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  • Dr. Michelle Aslami, PharmD.

Pharmacist's Guide to Choosing Allergy Medicine

Updated: Apr 29, 2022

The time has come – your car and porch are all yellow. It’s pollen season, and your itchy eyes, runny nose, and inopportune sneezes are letting you know. Choosing the best allergy medicine doesn’t have to be as hard as pressure washing the pollen off of your deck.

Your local pharmacy has tons of options, but it might not be easy choosing which one to take home. It’s also important to ask yourself if your symptoms are allergy related or could be something more serious or contagious. It's not common to have a fever, body aches, or chills if pollen-related, so you should contact your healthcare provider if these symptoms arise as you could have a cold, flu, or even COVID-19.

Seasonal allergy symptoms may include one or more of the following symptoms:

  • Runny nose

  • Stuffy nose

  • Itchy eyes

  • Watery eyes

  • Sneezing

  • Scratchy throat

Allergy season is most commonly in the Spring from the tree, grass, and weed pollen, but many people have symptoms in the Fall, too. The handy guide below works for you year-round.

How do I know which allergy medication to choose?

  1. If you need one pill for it all (runny nose, itchy/watery eyes, sneezing)

I recommend antihistamines for the full-blown allergy symptoms. The medicines listed below are my first go-tos when patients come to the pharmacy because they are relatively safe, and they don’t make you drowsy so you can still be efficient in your workday. You should take them in the morning with water and feel a difference in your symptoms within a few hours. If the generic is available, go for it! Generic medicines usually work just as well as brands and can save you lots of money.

  • Cetirizine

  • Fexofenadine

  • Levocetirizine

  • Loratadine

For those over the age of 65, it is recommended to limit the maximum daily dose of cetirizine to 5mg per day as it can make people in this age group drowsy at higher doses. Fexofenadine and loratadine have a lower likelihood of causing drowsiness.

You may notice that the good ol’ fashioned diphenhydramine (found in Benadryl) isn’t on my list and that’s because it can cause drowsiness and dry mouth. Additionally, consistent use of diphenhydramine is not safe for anyone 65 years of age or older due to the risk of affecting memory, concentration, and balance along with increasing the risk of dementia when used long-term.

2. If you have a stuffy nose (with or without scratchy throat):

I recommend nasal steroid sprays which work as local decongestants, and they treat post-nasal drip and scratchy throats. Great headway has been made in the nasal steroid space as these recently became available as over-the-counter medicines whereas in the past they required a doctor's prescription.

  • Budesonide

  • Fluticasone

  • Triamcinolone

Which medications should I steer away from?

  • Pseudoephedrine

This is an oral decongestant not safe for people with a history of high blood pressure, diabetes, enlarged prostate, glaucoma and many other conditions so it’s generally not my go-to. It's sold behind the pharmacy counter and requires a valid driver’s license for purchasing in most states, so you may not see it on the shelves, anyway. I typically reserve this as a last resort for patients without underlying conditions. Talk to your doctor or pharmacist if the aforementioned medicines don't work well for you, and if it's safe to use pseudoephedrine.

Apart from medicines, it is helpful to avoid environmnetal triggers by limiting your time outdoors to be in the early morning or later in the evening when pollen levels are lower. If you have to be outdoors, consider wearing a mask that covers your nose and mouth to limit pollen exposure.

Allergy season is difficult to deal with, but choosing the right treatment for your symptoms does not have to be. Let us know what you think about this guide in the comments below!

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