The Insider’s guide to allergy medications

The Pediatric Insider

© 2014 Roy Benaroch, MD

Ah, spring is here. Time to plant my little seedings. Time to wash the yellow pollen off my car. And time to sniffle, sneeze, and snork. Confused by all of the choices of allergy meds? Look no further than this short, no-nonsense Pediatric Insider guide to allergy medications.

Antihistamines are very effective for sneezing, drippy noses, and itchy noses and eyes. The old standard is Benadryl (diphenhydramine), which still works well—but it’s sedating and only lasts six hours. Most people use a more-modern, less-sedating antihistamine like Zyrtec (cetirizine), Claritin (loratidine), or Allergra (fexofenidine.) All of these are OTC and have cheapo generics. They work taken as-needed or daily. There are a few prescription antihistamines, but they have no advantage over these OTC products.

Decongestants work, too, but only for a few days—they will lose their punch quickly if taken regularly. Still, for use here and there on the worst days, they can help. The best of the bunch is old-fashioned pseudoephedrine (often sold as genertics or brand-name Sudafed), available OTC but hidden behind the counter. Don’t buy the OTC stuff on the shelf (phenylephrine), which isn’t absorbed well. Ask the pharmacist to give you the good stuff he’s got in back.

Nasal cromolyn sodium (OTC Nasalcrom) works some, though not as strongly as rx nasal sprays. Still, it’s safe and worth a try if you’d rather avoid a prescription.

Nasal oxymetazolone (brands like Afrin) are best avoided. Sure, they work—they actually work great—but after just a few days your nose will become addicted, and you’ll need more frequent squirts to get through the day. Just say no. The prescription nasal sprays, ironically, are much safer than OTC Afrin.

Nasal Steroid Sprays include OTC Nasacort, and Rx Flonase (or generic fluticasone), Rhinocort, Nasonex, Nasarel, Veramyst, and others. All of these are essentially the same (though some are scented, some are not; some use larger volumes of spray.) All of them work really well, especially for congestion or stuffiness (which antihistamines do not treat.) They can be used as needed, but work even better if used regularly every single day for allergy season.

Antihistamine nose sprays are topical versions of long-acting antihisamines, best for sniffling and sneezing and itching. They’re all prescription-only (though they’re super-safe). They’re marketed as either the Astelin/Astepro twins (Astepro came out later, when Astelin became available as a generic; it lasts longer) or Patanase.

Bonus! Eye allergy medications include the oral antihistamines, above; and the topical steroids can help with eye symptoms, too. But if you really want to help allergic eyes, go with an eye drop. The best of the OTCs is Zaditor, which works about as well as rx Patanol, which they’re trying to replace with rx Pataday.

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5 Comments on “The Insider’s guide to allergy medications”

  1. cathy Says:

    Some states (like Mississippi) will now only sell pseudoephedrine with a prescription. It’s worth asking if you can buy straight from the pharmacist, but thanks to the meth industry, you can’t buy it OTC everywhere.


  2. Sonia Says:

    Dr. Roy,

    There are various information regarding when to discontinue allergy medications prior to allergy test, some saying 2 weeks, some 7, some 5, and some 3. Can taking Benadryl 3 days prior to blood allergy test affect results? Specifically would it yield to low or undetectable antibody levels?


  3. Dr. Roy Says:

    Sonia, current allergy blood tests measure pre-formed IgE molecules against antigens, and they’re not affected by oral antihistamines at all.

    However, allergy SKIN TESTS, which measure in part the release of histamine from cells, are affected by oral antihistamines. They have to be stopped several days before the testing. For more specific info, I ask my patients to ask the allergist who is doing the tests.


  4. Sonia Says:

    Dr. Roy,

    Thank you for explaining!


  5. Christian Says:

    One of the advantages of OTC’s is that you don’t spend too much time at a doctor’s clinic. You need it? There’s always the corner drugstore. Your guide simply affirms my choice of Allergra. It’s what I take now for my sneezes and sniffles.


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