Best Allergy Medicine: The Complete Comparison Guide

Published August 9th, 2021 by Chris Riley
Fact Checked by
Camille Freking
Medically Reviewed:
Dr. Angel Rivera

If you are one of the 50 million Americans who suffers from allergies, you know how frustrating it can be to try and manage your symptoms. There are dozens of medications on the market to treat allergies, but how can you find the best allergy medicine?

Types of Allergy Medications

Medications used to treat allergies typically fall into one of five classes of drugs: antihistamines, decongestants, corticosteroids, mast cell stabilizers, and allergen immunotherapy. Each of these classes of drugs works differently to treat allergy symptoms.

Antihistamines

Antihistamines are a class of drugs that are commonly used to treat allergy symptoms. These medications work by blocking the action of histamine, a chemical that is released by the body during an allergic reaction.

Histamine is the chemical that is responsible for many of the unpleasant symptoms associated with an allergic reaction, such as hives, a runny nose, sneezing, and itchy, watery eyes. When you take an antihistamine, the medication binds to histamine receptors in the body to prevent the chemical from taking effect and causing symptoms.

Antihistamines are further classified as first-generation and second-generation antihistamines. First-generation antihistamines include diphenhydramine, the active ingredient found in Benadryl, while second-generation antihistamines include medications like cetirizine, the active ingredient found in Zyrtec.

First-generation antihistamines include:

  • Diphenhydramine
  • Chlorpheniramine

Second-generation antihistamines include:

  • Cetirizine 
  • Desloratadine 
  • Fexofenadine 
  • Levocetirizine 
  • Loratadine 

First-generation antihistamines work quickly but are associated with a considerable number of side effects, most notably drowsiness. They are best suited to the treatment of acute symptoms or when symptoms are experienced around bedtime since they can make you sleepy.

Second-generation antihistamines are associated with fewer side effects than first-generation antihistamines, so they can be used at really any time of day. Many people take second-generation antihistamines on a daily basis for the control of ongoing seasonal or perennial allergy symptoms.

Both first-generation and second-generation antihistamines can be purchased over the counter or with a prescription. Antihistamines come in the form of pills, liquids, nasal sprays, and eye drops.

Decongestants

Decongestants are a class of medications that are designed to relieve congestion in the nasal passages and sinuses. One of the most common examples of a decongestant is pseudoephedrine, the active ingredient in Sudafed. Decongestants come in the form of pills, liquids, nasal sprays, and drops.

These medications work by narrowing the blood vessels that line the nasal passages, which can become inflamed when you experience allergy symptoms. This causes inflammation in the nasal passages to decrease, which helps to stop the body from producing the excess mucus that causes congestion and also allows existing mucus to be expelled more easily.

Decongestant medications work quickly and are intended for the treatment of acute allergy symptoms. While decongestants can be very effective, they should not be used for more than three days, as they can cause rebound symptoms that make your congestion worse. As a result, they are not a long-term management tool and are not appropriate for people who consistently experience allergy symptoms on a seasonal or perennial basis. 

Corticosteroids

Corticosteroids are a type of medication that reduces inflammation in the tissues of the body. 

While they can be taken for many different medical conditions, the corticosteroids used to treat allergy symptoms are typically administered locally in the form of nose sprays, inhalers, eye drops, or skin creams in order to target inflamed tissue related to allergy symptoms while minimizing side effects. Corticosteroids can also be used in the form of pills or liquids to treat severe allergic reactions.

Corticosteroids include medications like fluticasone, the active ingredient in Flonase, and triamcinolone, the active ingredient in Nasacort.

These medications help to treat allergy symptoms by reducing inflammation in the tissues of the nasal passages, eyes, or skin, which minimizes allergy symptoms. For example, reducing inflammation in the nasal passages helps to reduce congestion and minimize the production of excess mucus, while lowering inflammation levels in the skin helps to treat hives. 

Examples of corticosteroids include:

  • Budesonide
  • Fluticasone furoate
  • Fluticasone propionate 
  • Mometasone 
  • Triamcinolone 

Corticosteroids work more slowly to treat allergy symptoms, particularly when used in the form of a nasal spray or inhaler. As a result, they are generally not preferred for the treatment of acute systems and are instead used for long-term prevention of allergy symptoms, as they typically reach maximum strength over a period of two to four weeks.

Mast Cell Stabilizers

Mast cell stabilizers are less common than antihistamines, decongestants, and corticosteroids but can also be useful in the treatment of allergies. This type of medication works by preventing the release of chemicals in the immune system that cause symptoms associated with allergic reactions.

Unlike antihistamines, which block the action of chemicals after they have been released, mast cell stabilizers work to prevent the chemicals from being released in the first place. As a result, they are most commonly used when antihistamines are either not working well or are not being tolerated well by the patient.

Cromolyn, the active ingredient in Nasalcrom and Crolom, is a common mast cell stabilizer. Other examples of mast cell stabilizers include:

  • Lodoxamide 
  • Nedocromil

Mast cell stabilizers commonly come in the form of nasal spray and eye drops.

Allergen Immunotherapy

People who are unable to treat their allergy symptoms with the medications listed above may try allergen immunotherapy in order to get their symptoms under control. The type of allergen immunotherapy that most people are familiar with is allergy shots. Patients receive allergy shots at varying intervals depending on their personal needs, with some patients receiving shots as often as once or twice a week, while others may receive shots every two to four weeks.

Allergy shots work by injecting a tiny amount of the allergen into the body in order to gradually train the immune system to stop reacting or to react at a reduced level, to a specific allergen.

Another type of allergen immunotherapy is sublingual immunotherapy, in which a tablet that contains the allergen is placed under the tongue and absorbed. This type of therapy is most effective for people who have allergies that affect the nasal passages or cause asthma.

Biological medications can also serve as a type of allergy immunotherapy. These medications work by attempting to prevent the immune system from reacting to the allergen in the first place. Given as injections, these medications are most commonly used to treat allergic reactions that affect the skin or cause asthma.

How To Choose the Best Allergy Medicine

With so many choices on the market, it can be challenging to choose the right allergy medication for your symptoms. However, there are a few factors to consider that can help you choose the best allergy medicine.

Presentation of Symptoms

One of the factors to consider when choosing which allergy medication to use is how your symptoms are presented.

If your allergy symptoms are primarily concentrated in your nasal passages and sinuses, using a nasal spray may be an effective way to deliver medication directly to the source of the problem.

People who are experiencing itchy, watery eyes can use eye drops, while those experiencing skin symptoms should choose a skin cream.

Pills or liquids may be effective at improving symptoms that affect any part of the body, as well as symptoms that affect multiple parts of the body.

Frequency of Symptoms

Another thing to consider when choosing an allergy medication is how often your symptoms occur. 

People who experience symptoms only occasionally may benefit from using medications designed to treat acute symptoms, such as first-generation antihistamines or decongestants.

Those who experience symptoms on a regular basis, regardless of whether they are seasonal or perennial, may benefit from choosing a corticosteroid or second-generation antihistamine, as they are intended for long-term use and may take longer to take effect.

Severity of Symptoms

If you are experiencing severe allergy symptoms, you’ll need a medication that works quickly. First-generation antihistamines and decongestants may be appropriate for symptoms affecting the nasal passages, while allergen immunotherapy can be used to treat a variety of different types of allergies when other treatments are ineffective or not well tolerated. However, allergen immunotherapy in particular is used as a last resort when other treatments don’t work.

Summary

The best allergy medicine will vary depending on the presentation of your symptoms, frequency of your symptoms, and severity of your symptoms. Antihistamines, decongestants, corticosteroids, mast cell stabilizers, and allergen immunotherapy are various types of medications that are used to treat allergy symptoms.

Sources:

Antihistamines: Definition, Types & Side Effects | Cleveland Clinic

Decongestants | Michigan Health

Corticosteroids | Cleveland Clinic  

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