Q: Every summer my nose runs and my eyes itch from my allergies. Claritin® has worked for me in the past but for some reason this year is different. I tried Allegra®, but it’s not helping, 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 special cells in your body called mast cells. When you come in contact with 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 you should try depends on which one will work best for you and how drowsy it makes you. There are 2 main categories of antihistamine medicines to choose from: sedating ones and non-sedating ones. The sedating antihistamines are older drugs that often cause drowsiness and dry you out. This drying action can actually help relieve your runny nose and watery eyes. Newer antihistamines don’t drowsiness but may not be as effective at drying up a runny nose.
Some antihistamines relieve allergy symptoms better with some people than with others. Many people have to try more than one before they find the one that works best for their allergy symptoms while causing the least drowsiness.
How important to you is avoiding drowsiness? Older antihistamines cause at least some drowsiness in most people. If this is a concern for you, start with the newer antihistamines because they cost little to no drowsiness.
One of the best antihistamines to try first is loratadine, also known as Claritin® and Alavert®. It’s taken only once a day, and rarely causes drowsiness. If loratadine isn’t helping you, another newer non-sedating antihistamine is Allegra®, or fexofenadine, available in either twice a day or once a day versions.
If either of those is not working for you, try cetirizine (Zyrtec®). It’s more likely to cause you some drowsiness compared to Claritin® or Allegra® but because it’s more drying than either of them it can help dry up your runny nose. You only have to take it once a day and it causes minimal drowsiness.
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 serious allergic symptoms but will cause drowsiness in most people. In fact, you can buy diphenhydramine as a sleeping pill without a prescription as Tylenol PM® or Sominex II. Benadryl® needs to be taken 3 to 4 times a day for best results. Some people take it just at night and substitute another antihistamine during the day.
There are other older antihistamines still available, including chlorpheniramine, brompheniramine, and triprolidine. Triprolidine causes less drowsiness than the other older antihistamines and seems to have the most drying action as well. Surgeons used to avoid having their nose drip while doing surgery. Its main drawback is that it’s only available as Actifed®, a combination with the original formulation of Sudafed®. I really like how effective it is for runny nose, watery eyes and nasal congestion.
4 Tips on how to choose an antihistamine:
1. Take a dose of your antihistamine BEFORE you come in contact with what you are allergic to, if possible. That way you’ll get better results than if you wait until your nose stuffs up and your eyes start itching.
2. If you have to drive or use machinery, choose one of the newer non-sedating antihistmines like loratidine (Claritin®), fexofenadine (Allegra®) or cetirazine (Zyrtec®) first. Everyone is a little different in how they react to a medicine.
3. If your first antihistamine choice doesn’t help you, try another one. It’s not unusual to get good results with one yet very little relief from another.
4. An antihistamine can be purchased as a single agent or combined with other medicines, like a decongestant. I recommend you avoid the Sudafed PE® that is sold on the shelf which contains phenylephrine because it is not as effective as the original formula of Sudafed® containing pseudoephedrine. If you need a decongestant for a stuffy nose I recommend the original version of Sudafed®, available from your pharmacist. You will need to bring photo identification to purchase it. Triprolidine/pseudoephedrine (Actifed®) is a good choice for runny and stuffy nose symptoms.
