7 OTC Allergy Medications That Actually Work, According to Doctors

For this article, author Erica Sweeney interviewed four allergists and one pharmacist. She also researched seasonal allergies and the most common treatments for the condition. She then scoured the Internet to read customer reviews about OTC allergy medications to learn which were most effective.

“Everyone is different,” Dr. Younus says. So, the best way to choose which medicine will work for you is to chat with your doctor about your symptoms and overall health. Some ingredients that doctors recommend looking for in antihistamines include cetirizine (Zyrtec), fexofenadine (Allegra), loratadine (Claritin), and levocetirizine dihydrochloride (Xyzal), Dr. Smith says. For nasal sprays, seek out fluticasone (Flonase), budesonide (Rhinocort), and triamcinolone (Nasacort) or the nasal antihistamine azelastine (Astepro).

Decongestants, like pseudoephedrine (Sudafed), are best avoided since they don’t offer long-term allergy relief, Dr. Smith says. These ingredients might be included in antihistamines — so, watch for products with a “D” in their name, such as Zyrtec-D or Allegra-D, which means they contain decongestants.

Be careful about allergy medications that cause drowsiness, too, Dr. Strauss says. Otherwise, you might struggle to get through your day, and they can affect your ability to drive or make decisions. Whether to opt for a nasal spray or a pill is up to you. For mild symptoms, an oral antihistamine alone may work, but if they’re mild to severe, layer on a nasal steroid, Dr. Smith says. When congestion is your main problem, Dr. Strauss says a steroid nasal spray is your best bet.

These are the three main types of OTC allergy medications:

• Antihistamines block histamine, a natural chemical that the body releases when it encounters an allergen, Aungst says. It’s the histamine release that causes allergy symptoms, so antihistamines are effective at relieving itching, sneezing and a runny nose, Dr. Smith says. Oral antihistamines include Allegra, Claritin, Zyrtec and Xyzal. Recently, Astepro, an antihistamine nasal spray, became available OTC, Dr. Smith says.

• Nasal corticosteroids, including Flonase or Nasonex, reduce inflammation and swelling directly in the nasal passages, says Dr. Younus. (Because Flonase is alcohol-based, it can be drying and may cause nose bleeds in some people. Nasocort and Nasonex do not contain alcohol, so they won’t dry the nose as much. Flonase Sensimist is an alcohol-free, aqueous formula with a lower dose of a slightly different corticosteroid.) “The anti-inflammatory effect of a corticosteroid leads the mucus-secreting cells to calm down and reduce blood flow, which makes your nose feel less blocked,” Dr. Smith says, adding that these medications also help with dry, itchy eyes. Nasal corticosteroids can take a couple of weeks to kick in, however, so Dr. Strauss recommends combining them with an antihistamine for “maximal effect.” That said, nasal sprays shouldn’t be considered an as-needed medication — you should start taking them daily in early March to get ahead of allergy season, Dr. Smith says.

• Decongestants, like Sudafed, can improve nasal congestion temporarily by shrinking swollen nasal passages, Dr. Younus says. However, doctors typically don’t recommend them for seasonal allergies because they can cause side effects, like irritability, difficulty sleeping and increased blood pressure, adds Dr. Strauss. They’re also not as effective for allergies as antihistamines and steroids. You should also avoid decongestant nasal sprays, such as Afrin, Dr. Strauss emphasizes. Using this medication for more than a few days can cause rebound congestion, which can make your symptoms worse.

Patients with kidney disease, seizure disorders, heart conditions, and high blood pressure should check with their doctor before taking OTC allergy medications,says Dr. Strauss. So should pregnant women and men with enlarged prostates. Older adults might also need to avoid the medications, as the drugs could cause drowsiness and increase the likelihood of falls. If you have a kid with allergies, it's also important to make sure to choose a medication that is appropriate for their age.

If you’ve tried OTC allergy meds and are still dealing with congestion, sneezing, and other symptoms, see your doctor. Also, make an appointment if you’re not exactly sure what’s triggering your allergies, or if your symptoms are getting worse and lasting longer, Dr. Younus says.

“A good barometer is when you notice that the over-the-counter options are not cutting it, and the symptoms start to affect your quality of life,” Dr. Smith says. Doctors may prescribe stronger versions of OTC medications, allergy immunotherapy, such as allergy shots, or the medication Singulair, which he says works a little differently than antihistamines by blocking inflammatory molecules called leukotrienes.

Erica Sweeney, the author of this article, is an experienced health writer whose work has appeared in The New York Times, Men’s Health, HuffPost, Parade, and many other publications. She conducted interviews, researched allergies and allergy medications, and read customer reviews to compile this list.