Treating Allergies with OTC Medications

Most allergies can be treated successfully with OTC medications. Here is a rundown of the most common non-prescription allergy medications.

Allergy symptoms can often be treated successfully with over-the-counter (OTC) drugs. If these don’t work well enough, your doctor can prescribe alternatives. Some of which are stronger versions of OTC products.

Many allergy medications work best when taken before you come in contact with allergens and have symptoms. That way the drugs can prevent or reduce the production of chemicals responsible for the allergic reaction.

Antihistamines

Antihistamines are often the first choice. They treat the effects of histamine, which are sneezing, runny nose, and itchy eyes. But it does not treat nasal congestion. Products come in pills, nasal sprays, and eye drops.

“Second-generation” antihistamines are long-lasting—12 or 24 hours. They often do not cause drowsiness.

Examples include:

• Cetirizine (Zyrtec)
• Desloratadine (Clarinex)
• Fexofenadine (Allegra)
• Loratadine (Claritin, Alavert)

Most are available as less expensive OTC generics. Some also contain a decongestant. This is indicated by a “D” appended to the brand name.

Older “first-generation” antihistamines have side effects. They should be used with caution.

Examples include:

• Diphenhydramine (as in Benadryl)
• “Pheniramines” (such as chlorpheniramine, as in Chlor-Trimeton)

The antihistamine effect wears off after several hours. But they can cause drowsiness that sometimes lasts more than 12 hours. For this reason, people take them before going to bed. The sleepiness can still impair driving the next day, even if you don’t feel drowsy. What’s more, these drugs have anticholinergic effects. That means they interfere with the neurotransmitter acetylcholine. Side effects of which include:

• Cause or worsen memory problems, confusion, and cognitive impairment in older people
• Worsen urinary symptoms in men with prostate enlargement

Decongestants

Decongestants shrink dilated blood vessels in the nose, lessening swollen nasal passages. They come as OTC pills, capsules, liquids, and nasal sprays.

• Oral products contain pseudoephedrine or phenylephrine.
• Sprays contain phenylephrine or oxymetaxoline.
• Pseudoephedrine and oxymetazoline provide symptom relief longer than cold formulations containing phenylephrine.

You shouldn’t use decongestant nasal sprays for more than two or three days in a row. That’s because they lose effectiveness and can cause a rebound effect, resulting in even worse nasal congestion.

Talk with your healthcare provider or pharmacist before using either oral or nasal decongestants if you:

• Have high blood pressure, heart disease, glaucoma, thyroid disease, an enlarged prostate, or diabetes
• Are pregnant or breastfeeding
• Are taking other medications on a regular basis (many of which interact with decongestants)

You may be able to use decongestant nasal sprays even if you are advised against pills or capsules. That’s because they are less likely to have systemic effects. Finally, these drugs can cause nervousness, sleeplessness, and palpitations in some people.

Cromolyn sodium nasal spray

Cromolyn sodium nasal spray is safe and effective for preventing hay fever symptoms in adults and children as young as six.

• It blocks the release of histamine.
• It is best started before allergy season begins.
• It won’t help as much after symptoms appear.

Unlike decongestant nasal sprays, it doesn’t produce rebound congestion. It also has the fewest side effects of any allergy drug, but it isn’t as effective as nasal steroid sprays.

• Saline nasal sprays: help wash out nasal mucus and can be used long term. Neti pots work similarly.
• OTC eyedrops that contain antihistamines (pheniramine) may help relieve itchiness caused by allergies.

• Nasal steroid (corticosteroids)sprays are the most effective drugs for treating nasal allergy symptoms. They used to be available only by prescription but now select products can be bought OTC.

• Topical steroids are sometimes prescribed for allergic skin conditions such as atopic eczema and hives.

• Monoclonal anti-IgE drugs have been approved to treat allergic asthma but not allergic rhinitis. Some doctors, though, prescribe it for that.

• Leukotriene antagonists or blockers inhibit the inflammatory effect that produces nasal congestion.

Medication adherence The World Health Organization defines medication adherence as "the degree to which the person's behavior corresponds with the agreed recommendations from a health care provider." Poor adherence to prescribed regimens can result in serious health impacts including hospitalization and death. About half of all medications for chronic diseases are not taken correctly. People change or skip doses, stop too soon, don’t take them at all, or never fill their prescriptions. What to do when you get a new medication:

• Take notes on what your doctor tells you about the medication.
• Double check with the pharmacist on how to take the medication.
• Ask questions to make sure you fully understand the medication. Be clear about when and how to take it.
• Creating a chart for your daily medication regimen can help you stay on track. So might a pill box with multiple sections. This is helpful if you take more than one medication. This is also helpful if you take medications more than once a day.
• If you’re being treated for a chronic condition, check regularly with your doctor about whether you are taking the medication(s) correctly.
• If you are concerned about or are experiencing side effects, talk to your doctor.
• Do not take yourself off of medications without the knowledge and guidance of your doctor.
• If you’re having trouble sticking to your medication, for any reason, talk with your doctor. They may be able to suggest other treatments or refer you to services that can help.