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Xyzal vs Allegra: How To Choose The Best Antihistamine For Allergy Relief

Written by Andrew Le, MD

UpdatedFebruary 28, 2024

More than 100 million people in the US experience various types of allergies each year, from seasonal allergies to skin and food allergies. These allergies can cause uncomfortable symptoms, including sneezing, runny nose, itching, and hives.

Two commonly prescribed antihistamine medications used to manage these allergy symptoms are Xyzal (levocetirizine) and Allegra (fexofenadine), which work by blocking histamine receptors. However, there are some key differences between these two drugs.

In this article, you will learn about the variations between Xyzal and Allegra in terms of effectiveness, potential side effects, costs with insurance, and other vital factors. Comparing these key differences is essential when weighing which allergy treatment option best suits an individual.

🔑 Key Takeaways

  • Xyzal and Allegra are antihistamines blocking histamine receptors to relieve allergy symptoms like runny nose, hives, and itching.
  • In studies, both Xyzal and Allegra effectively improve allergy symptoms and quality of life, but Xyzal may have better efficacy.
  • Common side effects for both include drowsiness, headache, nausea, and muscle pain; serious rare side effects can include allergic reactions and flu-like symptoms.
  • It is not recommended to take Xyzal and Allegra together due to the increased risk of side effects.
  • A 10-tablet supply of Xyzal costs around $20, while a 5-tablet supply of Allegra costs around $17, with generics and discount cards available to reduce costs.
  • Patient assistance programs can provide Xyzal and possibly Allegra at reduced costs or free for those who qualify.
  • Allegra comes in regular and orally disintegrating tablets, liquid forms, and gelcaps, while Xyzal comes in tablets, dissolvable tablets, and oral solutions.
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1. Mechanism of Action

Xyzal and Allegra have some similarities but also key differences in how they work to provide relief of allergy symptoms. Here are the mechanisms of action for Xyzal and Allegra.

Xyzal

Xyzal, with the active ingredient levocetirizine, belongs to the second generation of oral antihistamines. Its mechanism of action involves blocking the effects of histamine, a natural chemical produced by the body in response to allergens. Histamine is responsible for causing symptoms such as:

Levocetirizine specifically targets the H1 receptors, preventing histamine from binding to them. By blocking these receptors, Xyzal helps reduce or prevent allergy symptoms.

Allegra

Allegra, containing the active ingredient fexofenadine, is classified as a second-generation oral antihistamine. Like Xyzal, its primary mechanism of action involves blocking the effects of histamine, specifically at the H1 receptors.

By inhibiting the binding of histamine to these receptors, Allegra helps alleviate symptoms associated with allergic reactions, such as:

  • Sneezing
  • Itching
  • Runny nose

2. Dosage

The dosage amount and frequency differ between Xyzal and Allegra across age groups. Understanding the specific recommendations is key for proper administration. Below are the dosage recommendations for Xyzal and Allegra by formulation and age.

Xyzal

The dosing of Xyzal is as follows.

Usual adult dose for urticaria:

  • 5 mg orally once a day in the evening
  • Some patients may be adequately controlled on 2.5 mg orally once a day in the evening.

Usual Adult Dose for Allergic Rhinitis:

  • Seasonal Allergic Rhinitis (OTC): 5 mg orally once a day in the evening; some patients may be adequately controlled on 2.5 mg daily.

For the usual pediatric dose for allergic rhinitis, consider the following.

Perennial allergic rhinitis:

  • 6 months to 2 years: 1.25 mg orally once a day in the evening The recommended dose in pediatric patients 6 months to 2 years should not be exceeded.

Seasonal allergic rhinitis (OTC):

  • 6 to 11 years: 2.5 mg orally once a day in the evening
  • 12 years or older: 5 mg orally once a day in the evening; some patients may be adequately controlled on 2.5 mg once a day
  • Avoid use in patients less than 6 years.

Usual pediatric dose for rrticaria:

  • 6 months to 5 years: 1.25 mg orally once a day in the evening
  • 6 to 11 years: 2.5 mg orally once a day in the evening
  • 12 years or older: 5 mg orally once a day in the evening; some patients may be adequately controlled on 2.5 mg once a day
  • The recommended doses in pediatric patients 6 months to 12 years should not be exceeded.

Allegra

The recommended dosage for Allegra depends on the age group and the specific formulation. Here's a summary.

Allegra tablets:

  • Adults and Children 12 Years and Older: 60 mg twice daily or 180 mg once daily with water. 60 mg once daily is recommended as the starting dose for those with decreased renal function.
  • Children 6 to 11 Years: 30 mg twice daily with water. 30 mg once daily is recommended as the starting dose for pediatric patients with decreased renal function.

Allegra ODT (Orally Disintegrating Tablets):

  • Children 6 to 11 Years: 30 mg twice daily. It's designed to disintegrate on the tongue and should be taken on an empty stomach. Not intended to be chewed.

Allegra oral suspension:

  • Children 2 to 11 Years (Seasonal Allergic Rhinitis): 30 mg twice daily. Shake the bottle well before each use.
  • Children 6 Months to 11 Years (Chronic Idiopathic Urticaria): 30 mg (5 mL) twice daily for patients 2 to 11 years of age and 15 mg (2.5 mL) twice daily for patients 6 months to less than 2 years of age. For those with decreased renal function, the recommended starting doses are 30 mg (5 mL) once daily for patients 2 to 11 years and 15 mg (2.5 mL) once daily for patients 6 months to less than 2 years.

3. Efficacy in Allergy Symptoms

Studies comparing Xyzal and Allegra provide helpful insight into their efficacy in managing different allergy symptoms. Here is an overview of studies analyzing the efficacy of these medications.

Xyzal

In a study involving patients with persistent rhinitis, levocetirizine significantly improved quality of life and symptoms over 6 months, with lower treatment cessation rates and overall costs than a placebo.

A review highlighted levocetirizine as effective and well-tolerated for allergic rhinitis and chronic idiopathic urticaria, with better efficacy than other antihistamines in allergen challenge chamber studies.

For patients with persistent allergic rhinitis due to house dust mites, levocetirizine demonstrated an 86% improvement in symptoms over the first week, including unexpected improvement in nasal congestion. The treatment was well-tolerated.

In a long-term management trial, levocetirizine not only improved symptoms and quality of life but also reduced overall disease costs, making it a valuable option.

Overall, levocetirizine, the active ingredient of Xyzal, is an effective and well-tolerated option for persistent rhinitis, offering improvements in symptoms, quality of life, and overall cost-effectiveness.

Allegra

In a study comparing once-daily fexofenadine HCl to placebo for autumn seasonal allergic rhinitis, both the 120 mg and 180 mg doses significantly improved symptoms compared to placebo. Adverse events were similar to placebo, with headache being the most reported.

A review of fexofenadine's use in managing seasonal allergic rhinitis and chronic idiopathic urticaria showed its effectiveness, comparable to loratadine and cetirizine. Fexofenadine was well-tolerated, with no adverse cardiac effects and minimal side effects.

In an allergen exposure unit study, the fexofenadine-pseudoephedrine combination demonstrated a rapid onset of action at 45 minutes, effectively treating a broad range of allergy symptoms.

Overall, fexofenadine proves to be an effective and well-tolerated option for managing seasonal allergy symptoms, with both the standalone formulation and the combination with pseudoephedrine demonstrating positive outcomes.

4. Side Effects

While generally well-tolerated, both medications have potential side effects ranging from mild to severe. Below are the potential side effects of each medication.

Xyzal

Common side effects:

  • Drowsiness and Tiredness: Some users may experience drowsiness or tiredness. It is advised to avoid activities requiring mental alertness, such as driving or operating heavy machinery, until the individual knows how Xyzal affects them.
  • Sinus Pain and Ear Infections: Sinus pain and ear infections are reported side effects, which may require medical attention.
  • Digestive Issues: Users may experience vomiting, diarrhea, constipation, and dry mouth.

Serious side effects:

  • Allergic Reaction: In rare cases, an allergic reaction may occur, presenting as hives, difficulty breathing, or swelling of the face, lips, tongue, or throat. Immediate medical attention is necessary.
  • Urinary Issues: Painful or difficult urination, or little to no urination, should be reported to a healthcare professional.

Allegra

Common side effects:

  • Nausea and Upset Stomach: Nausea, upset stomach, and diarrhea are reported side effects of Allegra.
  • Drowsiness: Similar to Xyzal, Allegra may cause drowsiness and tiredness.
  • Menstrual Cramps: Some users may experience menstrual cramps.
  • Headache and Muscle Pain: Headache and muscle or back pain are among the reported side effects.

Serious side effects:

  • Allergic Reaction: Allergic reactions with symptoms like hives, difficulty breathing, and swelling require immediate medical attention.
  • Flu-like Symptoms: Fever, chills, and body aches may occur.

⚠️ Warning

It is not recommended to take Allegra with Xyzal simultaneously due to an increased risk of side effects.

See prices for Allegra on Amazon

5. Cost

The costs of Xyzal and Allegra vary, with savings options making them more affordable. Below is a price comparison between Xyzal and Allegra.

Xyzal

Xyzal, specifically the oral tablet 5 mg, comes with around $20 for a supply of 10 tablets. If opting for the generic version, levocetirizine, the price is lower, starting from $13.48 for 30 tablets.

Various discounts are available, and the Drugs.com Discount Card can save customers up to 80% or more off prescription costs. Coupons and savings options, such as free 5-day samples and discounts on Children's Xyzal products, further reduce costs.

For those seeking additional financial assistance, patient assistance programs like Rx Outreach Medications may offer Xyzal at a reduced cost or for free, depending on eligibility criteria.

Allegra

Allegra Allergy, specifically the oral tablet 180 mg, costs around $17 for a supply of 5 tablets. The generic version, fexofenadine, starts from $9.92 for 5 tablets.

Like Xyzal, the Drugs.com Discount Card can provide up to 80% off prescription costs. For Allegra Allergy Tablet Products and Allegra Allergy 24HR Gelcaps, coupons and savings options are available.

While specific patient assistance programs are not listed, users are encouraged to consult with their healthcare providers for potential information on available programs in their area.

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Wrap Up

Xyzal and Allegra are antihistamines that effectively treat allergy symptoms by blocking histamine receptors.

However, studies show Xyzal may have better efficacy compared to Allegra. Additionally, Xyzal tends to have fewer side effects than Allegra, although both can cause drowsiness and headaches.

Xyzal also has more affordable generic options, starting around $13 for 30 tablets versus $9.92 for just 5 tablets of generic Allegra.

Given the potentially better efficacy, fewer side effects, and lower cost, Xyzal is the preferred antihistamine treatment over Allegra for patients suffering from seasonal and chronic allergies.

FAQs on Xyzal and Allegra

What kind of allergies is Xyzal good for?

Xyzal is good for relieving common allergy symptoms associated with hay fever or other respiratory allergies, such as sneezing, watery eyes, and itching.

What is the strongest over-the-counter antihistamine?

The strongest over-the-counter antihistamine is diphenhydramine (Benadryl). As a first-generation antihistamine, it most strongly blocks histamine receptors and is often used in emergency rooms to treat severe allergic reactions.

What is the safest antihistamine to take daily?

The safest antihistamines to take daily are second-generation options like fexofenadine (Allegra) and loratadine (Claritin), which typically do not cause significant side effects with regular use.

Which antihistamine is best for itchy skin?

The best antihistamines for itchy skin relief are non-drowsy oral options such as loratadine (Claritin), cetirizine (Zyrtec), or fexofenadine (Allegra). These can reduce allergy-associated skin irritation without causing sleepiness.

Illustration of a healthcare provider asking questions on a smart phone.
Allergy treatment - Online visit
Get virtual care from a licensed clinician—no appointment needed
Illustration of a healthcare provider asking questions on a smart phone.
  • $29 one-time assessment
  • No video call or appointment necessary
  • Personalized treatment plan prescribed for your condition

References