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Top 5 Best Antihistamines for Allergies

Written by Andrew Le, MD

UpdatedMay 29, 2024

Given that over 100 million Americans experience allergy symptoms yearly, it's clear that allergies are a prevalent issue. If you're part of this group, you're likely familiar with the discomfort these symptoms can cause.

When finding relief, turning to an antihistamine is a common choice. But with numerous options out there, it's crucial to determine which one suits you best.

This guide aims to assist you in pinpointing the best antihistamine for your allergies. Continue reading to gain valuable insights about antihistamines!

Understanding How Antihistamines Work

Antihistamines are medications designed to counteract the effects of histamines, chemicals released by the body during an allergic reaction. They alleviate allergy symptoms and provide relief from conditions such as:

  • Allergic rhinitis
  • Conjunctivitis
  • Dermatological reactions
  • Sinusitis
  • Urticaria

These drugs work by binding to specific histamine receptors in the body. Antihistamine medications that attach to H-1 receptors are typically used to alleviate symptoms of allergies and treat illnesses mediated through similar mechanisms.

H-1 antihistamines are further divided into two generations, each with its own characteristics and applications in allergy relief. Let’s discuss them below!

First-Generation Antihistamines

First-generation antihistamines, introduced in 1942, influence histamine receptors in the brain and spinal cord. They effectively target H-1 receptors. However, these antihistamines have a notable characteristic. They can cross the blood-brain barrier, potentially causing drowsiness.

Example drugs from the first-generation category also include:

  • Brompheniramine (Children’s Dimetapp Cold)
  • Chlorpheniramine (Advil, Chlor-Trimeton, Dimetapp, Tylenol)
  • Dimenhydrinate (Dramamine)
  • Diphenhydramine (Benadryl)
  • Doxylamine (Vicks NyQuil)

These antihistamines start working in about 30 to 60 minutes, providing relief for 4 to 6 hours. Chlorpheniramine, in particular, is a popular choice for emergencies. Side effects of first-generation antihistamines, aside from drowsiness, may include:

Second-Generation Antihistamines

Second-generation antihistamines represent a newer class of medications. They have a limited side effect profile, including a reduced likelihood of causing drowsiness due to their reduced ability to penetrate the blood-brain barrier.

Examples include:

  • Cetirizine (Zyrtec)
  • Desloratadine (Clarinex)
  • Fexofenadine (Allegra)
  • Loratadine (Claritin)

These drugs can be taken orally, nasally, or via an eye dropper and typically provide relief for up to 24 hours. Though generally well-tolerated, some potential side effects of second-generation antihistamines may include:

Now that we've explored how antihistamines function, let’s turn our attention toward the five recommended antihistamines for allergies.

5 Recommended Antihistamines for Allergies

Many antihistamines today offer a range of options for individuals seeking effective allergy relief. To assist you in making an informed choice, we've thoroughly examined and curated a comprehensive guide on each antihistamine, prioritizing factors such as:

  • Efficacy
  • Price
  • Availability
  • Safety
  • Duration of action

Explore our top-recommended antihistamines below!

See prices for Zyrtec in Amazon

Cetirizine, available in various forms, including tablets, chewable tablets, capsules, orally disintegrating tablets, and oral liquids, can be obtained with a prescription or over-the-counter (OTC). It belongs to the second generation of histamine H1 antagonists.

This highly effective antihistamine is especially useful in alleviating sneezing, runny nose, and watery eyes triggered by seasonal allergies, as well as allergens like dust mites and molds. Cetirizine typically takes effect within 20 to 60 minutes and provides relief for at least 24 hours.

Research has shown that Cetirizine specifically reduces the movement of neutrophils and eosinophils, types of white blood cells, which help alleviate allergic reactions.

For consumers, generic brands of Cetirizine are generally priced between $15 and $17.43 for a pack of 30 tablets. The price range for the Zyrtec brand typically falls between $24 to $44.44 for the same quantity. Moreover, you can find brands such as:

  • Aller-tec
  • Aller-tec D
  • Quzyttir
  • Reactine
  • Wal Zyr 24 Hour Allergy
  • Wal Zyr D
  • Wal-zyr
  • Zerviate

Another notable advantage of Cetirizine is its minimal likelihood of negative interactions with other drugs, especially those processed by liver enzymes, owing to its lack of hepatic metabolism. This property makes Cetirizine a safer option in terms of potential drug interactions.

Pros

  • Administered once daily.
  • Over-the-counter availability.
  • Offered in various forms, including tablets, chewable tablets, orally dissolving tablets, capsules, and liquid solutions.
  • A first-choice antihistamine.
  • Certain liquid formulations are suitable for children as young as two years old.
  • Less likelihood of causing drowsiness compared to many alternative antihistamines.
  • Minimal likelihood of negative interactions with other drugs.

Cons

  • It may induce drowsiness more than loratadine or fexofenadine.
  • Increased likelihood of adverse effects in individuals with liver or kidney conditions.

⚠️ Precautions

Individuals with allergic reactions to hydroxyzine should avoid using Cetirizine, as this antihistamine is a derivative of hydroxyzine.

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See prices for Claritin (loratadine) on Amazon

Loratadine, the active ingredient in the popular antihistamine brand Claritin, is a trusted OTC medication approved by the Food and Drug Administration (FDA) for relieving symptoms of allergic rhinitis and urticaria.

It is available in various forms, including pills, oral liquids, chewable tablets, and orally disintegrating tablets. Loratadine takes effect within 1 to 3 hours and usually lasts up to 24 hours.

A pack of 30 Claritin tablets typically ranges from $26.99 to $47. Generic brands of Loratadine offer a more budget-friendly option, priced between $6.13 and $24 for the same quantity. Other available brands are:

  • Alavert
  • Alavert D
  • Allerclear
  • Diphen
  • Loradamed
  • Wal-itin
  • Wal-itin D

It's worth noting that Loratadine undergoes a metabolic transformation in the liver facilitated by the CYP450 pathway. While it typically does not lead to severe drug interactions, medications influencing the CYP450 enzyme system may potentially require adjustments in treatment.

Extra caution is advised for individuals with liver disease or impaired liver function. With its proven effectiveness and lasting relief, Claritin remains a go-to solution for individuals and families seeking respite from allergy symptoms.

Pros

  • Administered once daily.
  • Over-the-counter availability.
  • Offered in various forms, including pills, oral liquids, chewable tablets, and orally disintegrating tablets.
  • Induces less drowsiness than cetirizine.
  • An advantageous option for individuals aged 65 and above, as it is better tolerated.
  • Liquid formulations and specific chewable tablets are suitable for children as young as two years old.

Cons

  • Less potent than Cetirizine, and consequently, it may be less effective in comparison.
  • Takes longer time to take effect than Cetirizine.
  • May be less effective in younger children compared to Cetirizine.
  • May have a higher risk of side effects for individuals with liver or kidney issues.
  • Tablets, capsules, and orally disintegrating tablets are unsuitable for children under six years of age.

⚠️ Precautions

Individuals with Phenylketonuria (PKU), a rare genetic condition leading to an accumulation of phenylalanine in the body, should consult their primary care doctor before using Claritin. Certain forms of Claritin, like orally dissolving tablets, might contain phenylalanine, potentially worsening PKU symptoms.

See prices for Allegra (fexofenadine) in Amazon

Fexofenadine, available as an OTC drug, is a second-generation antihistamine known for its effectiveness in relieving allergy symptoms. With a duration of action that begins within 2 hours and typically lasts up to 24 hours, Fexofenadine offers prolonged and consistent relief.

Available in various forms, including tablets, syrup, and orally disintegrating tablets, Fexofenadine provides flexibility in administration.

Allegra, brand name of Fexofenadine, is priced between $23.99 and $36.69 for a pack of 30 tablets. Generic brands of Fexofenadine offer a more cost-effective option, generally ranging from $7.49 to $17 for the same quantity.

Pros

  • A first-choice option for allergies.
  • Lowest likelihood of causing drowsiness among second-generation antihistamines.
  • Provides longer-lasting relief and can be taken once a day to alleviate symptoms.
  • Allegra is available in various forms, including 12-hour and 24-hour tablets, as well as liquid and quick-dissolving tablets for those who have difficulty swallowing pills.
  • All formulations are accessible without a prescription.

Cons

  • May interact with the antifungal medication ketoconazole, the antibiotic erythromycin, and antacids containing aluminum and magnesium.
  • The effectiveness of Fexofenadine may reduce when consumed with green tea and grapefruit, apple, or orange juices.
  • Individuals on a low-salt diet may want to avoid the liquid form of Allegra as it contains sodium.
  • It's not recommended to use once-daily Allegra formulations for children under 12 years old.
  • If you have liver or kidney problems, there may be a higher risk of experiencing side effects.

⚠️ Precautions

Liquid forms of this product may include added sugar, while rapidly dissolving tablets might contain aspartame. If you have conditions like diabetes, phenylketonuria (PKU), or any other health issue that necessitates restricting or avoiding these substances in your diet, it's important to exercise caution. Consult your doctor or pharmacist for guidance on using this product safely.

See prices for Levocetirizine using insurance vs coupons

Levocetirizine is a potent antihistamine available in oral tablet form, with onset of action within 1 hour and lasting up to 28 hours. Supported by numerous studies, Levocetirizine stands out as a powerful, reliable, and long-lasting treatment option for managing both occasional and persistent allergic rhinitis, as well as chronic idiopathic urticaria.

This second-generation antihistamine is available both with a prescription and OTC, offering accessibility to a wide range of users. The generic form of Levocetirizine is still available on the US market, even though the only branded version, Xyzal, has been discontinued by the manufacturer.

One pack of 55 5mg tablets of Levocetirizine typically ranges from $24.99 to $28.40, providing an affordable option for those seeking effective allergy relief.

It's worth noting that Levocetirizine oral tablets may potentially interact with other medications, including asthma or chronic obstructive pulmonary disease (COPD) drugs like Theophylline, as well as certain HIV drugs like Ritonavir. It is advisable to consult with a healthcare professional before starting any new medications or supplements while using Levocetirizine.

Pros

  • Taken once per day.
  • Over-the-counter availability.
  • Cheap option compared to other antihistamines.
  • Effects may last longer compared to other antihistamines.
  • No known food interactions.

Cons

  • May induce drowsiness more than Loratadine or Fexofenadine.
  • May not be suitable for individuals with kidney issues due to a heightened risk of side effects.
  • Tablets are not recommended for children under the age of 6.

⚠️ Precautions

If you experience any of the conditions mentioned or if any of these situations apply to you, it is crucial to inform your healthcare provider. Levocetirizine may not suit you if:

  • You are allergic to Cetirizine.
  • You have severe kidney issues or are undergoing dialysis.
  • You are a child between 6 months and 11 years old with kidney problems.
See prices for Desloratadine using insurance vs coupons

Desloratadine is a trusted second-generation antihistamine available by prescription only. Its non-drowsy formulation takes effect within 3 hours and provides a full 24 hours of uninterrupted relief. A study evaluating once-daily desloratadine treatment in patients with seasonal allergic rhinitis concluded that Desloratadine, across various doses, alleviated symptoms of seasonal allergic rhinitis.

Research suggests that Desloratadine doesn't interact significantly with certain drug transporters or metabolic pathways in the body. This makes it compatible with medications like ketoconazole, erythromycin, fluoxetine, or azithromycin. Additionally, food or grapefruit juice doesn't alter its effectiveness.

The brand name Clarinex, known for its effectiveness, is priced between $202.09 and $286.33 for a pack of 30 5mg tablets. Generic versions of Desloratadine offer a more affordable option, typically priced from $25.87 to $42.90 for the same quantity.

Pros

  • Unlikely to induce drowsiness.
  • Requires just once-daily administration.
  • Food or grapefruit juice doesn't alter its effectiveness.

Cons

  • Accessible via prescription only.
  • Expensive compared to other antihistamines.
  • Individuals with liver or kidney issues may necessitate a lower dosage due to potential side effects.
  • Tablets aren't recommended for children under 12 years old.
  • ODTs aren't recommended for children under six years old.

⚠️Precautions:

Desloratadine is a primary metabolite of loratadine. Refrain from using medications that contain loratadine while taking desloratadine. Additionally, the orally disintegrating tablets (ODTs) of Clarinex (desloratadine) contain phenylalanine. If you have phenylketonuria (PKU), it is crucial to be aware that using the ODT form of Clarinex can pose a risk to your health.

Factors to Consider When Choosing an Antihistamine

When choosing the right antihistamine, there are several essential factors to consider. Let’s take a closer look at each of these factors.

Effectiveness

Look into clinical studies and see if the medicine has been proven to work. This will give you an idea if it's a good choice. When choosing an antihistamine, it's important to recognize that effectiveness can vary depending on the type of allergy.

Side Effects and Tolerance

Familiarize yourself with the potential side effects of the antihistamine you're considering. Additionally, consider the possibility of developing tolerance over time, as well as any withdrawal symptoms that may occur upon discontinuation. This awareness is crucial for long-term usage.

Duration of Action and Dosage

Distinguish between short-acting and long-acting antihistamines. Short-acting options provide quick relief but may require more frequent dosing, while long-acting ones offer sustained effects over a longer period with fewer administrations.

Consider how frequently you're comfortable taking the medication. This may impact your daily routine and should align with your lifestyle.

Interactions with Other Medications

It's important to know if the antihistamine you choose could interact with other medications or any existing medical conditions you may have. This can prevent unwanted complications or reduce effectiveness.

By taking these factors into account, you can make a well-informed decision about which antihistamine aligns best with your allergy management needs.

Wrap-Up

Among the recommended antihistamines for allergies, Cetirizine is notable for its swift relief. Loratadine, on the other hand, stands out for its well-tolerated nature, particularly suitable for individuals aged 65 and above.

Fexofenadine offers the distinct advantage of prolonged relief, allowing for convenient once-daily administration. Levocetirizine, in turn, presents an economical option for users.

Notably, Desloratadine distinguishes itself with its compatibility with a variety of medications. This makes it an adaptable choice for individuals seeking reliable allergy relief while concurrently managing other aspects of their health.

A healthcare professional can provide personalized recommendations based on specific needs and circumstances. Remember, the best antihistamine effectively manages your allergies with the fewest side effects, allowing you to enjoy life without the constant burden of allergic reactions.

FAQs on Best Antihistamines for Allergies

Are there any significant differences between over-the-counter and prescription antihistamines?

Over-the-counter (OTC) antihistamines are available without a prescription and are generally safe for most people to use. Prescription antihistamines may be recommended for specific cases of severe allergies or conditions not effectively managed by OTC options.

Are there any specific antihistamines recommended for certain types of allergies (e.g., seasonal, pet dander)?

Second-generation antihistamines like cetirizine and loratadine are effective for various allergies, including seasonal allergies (hay fever), pet dander allergies, and more.

How can I determine the best antihistamine for allergies if I have pre-existing medical conditions?

Individuals with certain medical conditions like glaucoma, enlarged prostate, or respiratory issues should consult their healthcare provider before using antihistamines, as some formulations may exacerbate these conditions.

Can you provide insights into the best antihistamine for allergies during pregnancy or breastfeeding?

Second-generation antihistamines like loratadine (Claritin) or cetirizine (Zyrtec) are considered safer options. However, it's important to note that individual circumstances may vary, and a healthcare provider can provide personalized advice based on your specific situation.

Are there any natural alternatives that can complement the effects of antihistamines for the treatment of allergies?

Yes, there are natural remedies that may help alleviate allergy symptoms and can complement the effects of antihistamines. These include saline nasal irrigation, quercetin, butterbur, and local honey.

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Get virtual care from a licensed clinician—no appointment needed
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  • $29 one-time assessment
  • No video call or appointment necessary
  • Personalized treatment plan prescribed for your condition