The Best Allergy Medicine

We crowned Nasacort king of the steroid sprays because its active ingredient, triamcinolone, effectively treats inflammation in the nose without affecting your adrenal system and the release of hormones throughout your body, unlike our third choice, FLONASE. In addition, Nasacort uses a water-based formula, free of alcohol and scent; according to Dr. Cavuoto Petrizzo, this makes it less likely to cause irritation in sensitive noses.

At $13 for 0.37 fluid ounce, Nasacort is also the best value of the steroid sprays. Of course, that’s assuming it works for you, but with the manufacturer’s money-back guarantee, there’s little financial risk if you start here.

Rhinocort’s active ingredient, budesonide, is the only over-the-counter steroid spray that qualifies as category B for pregnancy — in other words, research shows that using Rhinocort in any trimester does not increase the risk of birth defects. All other steroid sprays get classified as category C and should only be used if the potential benefits to the mother outweigh the potential risks to the fetus (although we definitely recommend checking with your OB-GYN before taking any medicines, category B or otherwise). Like Nasacort, Rhinocort offers seasonal allergy relief without scent or alcohol, making it a good choice for moms-to-be with sensitive noses too.

Focusing purely on results from academic studies, FLONASE comes out even with Nasacort and Rhinocort, and for lots of people, it will be a great choice. It’s scented, which you might love, and contains alcohol, which you probably will have no feelings about unless your nose is dry and irritated from your allergies (if that’s the case, alcohol may irritate it more).

More worrisome is a study done by the University Department of Otolaryngology and St. Michael’s Hospital in Bristol, which found that fluticasone, the active ingredient in FLONASE, may actually suppress the adrenal system. In essence, your body has a negative feedback loop for cortisol production and taking fluticasone may signal to your body (globally, not just in the nasal cavity) that it no longer needs to produce its own cortisol. Sure, the odds of fluticasone messing with your adrenal system are slim, but with other great options on the table, we’re playing it safe.

Allegra’s third-generation antihistamine, fexofenadine, is one of a class of medicines developed with the goal of improving clinical efficacy and minimizing side effects. Indeed, in a 2011 study published in the New England Journal of Medicine and the Journal of Allergy of and Clinical Immunology, researchers note that fexofenadine is the most consistently nonsedating of the later antihistamines — it really won’t make you drowsy. They recommend it specifically for “airline pilots and others in safety-critical occupations,” but safety and alertness are important for pretty much anyone in our book, so we’ve given Allegra top honors among the antihistamines.

Allegra’s 24-hour formula is available in tablet, gelcap, and a combination pill with decongestant, making it a versatile option too.

Studies show that cetirizine, the active drug in Zyrtec, may act faster than fexofenadine by anywhere from 20 minutes to two hours. However, Zyrtec is also associated with a higher incidence of drowsiness. “Cetirizine causes drowsiness in 14 percent of people,” says Dr. Vanlandingham, adding that some allergy sufferers choose to take 24-hour Zyrtec at night when drowsiness won’t impact them. If you do go for Zyrtec, you can choose between regular tablets, liquid gels, and quick-dissolve tabs.

Children’s Allegra relies on fexofenadine, the same active ingredient found in adult Allegra. That means no risk of drowsiness. Plus there’s ample research that it’s effective against seasonal allergies — and safe even for kids. It can be given to children as young as 2 and comes in a liquid 12-hour dose. Adults can also take it, but it has less fexofenadine than you’d probably want: 30 mg versus the 180 mg found in adult Allegra Allergy. If your child balks at anything remotely resembling cough syrup, you can also try Allegra’s meltable tablets. These contain the same active ingredient and dosage, though they’re not recommended for children younger than 6.

Other Allergy Pills to Consider

• Claritin, one of the first second-generation antihistamines to hit the market, will work great for many allergy sufferers, though likely not with the same potency as Zyrtec and Allegra, which came to market later and improved on the Claritin formula. Claritin’s active ingredient, loratadine, is also slightly more likely to trigger drowsiness, though not to the same degree as Benadryl and other first-gen antihistamines.
• Alavert contains the same active ingredient as Claritin and generally costs half as much. The 24-hour formula is available in quick-dissolve tablets in mint or citrus flavors — yum?

The ketotifen in eyedrops acts as both an antihistamine and a mast cell stabilizer. Similar to antihistamines, mast cell stabilizers block the release of histamine, the chemical that triggers allergy symptoms — the difference is that while antihistamines prevent histamine from binding to its receptors, mast cell stabilizers block the chemical from even being released.

“Zaditor and Alaway are basically equivalent. Both contain ketotifen, which is also available as a generic,” says Dr. Vanlandingham, so our top pick selection came down to value. At $10 for 0.34 fluid ounce (compared to $13 for half that amount), Alaway stands out as the most cost-effective eye drop for allergic rhinitis.

But be aware that all allergy eye drops — including both of our top picks — come with a caveat: They contain the preservative BAK (benzalkonium chloride). This ingredient helps your eyes absorb active ingredients like ketotifen, but prolonged exposure to BAK is linked to health concerns. Anna George, allergist and immunologist at The Woodlands Allergy told us, “There is a large body of evidence that BAK has toxic effects on the ocular surface that is time- and dose-dependent. Because of this, I do not recommend daily, year-round use of allergy eye drops.” That doesn’t mean you need to steer clear of them altogether. “If they’re used sporadically though the season or with random allergy encounters (like cat dander) they’re likely to be safe for most people,” Dr. George told us.

In other words, don’t use them every day. And if you’re still worried, consider an alternative. Dr. George noted, “Nasal sprays, if used appropriately, can be very helpful for eye symptoms, as can allergy shots.” And Dr. Laura Periman, ophthalmologist and leading dry eye expert, suggested: “See your doctor. Prescription-grade antihistamine drops are significantly more effective than OTCs and have much lower BAK levels with less need for repeat dosing. This lessens the BAK burden which is harmful to the Ocular Surface.”