Spring is here and for many allergy sufferers, that means sneezing, itchy eyes, a runny nose, and feeling stuffed up. The local pharmacy shelves are full of medications to treat allergies. The question is, which one do you select?

What is the first thing I should think about?

Not every allergy medicine is right for every person. Some may interact with your other medications or make certain health conditions worse. For example, some allergy pills that contain decongestants can increase blood pressure or worsen anxiety. Therefore, check with your pharmacist to verify that you can safely take these medications.

What is the best choice for seasonal allergies?

If your symptoms are mild to moderate, an over-the counter second-generation antihistamine pill is a reason able option. In Canada, the most common options are loratadine (Claritin), desloratadine (Aerius), cetirizine (Reactine), and fexofenadine (Allegra). These pills are best for sneezing, itchy and runny nose, and they are usually less sedating than older first-generation pills. 

Most people find the right product through trial and error, as response can vary from person to person. So, if one product is not helping enough, ask your pharmacist about trying a different option. Keep in mind that these pills are not as effective for nasal congestion as corticosteroid nasal sprays. There are also newer, stronger second-generation antihistamine pills available by prescription only, such as bilastine (Blexten) and rupatadine (Rupall).

These are typically prescribed if a sufficient trial of over the-counter options was not effective or if the symptoms are more bothersome. If your symptoms are moderate to severe, and especially if they involve nasal congestion, the gold standard is a corticosteroid nasal spray.

In Canada, there are several over-the-counter corticosteroid nasal spray options available, such as fluticasone (Flonase) and triamcinolone (Nasacort). However, most corticosteroid nasal sprays are available by prescription only, such as budesonide (Rhinocort Aqua), ciclesonide (Omnaris), fluticasone furoate (Avamys), and mometasone (Nasonex). There is also a combination antihistamine and corticosteroid nasal spray, azelastine/fluticasone (Dymista). Corticosteroids reduce inflammation in the nose and are better than antihistamine pills for nasal congestion. Keep in mind that they often take a few days to start helping, so they are not a quick fix, and they work best when started before or early in the allergy season.

To improve symptom relief, prescription antihistamine pills may be added together with corticosteroid nasal sprays.

What if my eyes are the main problem?

If your biggest allergy symptoms are itchy and watery eyes, antihistamine or other anti-allergy eye drops may help. Usually prescription antihistamine eye drops, such as olopatadine, may be more effective than over-the counter anti-allergy eye drops, such as cromolyn sodium.

What about Benadryl and similar older allergy pills?

Older first-generation antihistamines, such as diphenhydramine (Benadryl), can cause drowsiness. Therefore, for most daytime seasonal allergy symptoms, the newer antihistamines are preferred. They may still have a role in special situations. If your symptoms keep you up at night, then diphenhydramine or other sedating antihistamines may be a suitable option. In fact, most over-the-counter sleep aids contain diphenhydramine and use its side effect for therapeutic benefit. Also, many cough-and-cold products marketed for nighttime use contain a first-generation antihistamine. Diphenhydramine may also be used as part of the emergency treatment of a severe allergic reaction.

What if I am at risk of anaphylaxis?

If your allergic reaction is very severe, such as swelling of the lips, tongue, and difficulty breathing, you require immediate epinephrine injection and a visit to the emergency department. People at risk of severe allergic reaction or anaphylaxis are prescribed and always carry an epinephrine autoinjector (Epi-Pen). You do not need a prescription for an epinephrine autoinjector, so if you think you need one, ask your pharmacist.

When do I need to get a prescription?

If you have used over-the-counter antihistamine pills or a nasal corticosteroid spray properly for a reasonable trial and still are not getting enough relief, it may be time to consider prescription options. The same applies if your symptoms are moderate to severe from the start or if your eyes are very bothersome, especially during peak pollen season.

In Ontario, pharmacists can assess and prescribe for allergies. So, if you think you have allergic rhinitis or allergic conjunctivitis, talk to your pharmacist about your symptoms and how prescription options may help you. The pharmacist assessment for eligible patients is OHIP covered under Ontario’s publicly funded common ailment services.

If you are not sure what is right for you, ask your pharmacist. We can help you choose the safest and most effective option based on your symptoms.

Originally published in East Gwillimbury’s Bulletin Magazine April 2025