Pills vs. sprays? How to choose the best spring allergy medication for you

·Writer, Reporter and Producer
·8 min read
For millions of Americans, spring means the onset of allergy symptoms. Exerts weigh in on some of the medications you may encounter in your search for allergy relief. (Getty Images)
For millions of Americans, spring means the onset of allergy symptoms. Exerts weigh in on some of the medications you may encounter in your search for allergy relief. (Getty Images)

Spring is in the air, the days are getting longer and warmer... but for millions of Americans it’s dreaded allergy symptoms that are in full bloom. And if you’re one of them, you may be desperately stalking the pharmacy aisle hunting for that silver bullet to zap the sneezing, itchy, runny nose and congestion that can make springtime pure misery.

With everything from sprays to syrups to antihistamines to steroids on the market, the options may seem endless and even overwhelming; but you can narrow down which would work best for you by understanding their different uses — and in some cases, limitations.

Yahoo Life asked some allergy experts to weigh in on some of the options you may encounter on your quest for relief this spring allergy season. Here’s what they had to say:

Nasal allergy sprays

(Getty Images/iStockphoto)
Nasal spray options include steroid sprays, antihistamine sprays, decongestant sprays and saline sprays. (Getty Images/iStockphoto)

“I think as you get older, it's really preference,” Dr. Clifford Bassett, a clinical assistant professor at the NYU Grossman School of Medicine and founder and medical director of Allergy and Asthma Care of NY, tells Yahoo Life of choosing allergy medications. “I personally like nasal sprays.”

There are several different types of nasal sprays, including steroid sprays, antihistamine sprays, decongestant sprays and saline sprays.

“My go-to nasal sprays would be over the counter nasal steroid sprays that are extremely safe and well-tolerated,” Bassett says.

They’re “very effective” because they go straight to the source — the tissues and nasal mucosa — and work by reducing inflammation in nasal passages to relieve congestion. In fact, they’re one of the best options for fighting congestion; they’ve been shown in multiple studies to work better than oral antihistamines at relieving congestion, and are on par with oral antihistamines at relieving eye symptoms. But nasal steroid sprays work best if you begin using them several weeks before the onset of allergy symptoms.

Nasal antihistamine sprays — which prevent nasal symptoms by blocking the production of histamine — can work well when combined with the nasal steroid, but require a prescription.

“The nasal antihistamine has an advantage where it may also add in some improvement for post-nasal drip,” Bassett says, “which is a very annoying and unpleasant symptom that’s associated with clearing the throat.”

The third type of spray, nasal decongestant sprays, also work well if you’re stuffed up. But they’re only intended for short-term relief and shouldn’t be used for more than a few days at a time.

“They’ll work very well to open your nose up,” Dr. Mark Corbett, president-elect of the American College of Allergy, Asthma and Immunology, tells Yahoo Life of nasal decongestant sprays. “But you’ve got to watch those, because if you take them for more than five to seven days you can get addicted to them.”

“Many, if not most people, will develop what we call ‘rebound congestion,’” Bassett explains. “Instead of continuing to improve, it may cause more congestion. And you may be over-reliant on that thinking it’s helping you, and you get into a cycle. So we don’t like to over utilize nasal decongestant sprays.”

“Of course, we have Mother Nature, too,” Bassett adds. “We have nasal saline sprays.”

Nasal saline sprays — which are generally just a combination of salt and sterilized water — can help reduce the amount of mucus in your nose during peak allergy season. While they may not be the best preventative solution, they can work great at cleaning any allergens or irritants out of your nose after exposure.

“Especially if you’ve been exposed to a lot of dust,” Corbett explains, “or say you’ve been out during a bad pollen season walking outdoors, you want to use some nasal saline just to flush your nose out.”

But although Corbett says nasal sprays are “clearly the best choice for allergic rhinitis” and symptoms from nasal sprays are usually minimal, it can be difficult to get many patients to use them over other methods.

“People don’t want to spray anything up their nose. Occasionally they’ll get bloody noses, but I think it’s just the act of spraying something up your nose is weird for a lot of people.”

Oral allergy pills

Experts advise taking newer oral antihistamines over so-called first generation preparations. (Getty Images)
Experts advise taking newer oral antihistamines over so-called first generation preparations. (Getty Images)

For those opposed to nasal sprays, oral allergy medications are another option.

“Oral medications are very easy,” Bassett says. “Some people, they don’t agree with me and they just don’t like to take nasal sprays. And for those people, a general remedy is usually an oral antihistamine, which is safe.”

Antihistamines can be taken for quick relief, but work best if used before the onset of allergy symptoms. And while antihistamines on their own won’t do anything for nasal congestion, they can help with sneezing, runny nose and itchiness.

“If you have a patient who has both allergic rhinitis and they have itchy, watery eyes, and they’re breaking out in some hives or they’re itching on their skin, then I think an oral antihistamine can be helpful to add,” Corbett explains.

But he says it’s important to go for newer antihistamines like fexofenadine and cetirizine, and to avoid the so-called first generation antihistamines like diphenhydramine. Unlike newer antihistamines, which have minimal side effects and can be taken as little as once or twice a day, first generation antihistamines may cause drowsiness and need to be taken more frequently to be effective.

“We don’t like to take those routinely because they can make people too sleepy,” Corbett says of first generation antihistamines. “There’s also been some recent studies in older adults showing if they stay on those types of medications, it can affect their memory.”

And while Corbett touts the benefits of nasal steroids sprays, he says oral steroids are generally not a good idea. They can have “a ton of bad side effects,” including impacting bone density and increasing the risk of fractures, high blood pressure and diabetes. And in children, regular use of oral steroids can cause a decrease in growth rate.

“You absolutely do not want to take those routinely for allergies,” Corbett says.

Allergy syrups

Antihistamine syrups may be a good option for children. (Getty Images/iStockphoto)
Antihistamine syrups may be a good option for children. (Getty Images/iStockphoto)

For kids or anyone who hates swallowing pills, antihistamine syrups are often the best choice. They serve the same purpose as antihistamine tablets, and can come in more appealing flavors.

“If I have an antihistamine that dissolves in the mouth, or it’s liquid and it has a nice flavor, it’s easier and more palatable to have the children accept that,” Bassett says.

What’s that “D” label?

While oral antihistamine pills and syrups can help with a lot of symptoms, they generally don’t address the big one — congestion. So that’s where preparations labeled “D” come in. If a medication has the suffix “D” in its name, that means it contains a decongestant called pseudoephedrine, or sometimes phenylephrine, and can help relieve stuffiness.

But just as nasal decongestant sprays have their limitations, oral decongestants are also generally only recommended for short-term use.

“They can cause issues, especially in older patients with high blood pressure,” Corbett explains of oral decongestants. “They can affect diabetes; they can also affect the prostate in older men where they have trouble urinating. So you’ve got to be careful on those, and we don’t like to stay on those for a long period of time.”

Because pseudoephedrine can be used for nefarious purposes — like illegally making methamphetamines — you’ll have to go to the pharmacy counter to pick up most decongestants. You don’t need a prescription, but in many states you’ll need to show your ID and sign a logbook. And if your physician decides you need to stay on decongestants regularly and you’re not having any adverse symptoms, they may write you a prescription with regular refills.

Decongestants containing phenylephrine generally don’t involve having to make a trip to the pharmacist, but Corbett says it isn’t worth cutting corners.

“They don’t work,” Corbett says of phenylephrine decongestants. “They’ve never really been shown to be good, so if you really want to get a decongestant to help with stuffy nose, you really want to get one that you’ve got to get from the pharmacist.”

Most allergy medications tend to work best if taken before symptoms begin. (Getty Images)
Most allergy medications tend to work best if taken before symptoms begin. (Getty Images)

Whatever method you choose, experts say that symptoms can often be easily managed by keeping an open dialogue with your physician or allergist, finding the solution that works best for you and — Bassett emphasizes — starting early.

“The medications work; they work well,” Bassett says. “But they do work best for people before the height of the season; before allergies really kick in.”

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