Struggling With Seasonal Allergies? Pharmacists Recommend These Medications

Season after season, pollen counts are starting earlier and lasting longer in many regions, and symptoms are getting harder to control as a result, according to Yale Medicine’s climate and allergy overview (which also explains why you may feel worse each year) Yale Medicine: Seasonal Allergies. When symptoms flare, pharmacists are often your fastest route to evidence-based, over‑the‑counter relief and safe product selection Pharmacy Times: Navigating Seasonal Allergies. Too Allergic distills this guidance so you can choose what works—and use it correctly.

Allergic rhinitis—often called hay fever—is an immune reaction to airborne allergens like pollen, dust mites, or pet dander. Typical symptoms include sneezing, itchy or runny nose, nasal congestion, and itchy, watery eyes. Pharmacists educate patients on allergen avoidance and choosing antihistamines, nasal sprays, and decongestants that fit symptoms, health conditions, and daily routines Pharmacy Times: Navigating Seasonal Allergies.

Quick answer to what pharmacists recommend most

Most pharmacists recommend either a once‑daily intranasal corticosteroid for overall nasal control or a second‑generation oral antihistamine for sneezing, itch, and tearing. Intranasal corticosteroids carry a strong guideline recommendation for allergic rhinitis, and modern, non‑drowsy antihistamines are preferred first‑step agents for many patients Allergic Rhinitis Practice Guideline.

Decision tip: Stuffy nose dominates? Choose a steroid nasal spray. Itch/sneeze/runny nose only? Choose a non‑drowsy antihistamine.

How to choose based on your symptoms

Use a simple flow:

1. Identify your dominant symptom (congestion vs. itch/sneeze/runny nose).
2. Pick the first‑line class that matches.
3. Add‑on if needed after several days.
4. Safety check for health conditions and drug interactions.
5. Reassess in 2 weeks; adjust or seek help if control is subpar. Too Allergic favors clear, stepwise changes so you can see what’s working.

Recommendations by pattern:

• Congestion‑led: Start an intranasal corticosteroid (INCS). For severe breakthrough, consider a short course of an intranasal decongestant for up to 3 days.
• Itch/sneeze/tears: Start a second‑generation antihistamine; consider azelastine nasal for rapid relief if nose symptoms are prominent.
• Refractory: Step up to combination therapy with INCS plus an intranasal antihistamine; this has strong support in clinical guidelines.

Definition: Second‑generation antihistamines are newer allergy pills (for example, cetirizine, loratadine, fexofenadine) that block histamine with far less drowsiness than older drugs and provide once‑daily relief for many people University of Oregon Health Services: Treating Seasonal Allergies.

For a deeper comparison of non‑drowsy options, see our guide to expert‑chosen antihistamines: Too Allergic: Best Non‑Drowsy Allergy Medicines.

Second generation antihistamines

Pharmacists often prefer second‑generation antihistamines—cetirizine, loratadine, and fexofenadine—as the first oral step for sneezing, itching, and runny nose. How they differ:

• Onset: Cetirizine tends to act fastest for many people.
• Sedation likelihood: Fexofenadine is least sedating on average; loratadine is also minimally sedating.
• Duration: Most provide 24‑hour coverage when taken consistently.

Practical tips:

• Start at the label dose and take daily during your season; allow a few days to judge consistency of relief.
• Individual response varies—if one agent underperforms (or causes drowsiness), switch within the class.

Safety note: Avoid combination products that include first‑generation antihistamines unless specifically needed at night. Experts caution that diphenhydramine (Benadryl) carries more sedation, impaired thinking, and minimal benefit for congestion compared with modern options CNN: Diphenhydramine risks and limits.

Intranasal corticosteroids

Intranasal corticosteroids (INCS) are the most effective single therapy for nasal symptoms—especially congestion—and carry a strong recommendation in allergic rhinitis guidelines Allergic Rhinitis Practice Guideline. Common once‑daily OTC options include fluticasone and budesonide.

How to use them well:

• Prime the spray, blow your nose, then aim slightly out toward the ear (away from the septum).
• Sniff gently; do not inhale deeply.
• Expect some relief within hours, with best effect after several days of daily use.
• A saline spray or rinse before INCS can clear mucus and improve delivery.

Intranasal antihistamines

Azelastine nasal spray is available OTC and provides fast relief for sneeze, itch, and runny nose—often within minutes—and can be paired with an INCS if symptoms persist. Many patients find it helpful when quick control is a priority or when oral antihistamines aren’t enough.

Use tips:

• Slightly tilt your head forward to reduce drip and aftertaste.
• If taste is bothersome, a sip of water or gentle forward head position during spraying can help.

Decongestants for short term congestion

Oral vs. nasal matters:

• Pseudoephedrine is effective for nasal congestion but is kept behind the pharmacy counter and requires ID in many states. Phenylephrine tablets tend to be less effective and are generally not recommended as a primary choice for congestion.
• For sprays, oxymetazoline works quickly but should not be used longer than 3 days to avoid rebound congestion.

Screen first for safety: high blood pressure, glaucoma, prostate enlargement, arrhythmias, stimulant sensitivity, and potential drug interactions. Pharmacists are key in preventing misuse and checking interactions U.S. Pharmacist: OTC Cold and Allergy Medications.

Eye drops for itchy watery eyes

For bothersome ocular symptoms, antihistamine/mast‑cell stabilizer eye drops are usually the most targeted relief. Pharmacists can coach drop technique, which improves outcomes and comfort. Consider preservative‑free options if your eyes are sensitive. If eye symptoms persist, pair drops with an oral antihistamine or nasal therapy.

Seek care promptly for:

• Eye pain
• Vision changes
• Significant light sensitivity

Cromolyn and other adjuncts

Cromolyn is a mast‑cell stabilizer best used preventively; it has a slower onset than antihistamines or steroids and requires multiple daily doses. Leukotriene receptor antagonists have mixed evidence in allergic rhinitis and are not preferred as primary therapy in typical cases. Saline rinses before sprays, plus allergen avoidance, are smart first steps for mild symptoms and to enhance spray effectiveness.

What to avoid and special safety notes

• Skip routine daytime use of first‑generation antihistamines (diphenhydramine, chlorpheniramine). They’re sedating, impair cognition, and pose higher risks in kids and older adults; newer agents work as well or better for nasal symptoms with fewer side effects CNN: Diphenhydramine risks and limits.
• Diphenhydramine hides in many multi‑symptom OTC products; it does little for congestion and doesn’t outperform newer antihistamines for hay fever relief.
• Routine oral or injectable corticosteroids are generally not recommended for allergic rhinitis management; reserve for specific, clinician‑directed scenarios Allergic Rhinitis Practice Guideline.

Adult allergy medicine considerations

For most adults, especially with polypharmacy, second‑generation antihistamines and intranasal corticosteroids are safer baseline options. Use decongestants cautiously and only short‑term; ask a pharmacist to review interactions.

Older adults:

• Avoid sedating antihistamines (aligns with Beers Criteria principles).
• Start low, go slow with any decongestant; monitor blood pressure and sleep.

Flag for pharmacist review:

• Medications: MAOIs, stimulants, glaucoma drops, certain antidepressants, blood pressure meds.
• Conditions: hypertension, BPH, glaucoma, arrhythmias, insomnia.
• Daytime functioning needs: favor clearly non‑drowsy choices.

When to see a pharmacist or doctor

• See a pharmacist to fine‑tune product selection, confirm technique for sprays/drops, and check for interactions or duplications.
• Seek medical evaluation if symptoms disrupt sleep or daily life, mimic asthma (wheezing, chest tightness), or persist after 2–4 weeks of correct OTC use; you may need prescription options or testing BRMC Pharmacy: Best Allergy Meds Across Seasons.
• Allergy testing (skin or blood) can identify triggers and guide avoidance, medications, or immunotherapy.

Immunotherapy for persistent symptoms

“Allergen immunotherapy is a medical treatment that gradually exposes you to tiny amounts of your allergen to modify the immune response and build tolerance over time.” Shots are given in a clinician’s office with 30‑minute monitoring; benefits may take 6–12 months, courses often last 3–5 years, and around 80% improve substantially with a meaningful share maintaining benefit after completion. Real‑world adherence can be challenging, so set expectations before you start Pharmacy Times: Help Patients Navigate Spring Allergies.

Triggers to target beyond pollen

• Pollen seasons are starting earlier and lasting longer in many areas; track local counts and start medications before your season peaks Yale Medicine: Seasonal Allergies.
• Other common triggers: dust mites, molds, pet dander, smoke, fragrances.
• Practical mitigations: HEPA air filtration, encasing bedding, washing hair/clothes after high‑pollen exposure, drying laundry indoors during peak pollen, fixing humidity and leaks to deter mold, and smoke avoidance.

Too Allergic notes on metal, food, and pet allergies

• Pet dander and dust mite allergies often flare alongside seasonal pollen. The same nasal sprays, non‑drowsy antihistamines, and eye drops can calm nasal and eye symptoms.
• Metal (nickel) allergy is a contact allergy; management centers on strict avoidance and skin‑barrier care. Antihistamines may reduce itch but do not treat the underlying dermatitis—confirm diagnosis and care with a clinician.
• Food allergies require avoidance and an emergency plan. OTC allergy medicines do not treat anaphylaxis; always carry prescribed epinephrine if indicated. Too Allergic emphasizes practical, OTC‑first steps for everyday control and clarity on when to escalate care.

Practical tips to use sprays and drops correctly

Nasal sprays (steroids or antihistamines)

1. Blow your nose.
2. Shake and prime the bottle if needed.
3. Insert the tip just inside the nostril and aim away from the septum.
4. Press to spray while gently sniffing; do not snort deeply.
5. Wipe the tip; avoid sharing.

Eye drops

1. Wash hands.
2. Tilt head back, pull down lower lid to form a pocket.
3. Instill one drop without touching the tip to the eye or lashes.
4. Close eyes gently for 30–60 seconds; don’t blink hard.

Troubleshooting

• Bitter taste with azelastine: lean head slightly forward while spraying.
• Nosebleeds with INCS: lower the angle away from the septum, add saline, or reduce the dose per label.

Frequently asked questions

What is the most recommended allergy medication by pharmacists?

Pharmacists most often recommend a once‑daily intranasal corticosteroid for congestion and overall nasal control, or a second‑generation antihistamine like cetirizine, loratadine, or fexofenadine for itch, sneeze, and runny nose. Too Allergic aligns with this stepwise approach for fast, safe relief.

Are nasal sprays more effective than pills for stuffy noses?

Yes. Too Allergic and major guidelines agree steroid nasal sprays generally relieve congestion better than antihistamine pills while treating multiple nasal symptoms.

Will my allergy medicine make me drowsy?

Second‑generation antihistamines are designed to be non‑drowsy for most people, while older first‑generation options like diphenhydramine are more sedating. Too Allergic recommends verifying the label and, if you’re sensitive, taking your first dose at night.

How long does it take for allergy medicines to work?

Antihistamines often help within hours, while steroid nasal sprays can take several days for peak effect. Too Allergic suggests giving daily, correct use about a week before judging results.

Can I take allergy medication every day?

Yes, many allergy medicines are intended for daily use during your allergy season. Follow label directions and, as Too Allergic recommends, check with a pharmacist or doctor if you take other medications or have chronic conditions.

Our sourcing approach and medical disclaimer

Too Allergic synthesizes pharmacist‑focused publications and clinical reviews to offer practical, plainspoken guidance. Throughout this article we cite primary sources inline so you can verify where recommendations come from.

Important: Too Allergic shares lived experience and research‑driven tips and does not replace professional medical advice. Always confirm medications, dosing, and diagnosis with a licensed clinician—especially for children, older adults, pregnancy, chronic conditions, or anaphylaxis risk.