It can't be a cold—you've been stuffed up for weeks now. And those red, watery eyes? It must be allergies. You're not alone; about 20 percent of us are sneezing up a storm, according to the American Academy of Allergy, Asthma & Immunology. The good news is that you and your doctor have plenty of relief options, so you don't have to suffer.
Over-the-counter allergy drugs are extremely effective but may make you drowsy or a little less sharp than your usual self. In fact, a recent study found that taking Benadryl impaired driving performance more than drinking alcohol. For the occasional allergy sufferer—say, someone who only sneezes around Grandma's cat—over-the-counter allergy medications will probably be fine. "Even the most sedating allergy medication only sedates about 40 percent of people. Some people can tolerate them just fine, and they're a lot less expensive than prescription drugs," says Richard L. Wasserman, M.D., Ph.D., director of the Immunology Clinic at the Childrens' Medical Center of Dallas.
Finding the right over-the-counter medication for you "is a process of trial and error," says Nancy Y. Olson, M.D., chief of pediatric asthma, allergy, and immunology at the University of Kansas Medical Center. "If you try one and it doesn't work for you, you should try a different active ingredient, not just a different brand. A common mistake people make is that they switch brands, but they end up switching to an antihistamine in the same class." Even if you find a drug you like, you may find that in no longer works after regular use. In that case, you may need to switch antihistamines every few weeks.
Antihistamine pills aren't your only non-prescription option. Nasalcrom, a nasal spray "mast-cell inhibitor," is effective, says Dr. Olson, and has fewer side effects than over-the-counter antihistamine pills. The only downsides are that the spray must be used several times a day and before you have symptoms or at their earliest onset—once you're stuffy, the nasal spray has a hard time catching up.
If you're using over-the-counter antihistamines on a regular basis—several times a week for example—you should talk to your doctor about getting prescription allergy care to help minimize your symptoms and medication side effects. You might be surprised at the first-line treatment that many experts recommend for seasonal allergies. Nope, it's not Claritin—it's nasal steroids. According to Dr. Wasserman, "nasal sprays have the fewest side effects—they don't cause sedation, dry mouth, or dry eyes—and they're probably twice as effective as oral allergy medications." The sprays—like Vancenase AQ Nasal Spray or Beconase AQ Nasal Spray—cut down on swelling, inflammation, and redness. Allergists frequently combine them with prescription oral medications for maximum effectiveness. "I usually give patients an oral drug and a nasal steroid to start, and once they have no symptoms, I tell them to use the oral drugs only on an as-needed basis," says Dr. Wasserman.
Among the prescription allergy pills, there's no one drug that's more effective for everyone. And they're not more potent than over-the-counter pills, though they do have fewer side effects so they're easier to take on a regular basis. Zyrtec has a faster onset of action than Claritin and Allegra, but it's also more sedating. It's also a particularly good drug for allergy-sufferers with asthma, says Dr. Olson.
Claritin needs to be taken on a regular basis for maximum efficacy and is generally used for the duration of the time that you're affected by allergies, rather than on an as-needed basis. "It takes three to seven days to get the full response with Claritin," explains Jan K. Hastings, Pharm.D., assistant professor at the University of Arkansas for Medical Sciences College of Pharmacy. "At that point it should take effect pretty quickly." It may also take some time to get the full effect of Zyrtec and Allegra. People who used to take Seldane (now off the market) tend to like Allegra. "You're not necessarily interested in the most effective drug,"explains Dr. Wasserman. "You just want a drug that is effective enough to abolish symptoms for you with the fewest side effects."
There's good news if you hate the jittery way some decongestants can make you feel; find the right allergy medication for you and your doctor might give the go-ahead to toss your decongestant out of the medicine cabinet. "If people will take either a nasal steroid or an antihistamine on a regular basis, you won't need to use decongestants as frequently or at all," says Dr. Olson. Though you might use a decongestant when you're clogged up from a cold, "if you use decongestants for a chronic condition like an allergy, you'll develop another condition, called rhinitis medicamentosa. That's where your nose gets so irritated from repeated constriction and swelling that you almost get addicted to the decongestant nose sprays." So look into loosening your dependency on decongestants.