The best medicine for allergies depends on your main symptoms, but for most people, a newer (second-generation) antihistamine is the go-to starting point. These include cetirizine (Zyrtec), loratadine (Claritin), and fexofenadine (Allegra), all available over the counter. If your primary complaint is a stuffy or runny nose, a nasal corticosteroid spray like fluticasone (Flonase) is often more effective than a pill alone.
Antihistamines: The First Choice
When you’re exposed to pollen, pet dander, or dust mites, your immune system releases a chemical called histamine. Histamine is what triggers sneezing, itchy eyes, a runny nose, and hives. Antihistamines block histamine from latching onto your cells, which dials down those symptoms.
There are two generations of antihistamines worth knowing about. First-generation options like diphenhydramine (Benadryl) and chlorpheniramine work fast but cause significant drowsiness, dry mouth, and blurred vision. They also wear off in 4 to 6 hours, so you may need multiple doses throughout the day. Second-generation antihistamines like cetirizine, loratadine, and fexofenadine last a full 24 hours and are far less likely to make you sleepy. Fexofenadine is the least sedating of the three, while cetirizine is the most likely to cause mild drowsiness, though it’s still much better than Benadryl in that regard.
For most adults with seasonal or year-round allergies, a once-daily second-generation antihistamine is the simplest, most effective place to start. These are FDA-approved for hay fever, allergic conjunctivitis (itchy, watery eyes), hives, and allergic skin reactions.
Nasal Steroid Sprays for Congestion
If your worst symptom is a blocked or constantly dripping nose, antihistamine pills alone may not be enough. Nasal corticosteroid sprays reduce swelling and mucus production directly inside the nasal passages, targeting congestion in a way that oral antihistamines don’t do well. Fluticasone (Flonase) and budesonide (Rhinocort) are both available without a prescription.
The catch is timing. These sprays can take up to two weeks of daily use before you feel their full effect. They work best when used consistently throughout allergy season rather than on an as-needed basis. Many allergists consider nasal steroid sprays the single most effective treatment for nasal allergy symptoms, and they can be safely combined with an oral antihistamine for broader relief.
Decongestants: Useful but Limited
Decongestant sprays like oxymetazoline (Afrin) shrink swollen blood vessels in the nose and provide near-instant relief from stuffiness. The problem is they stop working quickly and can make congestion worse. After about three days of use, decongestant sprays can trigger rebound congestion, a cycle where your nose becomes more blocked than before, tempting you to spray more. The recommended limit is three days.
Oral decongestants like pseudoephedrine (Sudafed) don’t cause rebound congestion, but they can raise blood pressure and heart rate, cause insomnia, and aren’t safe for everyone. They’re best used short-term during a particularly bad stretch rather than as a daily allergy medication.
Prescription Options
When over-the-counter medications aren’t doing enough, prescription options exist. Antihistamine nasal sprays like azelastine work faster than steroid sprays and can be combined with them. Eye drops containing antihistamines or mast cell stabilizers target itchy, red eyes more directly than a pill can.
Montelukast (Singulair) is a prescription pill that blocks a different part of the allergic response. It was once commonly prescribed alongside antihistamines, but the FDA now requires its strongest warning label on this drug due to reports of serious mood and behavior changes, including depression, agitation, and suicidal thoughts. Because of this, the FDA recommends montelukast only for people whose allergies don’t respond to, or who can’t tolerate, other allergy medicines.
Immunotherapy for Long-Term Relief
If you’ve been taking allergy medication for years and want a more lasting solution, immunotherapy gradually retrains your immune system to stop overreacting to specific allergens. It comes in two forms: allergy shots given at a clinic, or tablets that dissolve under your tongue at home.
Allergy shots start with frequent injections of increasing allergen doses, then shift to monthly maintenance visits. The full course typically runs three to five years. Sublingual tablets follow a similar timeline but are taken daily at home. Both approaches are similarly effective at controlling symptoms, and both can provide improvement that lasts even after treatment ends. The daily dosing of tablets means higher extract costs compared to monthly shots, which is worth considering since treatment spans years.
Immunotherapy is the only allergy treatment that changes the underlying immune response rather than just managing symptoms. It’s most commonly used for pollen, dust mite, and pet allergies.
What About Natural Remedies?
Butterbur is the most studied herbal option for seasonal allergies. A review of six clinical trials found that butterbur extract appeared similarly effective to non-sedating antihistamines for intermittent hay fever symptoms. However, three of the largest trials were funded by the manufacturer, and independent replication is still needed. One crossover study of 20 patients found butterbur did not significantly reduce allergic skin reactions compared to placebo, while fexofenadine did. So the evidence is mixed and not strong enough to recommend butterbur over proven medications.
Saline nasal rinses (using a neti pot or squeeze bottle) are a genuinely useful add-on. They physically flush allergens and mucus out of the nasal passages and have no side effects. They won’t replace medication for moderate to severe allergies, but they can reduce how much medication you need.
Choosing Allergy Medicine for Children
Some over-the-counter allergy medicines are approved for children as young as 6 months, but not all of them. Age cutoffs vary between products, so always check the label for your child’s specific age. Children are more sensitive to many drugs than adults. Some antihistamines can cause excitability or excessive drowsiness in young children at doses that wouldn’t affect an adult.
One common mistake is accidentally doubling up on active ingredients. Different products marketed for different symptoms (say, one for allergies and one for colds) may contain the same antihistamine. Reading ingredient labels on every product prevents an accidental overdose.
Safety During Pregnancy and Breastfeeding
For breastfeeding mothers, cetirizine, loratadine, and fexofenadine are considered safe options among antihistamines. Nasal steroid sprays like fluticasone and budesonide are also on the list of medications generally considered compatible with breastfeeding. First-generation antihistamines like diphenhydramine can reduce milk supply in some women and are more likely to make both mother and baby drowsy, so the newer options are preferred.
Combining Medications Effectively
Many people get the best results from pairing two types of allergy medicine that work differently. A daily antihistamine pill plus a nasal steroid spray is one of the most common and effective combinations for moderate to severe hay fever. You can add antihistamine eye drops if itchy eyes are a major problem, and use saline rinses before your nasal spray to help it reach more of the nasal lining.
What you should avoid is stacking two products from the same category, like taking cetirizine and loratadine together. They work the same way, so doubling up increases side effects without meaningfully improving symptom control.