The best allergy medicine depends on the symptom you are trying to treat. A tablet that helps sneezing may not provide the strongest relief for nasal congestion. An eye drop may work better for itchy eyes, while a nasal spray may better address inflammation inside the nose. Start with the symptom, not the brand name.
For Sneezing, Itching, and Runny Nose
Oral antihistamines can help symptoms caused by histamine, including:
- Sneezing
- Runny nose
- Itchy nose or throat
- Itchy or watery eyes
Common less-sedating options include:
- Cetirizine
- Loratadine
- Fexofenadine
- Levocetirizine
Drowsiness is still possible, particularly with cetirizine or levocetirizine.
FDA recommends reading the Drug Facts label and following dosing instructions when selecting a nonprescription antihistamine.3
What About Diphenhydramine?
Diphenhydramine, commonly known as Benadryl, can relieve allergy symptoms but frequently causes drowsiness.
It may also cause:
- Dry mouth
- Blurred vision
- Constipation
- Difficulty urinating
- Confusion
- Impaired driving
It may be particularly problematic for some older adults and people using other sedating medications.
FDA warns that taking more than the recommended dose can cause serious heart problems, seizures, coma, or death.1
For Nasal Congestion and Inflammation
Steroid nasal sprays may help:
- Stuffy nose
- Sneezing
- Runny nose
- Nasal itching
Common OTC options include:
- Fluticasone
- Triamcinolone
- Budesonide
These sprays work best when used consistently and with correct technique. They may not provide complete relief after the first dose.
Aim the spray slightly outward, away from the nasal septum, rather than directly toward the center wall of the nose.
For Itchy or Watery Eyes
Antihistamine or mast-cell stabilizing eye drops may be useful when eye symptoms are the primary complaint.
Before selecting an eye drop, ask a pharmacist when you:
- Wear contact lenses
- Have eye pain
- Have changes in vision
- Have significant redness
- Recently had eye surgery
- Have glaucoma
- Are treating a young child
Eye pain, injury, discharge, or vision changes should not be treated as routine seasonal allergies without evaluation.
What About Decongestants?
Pseudoephedrine can reduce nasal congestion but may cause:
- Increased blood pressure
- Faster heart rate
- Insomnia
- Nervousness
- Difficulty urinating
Ask a healthcare professional before using it when you have hypertension, heart disease, glaucoma, thyroid disease, prostate symptoms, or take interacting medications.
FDA proposed removing oral phenylephrine as an OTC nasal decongestant after concluding that available evidence did not demonstrate effectiveness at permitted oral doses. The proposal did not immediately remove existing products from shelves.2
Always check the active ingredient rather than relying on a familiar brand name.
Avoid Duplicate Ingredients
Allergy products may be sold in combination with:
- Decongestants
- Pain relievers
- Cough suppressants
- Sleep aids
A “D” in a product name often indicates the addition of a decongestant, but the Drug Facts label is the reliable source.
When Allergy Symptoms Need Evaluation
Contact a healthcare professional when:
- Symptoms include wheezing or trouble breathing
- The lips, tongue, or face swell
- Symptoms occur after food, medication, or an insect sting
- You have recurrent sinus pain or fever
- Symptoms continue despite appropriate treatment
- The diagnosis is uncertain
- The patient is pregnant or breastfeeding
- A young child requires treatment
Call emergency services for signs of anaphylaxis or serious breathing difficulty.
The Bottom Line
Choose allergy treatment by symptom: consider an antihistamine for sneezing and itching, an appropriate nasal spray for persistent nasal symptoms, an allergy eye drop for itchy eyes, and check whether a decongestant is safe for you before using one for congestion. The allergy aisle is a wall of colorful boxes, but the active ingredient is the compass.
Frequently Asked Questions
What's the best allergy medicine for a runny, sneezing nose?
A less-sedating oral antihistamine such as cetirizine, loratadine, or fexofenadine is typically the first choice for sneezing, runny nose, and itching caused by histamine.
Is Benadryl a good everyday allergy medicine?
Diphenhydramine (Benadryl) can relieve allergy symptoms but frequently causes drowsiness, dry mouth, and other side effects, and can be particularly problematic for older adults. It's generally not the best choice for routine, ongoing allergy management.
Do decongestants like phenylephrine actually work?
FDA has proposed removing oral phenylephrine as an OTC nasal decongestant ingredient after concluding the evidence doesn't support effectiveness at permitted oral doses. Existing products haven't been pulled from shelves, but check the active ingredient rather than relying on brand recognition.
When should allergy symptoms be evaluated by a doctor instead of self-treated?
Seek care for wheezing or trouble breathing, facial or tongue swelling, symptoms after a food or insect sting, recurrent sinus pain or fever, or symptoms that don't improve with appropriate OTC treatment. Call emergency services for signs of anaphylaxis.
Sneezing and itching: consider an antihistamine. Persistent nasal symptoms: consider an appropriate nasal spray. Itchy eyes: consider an allergy eye drop. Congestion: check whether a decongestant is safe for you.
References
- U.S. Food & Drug Administration. FDA Warns About Serious Problems with High Doses of the Allergy Medicine Diphenhydramine (Benadryl). fda.gov/drugs/drug-safety-and-availability
- U.S. Food & Drug Administration. FDA Proposes Ending Use of Oral Phenylephrine as OTC Monograph Nasal Decongestant Active Ingredient. fda.gov/news-events/press-announcements
- U.S. Food & Drug Administration. The Over-the-Counter Drug Facts Label. fda.gov/drugs/understanding-over-counter-medicines/over-counter-drug-facts-label