Q: Every summer, my nose runs, and my eyes itch from my allergies. Claritin® has always worked for me in the past, but this year is different for some reason. I tried a different allergy medicine, Allegra®, but it’s not helping me either. What other antihistamines could I try?
Antihistamines work by keeping histamine locked away inside your body. Histamine is a compound that triggers inflammation and is stored in specialized cells in your body called mast cells. When you contact something you’re allergic to, your mast cells open up, spilling out histamine and triggering the symptoms we associate with an allergic reaction: stuffy or runny nose, itchy eyes, and sinus pressure. Because they work by preventing histamine from escaping from your mast cells, antihistamines work best if you take them at least 1 hour BEFORE being exposed to what sets your allergies off.
Which antihistamine is best for you will depend on how well it relieves your symptoms and drowsy it makes you.
There are 2 main categories of antihistamine medicines to choose from: sedating ones and non-sedating ones.
Sedating antihistamines include older drugs that often cause drowsiness and dry you out. This drying action can actually help relieve a runny nose and watery eyes. Newer antihistamines will rarely make you sleepy, so you can safely drive a car or operate machinery while taking them. There’s a trade-off, though. Newer antihistamines are not as effective at drying up a runny nose as their older counterparts.
Choosing an oral antihistamine often involves some trial and error, as some medicines relieve allergy symptoms better in some people than in others. It’s not unusual to try more than one antihistamine medicine before finding one that best addresses your allergy symptoms while causing the fewest side effects.
Older antihistamines cause at least some tiredness in most people. If this is a concern for you, try one of the newer antihistamines because they will cause little to no drowsiness.
One of the best antihistamines to try first is loratadine, also known as Claritin® and Alavert®. It’s taken once a day and rarely causes any drowsiness.
If loratadine doesn’t work for your allergy symptoms, try a different antihistamine medicine. Allegra® (fexofenadine) is available in 2 versions: a twice a day formulation and a once-daily formula. It’s also very similar to loratadine in its lack of side effects.
If either of those options doesn’t help you, your next best choice is Zyrtec® (cetirizine). Compared to Claritin® or Allegra®, once-daily Zyrtec® is more effective for dealing with a runny nose than either of them.
If Claritin®, Allegra®, or Zyrtec® aren’t giving you enough relief, you can try one of the older sedating antihistamines. The most powerful is Benadryl®, also known as diphenhydramine. It helps with severe allergic reactions and causes drowsiness in most people.
Available as Tylenol PM® or Sominex II, diphenhydramine is useful not just for allergic reactions but as a non-prescription sleeping pill. Benadryl® should be taken 3 to 4 times a day for the best results. Some people take it just at night to help them sleep, substituting another antihistamine during the day.
Other older antihistamines are still available, including chlorpheniramine, brompheniramine, and triprolidine. Triprolidine causesless drowsiness than other older antihistamines and has the most drying action, helping dry up a runny nose.
Surgeons used to take Actifed® to keep their nose from dripping while doing surgery. It’s only available as Actifed®, which has both triprolidine and the original formulation of Sudafed®. I really like how effective it is for my runny nose, watery eyes, and nasal congestion.
Here are 5 Tips on Choosing an Antihistamine:
- Don’t Wait.
Antihistamines work best if they are taken BEFORE you come in contact with what you are allergic to. Don’twait until AFTER your nose stuffs up, and your eyes start itching.
- Choose not to snooze.
A non-sedating antihistamine like loratadine (Claritin®), fexofenadine (Allegra®) or cetirizine (Zyrtec®) is your best choice if you need to drive or use machinery.
- Don’t give up.
If your first antihistamine choice doesn’t help you, try another one. It’s not unusual to get very little relief from one antihistamine, then good results with a different one.
- Consider a combo.
If taking an antihistamine isn’t enough to control your stuffy nose, consider adding a nasal spray or decongestant. Flonase® nasal spray or my favorite, triprolidine/pseudoephedrine (Actifed®) are good choices when your nose is stuffed up and runny at the same time.
- Avoid Sudafed PE® and generic phenylephrine.
If you need a decongestant for your stuffy nose and don’t have high blood pressure, I STRONGLY recommend using the original version of Sudafed®, available from your pharmacist by itself or combined with your favorite antihistamine. You will need to bring photo identification to purchase it.
