There are different types of antihistamines, and some are better than others depending on your age, health, and other medications you take.
Older formulas work, but beware of side effects and bad interactions
Doctors often refer to the first type of antihistamines that were on the market as “first-generation.” They are great at treating allergy symptoms. Unfortunately, in some people, they can result in side effects like anxiety, confusion, feeling sleepy, blurred vision, reduced mental alertness, urinary retention and constipation. These effects are more common for anyone taking certain antidepressant medications.
Ingredients of first-generation antihistamines include brompheniramine, chlorpheniramine, dimenhydrinate, diphenhydramine and doxylamine. Ask a pharmacist to help you compare products and read the labels if the print is too small. Some of the brand names for these products include Dimetapp Cold & Allergy, Chlor-Trimeton, Tavist, Benadryl, Vicks NyQuil and Tylenol Cold and Cough Nighttime.
The labels should also include warnings that people with certain medical conditions should not take first-generation antihistamines. Ask your doctor before use if you have:
- trouble urinating (from an enlarged prostate gland)
- breathing problems, such as asthma, emphysema, or chronic bronchitis
- thyroid disease
- heart disease
- high blood pressure
New formulations have fewer side effects, but you still need to be cautious
So-called “second-generation” antihistamines have fewer side effects and can be taken fewer times during the day. Again, ask your pharmacist to help you compare products. Ingredients in these products that may cause side effects include loratadine, cetirizine, levocetirizine, and fexofenadine. In the pharmacy, the brand names include Claritin, Alavert, Zyrtec, Xyzal, and Allegra.
There is still a potential for negative effects with certain illnesses. Talk to your doctor before taking a second-generation antihistamine if you have kidney or liver disease.
Medicines that treat a combination of cold, flu and allergy symptoms include these second-generation antihistamines. Some brand names for combination allergy medicines include Zyrtec-D, Allegra-D, Benadryl Allergy Plus, Claritin-D, and Actifed. When possible, only take medicines that treat your current symptoms.
Another option – nasal steroid sprays
Steroids, known medically as corticosteroids, can reduce inflammation associated with allergies. Nasal steroid sprays can prevent and treat nasal stuffiness, sneezing, and itchy, runny nose due to seasonal or year-round allergies. They can also decrease inflammation and swelling from other types of allergic reactions. Some over-the-counter nasal steroids include Rhinocort Allergy (budesonide), Flonase Allergy Relief (fluticasone), and Nasacort Allergy 24HR (triamcinolone). These are among the most effective medicines for allergy symptoms. Potential side effects should be mild and may include irritation, headache, and a bloody nose.
Allergies vs. COVID-19
There are some overlapping symptoms of allergies and the novel coronavirus (COVID-19). Allergies usually have more chronic symptoms, including itchy eyes, itchy nose, sneezing, wheezing, and coughing. They may be triggered by changing seasons or come as a reaction to something specific, like pet dander or certain foods. If you don’t have a fever, the symptoms are most likely due to allergies. Contact your doctor with any questions or concerns.
Ask your doctor and the pharmacist
You should always consult your doctor for medical advice before taking a new medication. Pharmacists are also trained to assist you regarding medications. Ask about potential side effects and interactions with drugs you already take. See if there are alternatives that would be better for you, and only take the medication as directed.
If you have additional questions at the pharmacy, the pharmacist can help you read labels, compare products and make recommendations.
About Wayne Rawlins, MD, MBA
Dr. Wayne Rawlins, vice president and chief medical officer at WellSpark Health, is a former member of the National Vaccine Advisory Committee, where he worked with the U.S. Department of Health and Human Services to advise and make recommendations on national vaccine policy. WellSpark Health and ConnectiCare are part of the EmblemHealth family of companies.