Allergy Meds 101: Your seasonal allergy med questions answered

More than 50 million people in the U.S. experience allergies every year, according to the American College of Allergy, Asthma & Immunology. In other words, if seasonal allergies have you sneezing, coughing, and blowing your nose—you’re not alone. Fortunately, there are many options to get rid of those pesky symptoms if you’re having an allergic reaction to something in the air.

As pharmacists, we’ve seen it all and know all the choices you have for seasonal allergy medicine. Here are answers to common questions about these options.

RELATED: Allergy statistics

1. What is the difference between seasonal and perennial allergies?

Seasonal allergies, also called hay fever or allergic rhinitis, generally occur around the same time each year. In many areas of the U.S., spring allergies start in February, lasting until early summer. In the late summer and fall, ragweed and mold allergies may be more common. 

Perennial allergies can affect you year-round—not just allergy season—or occur intermittently at different times. Common causes of perennial allergies include mold, dust mites, insects, and pet dander.  

Regardless of the type of allergy, when your immune system tries to fight the cause of the reaction, you may experience any or all of these symptoms: 

• Coughing
• Wheezing
• Sneezing
• Runny nose
• Nasal or chest congestion
• Itchy throat
• Headaches
• Fatigue
• Watery or itchy eyes

Allergy medications, both OTC and prescription, can help to alleviate these symptoms. Allergy medicine alone typically suffices for seasonal allergies; however, if your symptoms are affecting your quality of life or occur year-round, you might want to consider immunotherapy through allergy shots.

RELATED: What causes spring allergies? | What causes winter allergies? 

2. What are the different types of allergy medicine?

The allergy aisle can be extremely confusing. You may think you’re going to pop in for a box of Claritin, and then see 24 different kinds of Claritin: brand, generic, different dosages, and various forms. 

Allergy medications generally fall into the following four categories.

• Oral antihistamines: These meds block histamine and can help symptoms of sneezing, itchy or watery eyes, and post-nasal drip. Benadryl (diphenhydramine) is an older, first generation antihistamine, which can cause more side effects like drowsiness, dizziness,  and impaired coordination. Newer antihistamines, like Claritin (loratadine), Allegra (fexofenadine), Zyrtec (cetirizine), and Xyzal (levocetirizine), may still cause some drowsiness, but to a less extent than older antihistamines. 
• Decongestants: These help relieve a stuffy nose. A common decongestant is Sudafed (pseudoephedrine) or Sudafed PE (phenylephrine). Decongestants are sold alone and in combination with antihistamines (Allegra-D, Zyrtec-D, Claritin-D). If you have high blood pressure, you should check with your healthcare provider before using a decongestant, as they can increase blood pressure. 
• Nasal steroids: These help decrease inflammation in your nasal passages, relieving nasal congestion. They may take up to two weeks to work. Some examples are: Flonase (fluticasone), Nasacort Allergy (triamcinolone), and Rhinocort (budesonide). When using nasal steroids, you can also use nasal saline drops or sprays so your nasal passages don’t dry out.
• Eye drops: Allergy eye drops can help relieve symptoms of itchy, red eyes. Some examples are Zaditor (ketotifen) and Pataday (olopatadine), which are available over-the-counter. 

RELATED: Benadryl vs. Claritin

Always check with your pharmacist if you need help selecting an appropriate OTC allergy medication. If you struggle with allergy symptoms, you should make an appointment with an allergist to talk about testing for triggers, allergen avoidance, and the need for an EpiPen (emergency epinephrine).

3. What is the best seasonal allergy medicine?

The short answer is it depends on your symptoms. 

If you feel itchy and have a runny nose or watery eyes, you would most likely benefit from an antihistamine, preferably a non-drowsy one such as Xyzal. You can add a nasal steroid such as Flonase to help relieve those pesky nasal allergy symptoms. Nasal saline is a great option to keep nasal passages from drying out. OTC allergy eye drops can help relieve itchy eyes.

If you have a stuffy nose, you may want to add a decongestant. Many non-drowsy allergy meds include a decongestant, such as Allegra-D. But if you have high blood pressure, you should check with your healthcare professional before using an oral decongestant, because they can raise your blood pressure further. Also, some antihistamines are not safe for people who have certain medical conditions, such as glaucoma or prostate problems. Your pharmacist can help you pick the best product for your symptoms, considering any medical conditions you have and other medications you take.

RELATED: Treating seasonal allergies in teens, kids, and toddlers | Are you using the best seasonal allergy medicine?

4. How long does it take allergy medicine to work?

Oral antihistamines can take from 30 minutes to 2 hours to start working. Eye drops begin to work immediately. Steroid nasal sprays start working after a few days and may take a few weeks to reach the full effect. 

Note that when choosing a nasal spray, Afrin (oxymetazoline) works quickly to relieve nasal congestion, but when used for more than three days in a row, it can actually worsen congestion. For allergy symptoms, it’s better to choose another type of nasal spray, like Flonase. Ask your pharmacist if you need help finding an appropriate nasal spray.

5. How much does allergy medicine cost? 

The average price of Allegra is around $26.25 for 30 tablets while its generic, fexofenadine, is usually around $27.89 for 100 tablets—that’s over three times as many tablets for about the same cost. Other antihistamines may have similar costs, depending on where you purchase. 

Generic medications will provide allergy relief as effectively as a brand-name product and at a fraction of the price. Ask your pharmacist if you need help finding a generic product. The allergy aisle can be overwhelming.

And just as an FYI, you can get discounts with SingleCare on OTC allergy meds, but you’ll need to follow these steps.

6. Will allergy medicine make me drowsy?

Older antihistamines, such as Benadryl (diphenhydramine), can cause significant side effects like drowsiness, dizziness, and impaired coordination. Newer antihistamines, like Claritin (loratadine), Allegra (fexofenadine), Zyrtec (cetirizine), or Xyzal (levocetirizine), are less likely to cause drowsiness, and thus may be good options for the best non-drowsy allergy medicine.

Be careful when choosing any combination product (such as NyQuil) for allergies or cough and cold because many of them contain sedating antihistamines—or ingredients that may be unnecessary for allergies (such as acetaminophen, which helps pain and fever, but not allergies). Ask your pharmacist to help you choose a product that won’t immediately put you to sleep—and that has only the medication(s) you need, without extra ingredients. Extra, unnecessary ingredients can cause more side effects.

7. How often can you take allergy medication?

How often you can take allergy medicine depends on what type you’re taking. Some kinds, like Benadryl, can be taken every 4-6 hours, while others can be taken every 12-24 hours. For example, Allegra comes in both 12-hour and 24-hour formulations. Always check the directions on the label before taking allergy medication to ensure you are taking the right dosage.

8. What’s the best time to take allergy medicine?

It’s recommended that individuals with seasonal allergies start taking allergy medications preventively, 2-4 weeks before allergy season begins. Because allergy symptoms are often at their worst between 4 a.m. and 6 a.m., it may be a good idea to take your allergy medication at bedtime.

9. Can you take two types of allergy medication together?

Depending on your symptoms, some allergy medications can be safe to use in combination. Generally, you can use an antihistamine with a decongestant (if you have no conflicting medical conditions). 

However, you don’t want to double up allergy medications. For example, you generally wouldn’t want to take Claritin in the morning and Zyrtec in the evening (except in rare cases as directed by your doctor). 

RELATED: Zyrtec vs. Claritin

10. Can I drink alcohol with my allergy medications?

Generally, it is not advisable to combine allergy meds with alcohol. Combining the more sedating antihistamines with alcohol can be very dangerous, increasing the risk of side effects and impairment. Combining the newer, less sedating antihistamines with alcohol is less dangerous, but should still be avoided. 

11. Is it safe to take OTC allergy medications every day?

Generally, yes—though you should consult with your healthcare provider for guidance. Nasal steroid sprays may take a few weeks to become effective. If you have occasional symptoms, it is okay to take antihistamines as needed, following the package directions. 

If your allergy symptoms persist, you may have a sinus infection. Over-the-counter medications for sinusitis are similar to allergy treatments but in cases of a bacterial infection, a provider will prescribe an antibiotic, and possibly a corticosteroid.

12. Who shouldn’t take allergy medications?

Non-sedating antihistamines are relatively safe for most patients, but you should not take older antihistamines (like Benadryl) if you have prostate problems or glaucoma. You should not take decongestants if you have high blood pressure, unless you get the green light from your healthcare provider. If you are pregnant or breastfeeding, consult a healthcare professional before using allergy medications (or any medications). 

13. What should I do when OTC allergy medicine doesn’t work?

Most allergy medicine is now available over the counter (OTC). However, several nasal sprays are available by prescription only. These include Astepro (azelastine), Dymista (azelastine/fluticasone), and Nasonex (mometasone furoate). Flonase is available in prescription and OTC versions. 

OTC medications are often sufficient to treat allergy symptoms, but if your symptoms are not relieved by OTC meds, check with your healthcare provider to see if a prescription medication may be right for you. 

If you have asthma and allergies, there are a variety of treatments available by prescription to alleviate both, including inhalers or oral medication such as Singulair (montelukast).