Best allergy medicine for a runny nose

A runny nose can be highly annoying. And, if it’s caused by allergies, it may continue until you find out what you’re allergic to. Allergic rhinitis, also called hay fever or seasonal allergies, is a term used to describe symptoms that affect the nose and occur when breathing in something you’re allergic to, whether that’s pollen, dust, animal dander, or even food. When a person with allergic rhinitis is exposed to an allergen, their body releases chemicals that cause symptoms such as a runny nose, sneezing, and itchiness. 

Allergies can be a nuisance, but they are treatable. Your healthcare provider can recommend the best allergy medicine for your specific needs. Options usually include antihistamines, decongestants, and steroids. 

Antihistamines

Antihistamines come in different forms, including tablets, capsules, liquids, syrups, creams, eye drops, and nasal sprays. They work by inhibiting the actions of a substance known as histamine. “When you’re exposed to an allergen, your body produces histamine, which binds to receptors in blood vessels, making them enlarge. This leads to symptoms like swelling and redness. In the nose, histamine increases the production of mucus, which is why your nose runs,” says Manan Shah, MD, founder and chief medical officer of Wyndly.

The histamine release triggers allergy symptoms such as itchy, watery eyes, running or blocked nose, sneezing, and skin rashes. “By taking an antihistamine, you prevent histamine from binding to its receptors, which helps reduce the symptoms it causes. So, when it comes to a runny nose due to allergies, antihistamines can help reduce the mucus production and keep your nose dry,” Dr. Shah says. Examples of antihistamines used to manage a runny nose caused by hay fever, allergies, and the common cold include Benadryl (diphenhydramine), Clarinex (desloratadine), Allegra (fexofenadine), and Xyzal (levocetirizine).

Antihistamine nasal sprays

Antihistamine nasal sprays are popular choices for treating a runny nose due to allergies. Because you can apply the spray directly to the nasal tissues, they can offer quick relief from a runny nose, watery eyes, sneezing, and nasal itching. “Because they’re localized, they may have fewer systemic side effects compared to oral antihistamines,” Dr. Shah says. “They’re particularly useful for people who may not tolerate oral antihistamines well or for whom oral antihistamines aren’t fully effective.” 

Examples of antihistamine nasal sprays include Flonase (fluticasone), Astelin (azelastine), and Patanase (olopatadine). 

Side effects of antihistamines 

Antihistamines can trigger some side effects, including: 

• Drowsiness
• Dry mouth
• Gastrointestinal upset
• Headache
• Thickening of mucus
• Increased appetite

Because antihistamines can induce drowsiness, they may interact with other medications that have the same effects, such as antidepressants and sedatives. They may also interact with narcotics and alcohol. Antihistamines should be used with caution among certain groups of people, including pregnant people, lactating mothers, and people who have heart, liver, and kidney diseases. 

Decongestants

Decongestants are a type of medicine that temporarily relieves a blocked or stuffy nose (nasal congestion). Decongestants work by opening up blood vessels in the nose to enhance airflow. They are sold as standalone decongestants as well as in combination form, where they’re combined with a pain reliever or an antihistamine. Standalone decongestants include Sudafed (pseudoephedrine) and Afrin (oxymetazoline). Advil Cold and Sinus, which contains ibuprofen and pseudoephedrine, is an example of a combination decongestant.

Most decongestants come in pill or liquid form, but there are also decongestant nasal sprays. 

Decongestant nasal sprays

The nose comprises tiny blood vessels that can become swollen if subject to allergies or infections. The swollen blood vessels then block the airways, reducing the free flow of air and leaving you uncomfortable and unable to breathe easily. “Decongestant nasal sprays are effective at relieving a runny nose by narrowing the blood vessels in the lining of the nose, which reduces swelling and congestion. However, they are not typically used for a runny nose alone, as their primary function is to reduce nasal congestion,” Dr. Shah says.

Dr. Shah advises that decongestant nasal sprays should only be used with guidance from your healthcare provider because, while they are generally safe for short-term use, they should not be used for more than three consecutive days. “Overuse can lead to a rebound effect, where nasal congestion worsens, a condition known as rebound congestion. Long-term use can also potentially damage the nasal tissues,” he says.

In September 2023, the U.S. Food and Drug Administration (FDA) advisory committee met to discuss evidence suggesting that oral phenylephrine, one of the active ingredients found in most over-the-counter decongestants, is ineffective for relieving nasal congestion. However, the FDA has not yet arrived at a definite conclusion as the evidence is still under review. FDA advisory committee submissions do not include phenylephrine nasal sprays. 

Side effects of decongestants

Side effects of decongestants vary, depending on what the active ingredients are. Some common side effects of decongestants include:

• Nervousness
• Headaches
• Nausea
• Restlessness
• Sleep problems
• Dizziness
• Irregular heartbeat
• High blood pressure

Discuss all of the medications you are taking with your healthcare provider before using decongestants in order to reduce the risk of drug interactions. Decongestants may interact with antihistamines, diet pills, antidepressants, blood pressure medications, and asthma medications.

Steroids

Steroids, or corticosteroids, are anti-inflammatory medications used to treat various conditions, ranging from allergies to more severe medical conditions, such as inflammatory bowel disease, arthritis, and chronic pulmonary obstructive disease. Steroids work by reducing inflammatory effects. They come in many forms, such as tablets, capsules, liquids, injections, creams, lotions, gels, and nasal sprays.

Steroid nasal sprays

Steroid nasal sprays reduce symptoms of nasal allergies, such as inflammation, congestion, runny nose, and sneezing. “Steroid nasal sprays work slowly, targeting the swelling and irritation at the source, and are safe for long-term use with a doctor’s advice,” Dr. Shah says. “They’re effective, but don’t give immediate relief—it usually takes a few days to feel better,” Following the recommendations for use written on the package insert is important.

The following are examples of steroid nasal sprays:

• Beconase AQ (beclometasone)
• Flonase (fluticasone)
• Nasonex (mometasone furoate)
• Rhinocort Allergy (budesonide)
• Nasacort (triamcinolone acetonide)

Side effects of steroid nasal sprays

When used as recommended, steroid nasal sprays may not cause side effects. Side effects are rare, but examples include:

• Itchiness or burning sensation in the nose
• Dry throat
• Vision problems
• Nosebleeds
• Bad taste in the mouth
• Bad smell
• Headache

You should seek advice from a pediatrician before using steroid nasal spray for a child. It’s also important to seek medical advice from your healthcare provider before using steroid nasal spray if you are pregnant or breastfeeding, allergic to steroids, had nose surgery, have ever been diagnosed with tuberculosis, or are taking other steroid medications.

How to choose the best allergy medicine for a runny nose

When choosing the best allergy medicine for a runny nose, there are certain factors that you should consider.

First, check that the side effects are not self-debilitating. Read the medication label and ask your healthcare provider about potential side effects and how to manage them. For instance, some antihistamines can trigger drowsiness. In that case, you might need to choose a non-drowsy alternative.

When using nasal decongestants, be conscious of rebound congestion, commonly seen in nasal sprays containing oxymetazoline or phenylephrine. Such nasal sprays should only be used for a maximum of three days.

When choosing allergy medicines for a child, get medical advice from a pediatrician to ensure that whatever option you choose is safe for children. Additionally, if you are pregnant or breastfeeding, discuss the best allergy medicine that will be safe for both you and your child with your healthcare provider. 

When to see an allergist

If allergic symptoms persist, it’s a good idea to visit an allergist for proper medical care. They may start you on immunology treatment, such as allergy shots or drops. Allergy shots, known as subcutaneous immunotherapy, involve regular injections that help your body gradually build up a tolerance to allergens. Allergy drops, or sublingual immunotherapy, work similarly but are administered under the tongue. “Both immunotherapy treatments are longer-term strategies aimed at reducing your sensitivity to allergens, potentially leading to lasting allergy relief from allergy symptoms like a runny nose,” Dr. Shah explains.