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Over-the-Counter Allergy Medications

By: Morris Nejat, MD
Last Reviewed on: September 11
Introduction
Sneezing, wheezing, coughing and sniffling. So many allergy symptoms, so little time to get to the doctor for a prescription. Luckily, there are number of over-the-counter (OTC) medications that can help vanquish your symptoms. In fact, many OTC allergy drugs were once prescription products, and their effectiveness is typically equivalent to their prescription counterpart. Of course, navigating the sea of OTC products can be challenging. One thing to remember is that the same generic drug is often sold under multiple brand names. Still other products combine different generic drugs to treat a variety of allergy and cold symptoms. By understanding what is in your favorite OTC products, you will be able to save 25 percent to 75 percent by buying the generic equivalent. But first you need to know which medications are best for your particular symptoms.

Allergy Symptoms
Sneezing and itchy nose, throat and ears: These are the most common complaints of the allergy sufferer. These symptoms can be associated with seasonal triggers such as ragweed pollen, or ever-present triggers such as pets. The first line of treatment for these symptoms is antihistamines. During an allergic reaction, mast cells, which are found all over the body, release the chemical histamine, which in turn triggers allergy symptoms. Antihistamines block this action. The most popular OTC antihistamines are diphenhydramine (Benadryl), clemastine (Tavist) and chlorpheniramine (Chlor-Trimetron).

Side effects
A common side effect of antihistamines is drowsiness - so common, in fact, that some manufacturers have taken advantage of the effect and created sleep aids out of antihistamines. Popular examples include Unisom, Nytol and Sominex. In fact, diphenhydramine is almost as popular a sleep aid as it is an allergy product.

Because of this, over-the-counter antihistamines may impair your judgment and reflexes as much as alcohol does. It is best to avoid driving for a while after taking these medications. When combined with alcohol, they may have an even greater effect. Also, men with enlarged prostates may experience urinary retention while taking these products. For moderate to severe symptoms, or if the side effects of the treatment are intolerable, you should consult an allergy specialist to get one of the newer antihistamines that have fewer side effects.


In addition, drugs called mast cell stabilizers, like NasalCrom, can treat the same symptoms that antihistamines do. NasalCrom (cromolyn sodium) nasal spray is as an over-the-counter treatment for allergic rhinitis, more commonly known as hayfever. This product boasts an impressive safety profile, but is limited as far as usefulness. To achieve maximum benefit, one would need to use NasalCrom three to four times a day and give the medicine up to one month to start to work.

Congestion, sinus pain: These symptoms may or may not be associated with allergies. If you are not suffering from allergies, avoid a combination product that has antihistamines, in order to minimize side effects. The first line of attack for these symptoms is decongestants, which can be taken orally or topically, via a nasal spray or lotion or ointment. The most popular oral decongestant is pseudoephedrine, and it is available OTC or in prescription strength. Decongestants work by shrinking the mucous membranes. Unfortunately, when the medication wears off, so does the relief.

Oftentimes, decongestants may come with guaifensisin, an expectorant that loosens phlegm, or thick mucus. Although in theory, this is a good idea, in most OTC products there isn't enough to really be effective. You usually need the much higher dosages of prescription products to do any good. If congestion is particularly bothersome, you may want to use an OTC decongestant spray for a few days to help relieve the symptoms and allow some of the more long-term prescription and OTC medications to kick in.

Side effects
People with high blood pressure, diabetes and cardiovascular disease should use decongestants sparingly, if at all. Decongestants can constrict veins and reduce the effectiveness of blood pressure medications. Furthermore, decongestants may cause convulsions by stimulating the central nervous system. People older than 60 are particularly prone to convulsions as well as hallucinations. Pregnant women should also avoid decongestants since safety guidelines for them have not been established.

Even young, healthy people can get very jittery and shaky while taking these products. Try avoiding coffee or other forms of caffeine when taking a decongestant. If these symptoms persist, it would be wise to consult an allergist or other sinus specialists, such as an otolaryngologist (ear, nose and throat doctor).


Use of topical decongestants such as phenylephrine (Afrin, Neo-Synephrine, Vicks Sinex) or oxymetazoline (Afrin Original Nasal Spray, Neo-Synephrine 12 hour) for more than three to four days may cause a rebound effect that can be worse than the initial symptoms. Prolonged use may additionally make it more difficult to stop using these medications. When people abuse these topical decongestants, they may irreversibly damage the nasal mucous membranes.

Post-Nasal Drip: This symptom is very difficult to treat. The causes can be an allergy, infection or a nasal structural abnormality. Antihistamine-decongestant products are the OTC treatment of choice. If the drip is particularly bad, one can add an OTC antihistamine to help dry the drip further. I would especially recommend this at night when being sleepy is not as big of an issue. I would also recommend, however, seeing an allergy or sinus specialist for a more specific diagnosis in order to start the best treatment.
Cough of two-week duration or less: This kind of cough in the absence of other underlying medical problems or symptoms such as chronic bronchitis or a fever is probably due to a cold. I usually recommend a product with a cough suppressant such as dextromethorphan and a decongestant such a pseudoephedrine.

Cough of more than two weeks' duration: Now we are approaching the category of "chronic cough." The overwhelming majority of chronic coughs are related to three causes:

Allergy and asthma
Sinus infection
Gastroesophageal reflux (heartburn)
If a cough persists for more than a few weeks, one should see an allergist, otolaryngologist or a pulmonologist (lung specialist). Itchy, runny eyes: Most over-the-counter medications treat the symptoms of eye allergies using a topical decongestant (oxymetazoline, naphazoline) and an antihistamine (pheniramine).
You can use the chart below as a handy reference for looking up the different products found in OTC allergy products and using them to treat the appropriate allergy symptoms.

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