Do over-the-counter allergy medicines really work?

David Amrol, MD

Allergy and Immunology

If you’re one of the 60 million people in the U.S. dealing with seasonal allergies, finding an affordable and effective treatment for those itchy eyes and runny nose is probably high on your list. David Amrol, MD, explained which over-the-counter allergy medicines are most effective and how to use them.

Are over-the-counter allergy medicines effective?

“A lot of our best medicines are over the counter,” Dr. Amrol said. “Nasal steroids are probably the most effective medicine for allergic rhinitis and it’s usually our first line of treatment. Most people who are diagnosed with allergic rhinitis will start with a nasal steroid spray.”

Over-the-counter options include:

• Flonase (fluticasone)
• Rhinocort (budesonide)
• Nasacort (triamcinolone)

“They’re just as effective as any of the prescription nasal steroids,” he added. “Oral antihistamines are not as effective as nasal sprays, but they’re very good too. Zyrtec, Claritin, Allegra are all the same ones you get with a prescription.”

The nasal antihistamine Astepro (azelastine) is also now available over the counter. “It is a safe medication that works quickly and can be used as needed for several weeks or months at a time,” Dr. Amrol said.

Can children use over-the-counter allergy medicines?

Nasal steroids can be used for children who are age two and older. “We often do one spray per nostril, and then in older children and adults, we can do two sprays per nostril,” Dr. Amrol said.

Children can also take oral antihistamines like Zyrtec, Claritin or Allegra. “Children over two can take five milligrams and older children or adults can take 10 milligrams,” Dr. Amrol said. “These are all the non-sedating antihistamines. You want to avoid the more sedating antihistamines, like Benadryl, if you can.”

Astepro is also approved for patients aged 6 months and older.

Do saline rinses work for seasonal allergies?

Although saline rinses work well for patients with chronic sinusitis, especially those with polyps, there isn’t as much evidence that it works for allergic rhinitis. “But it’s relatively harmless and it can be beneficial for some people,” Dr. Amrol said.

A saline rinse involves using a neti pot or a NeilMed sinus rinse. It basically uses a saltwater type of solution that you put in your nasal passages to wash away the allergens, irritants and mucus while moisturizing the nose.

“We do recommend using either preboiled or distilled water to avoid infection that could be caused by an amoeba or other organisms in tap water,” Dr. Amrol said.

Do air filtration systems work for allergies?

For pollen, air filtration systems can be helpful. During the spring and fall, it’s best to keep the windows closed and use air conditioning as well as an indoor HEPA filter or a high efficiency particulate filter.

However, they don’t work as well on other allergens, like dust mites, which are not airborne very long and tend to be more settled into the carpet, pillows and bedding. An air filtration system doesn’t do a whole lot for these types of allergens except when you’re vacuuming or cleaning.

“When it comes to pet allergies, they may help some people, but by far the best treatment for allergic rhinitis to a pet is avoidance,” Dr. Amrol said.

Bottom line – air filtration systems are moderately effective, but Dr. Amrol doesn’t recommend spending a lot of money on them. He also doesn’t recommend cleaning the air ducts or doing other costly things that have probably marginal benefit.

When should you consider allergy shots?

If medications and avoidance are not effective, allergy shots, or allergen immunotherapy, would be the next step.

Patients are first tested to see what they are allergic to – either with skin testing or blood testing. If you’re allergic, you’ll receive injections once or twice a week for several months and then a maintenance dose for three to five years. After that, there should be a good long-term improvement in your allergy symptoms, which is sustained even after you stop.

“Allergy shots are the only treatment that can modify your allergy and reduce symptoms over time,” Dr. Amrol said. “Medicines help, but as soon as you stop, the symptoms return almost immediately.”