you can treat the underlying condition and get long-lasting relief from allergies.

You can read more about how I use sublingual allergy drops to treat my patients in my book: Dr. Dean Mitchell’s Allergy and Asthma Solution.

– Dr. Dean Mitchell, M.D.
Mitchell Medical Group, NYC

About the Author – Dr. Dean Mitchell, M.D.

Dr. Dean Mitchell, M.D. is a Board Certified Allergist and Immunologist based out of NYC. He graduated from the Sackler School of Medicine and completed training at the Robert Cooke Allergy Institute in New York City. He is also a Clinical Assistant Professor at Touro College of Osteopathic Medicine, a fellow of the American Academy of Allergy, Asthma, and Immunology, and the author of Dr. Dean Mitchell’s Allergy and Asthma Solution: The Ultimate Program for Reversing Your Symptoms One Drop at a Time. Dr. Dean Mitchell, M.D. has also been featured in The New York Times, The Huffington Post, Fitness Magazine, Dr. Oz and News NY 1. Dr. Mitchell also hosts the podcast The Smartest Doctor in the Room – a combination of a lively, personal and in-depth interview with top healthcare specialists.