Allergy Topics
With Severe Allergies, What Allergy Medications Should I Take?
by Dr. Christopher Chang, last modified on
1/8/23->
For those with moderate to severe allergies for which a single allergy medication never works, the following guide will help determine what combination of multiple allergy medications you should take for good symptom control.
If you are more interested in how these allergy medications work, click here.
Please check all boxes below if the statement describes your symptoms. Then read what multiple combination of medications and/or interventions may work best to control your allergy complaints. The information provided below applies to both adults and children (using pediatric dosages). To reiterate, you CAN take more than one allergy medication if you are suffering from more than one allergy symptom.
More Than 1 Allergy Symptom
With severe allergies encompassing more than one symptom involving different areas of the body, it is beneficial to take an oral anti-histamine 1-2 times per day. Typically, zyrtec has been the go-to oral allergy medication to take, though one can take other oral anti-histamines such as claritin, allegra, xyzal based on cost, side effects, etc. Although the directions state to take only once a day, if you have particularly bad allergy symptoms, it is fine to take such oral allergy medication twice a day (morning and evening)! Benadryl can also be taken every 4-6 hours if a very severe allergy flareup occurs. Along with medications, environmental control is very important to minimize exposure to whatever is triggering your allergies in the first place. Strong consideration should be made to get allergy testing done and if a candidate, start allergy shots.
Eye Symptoms
If you suffer from watery and/or itchy eyes, using an anti-histamine eye drop is the best action to take. You can use 1 drop 1-2 times a day. The best over-the-counter allergy eye drops are Zaditor and Pataday. Be aware that just because an eye drop is labelled as an "allergy eye drop" does NOT mean it will actually work for allergies... That's just marketing.
Runny Nose, Sneezing
As a first step, try an over-the-counter steroid nasal spray like flonase, nasacort, and rhinocort. These nasal sprays can be used 1-2 times a day. However, if symptoms persist, it is certainly worthwhile to ADD a prescription anti-histamine nasal spray like astelin or patanase. Astepro is the only over-the-counter antihistamine nasal spray. Of note, dymista nasal spray is a combination steroid and anti-histamine nasal spray. NasalCrom is another nasal spray that works well, but must be used within 1 hour of a known exposure to an allergic trigger. Along with medications, environmental control is very important to minimize exposure to whatever is triggering your allergies in the first place. Click here for more information. There is also a surgical procedure called RhinAer that can reduce the overall severity of nasal symptoms, though not cure it. Strong consideration should be made to get allergy testing done and if a candidate, start allergy shots.
Nasal Congestion
If a predominant symptom of nasal congestion is present, over-the-counter steroid nasal sprays like flonase, nasacort, and rhinocort are helpful along with the prescription drug singulair (generic, montelukast). Capsaicin nasal spray like Sinus Plumber has been helpful to obtain immediate relief, but keep in mind that it is relatively short-lasting. Along with medications, environmental control is very important to minimize exposure to whatever is triggering your allergies in the first place. Strong consideration should be made to get allergy testing done and if a candidate, start allergy shots.
Nasal Obstruction
Nasal obstruction due to allergies normally occurs due to enlarged inferior turbinates as well as diffuse nasal mucosal swelling. As a first step, try an over-the-counter steroid nasal spray like flonase, nasacort, and rhinocort. These nasal sprays can be used 1-2 times a day. However, if symptoms persist, it is certainly worthwhile to ADD a prescription anti-histamine nasal spray like astelin or patanase. Astepro is the only over-the-counter antihistamine nasal spray. Of note, dymista nasal spray is a combination steroid and anti-histamine nasal spray. NasalCrom is another nasal spray that works well, but must be used within 1 hour of a known exposure to an allergic trigger. Along with medications, environmental control is very important to minimize exposure to whatever is triggering your allergies in the first place. There is also a surgical procedure called RhinAer that can reduce the overall severity of nasal symptoms, though not cure it. Turbinate reduction is another procedure that can be performed to reduce the overall size of the turbinates. Again not a cure, but does help decrease overall symptom severity. Strong consideration should be made to get allergy testing done and if a candidate, start allergy shots.
Skin Issues (Hives or Rashes)
It is beneficial to take an oral anti-histamine 1-2 times per day. Typically, zyrtec has been the go-to oral allergy medication to take for allergic skin conditions, though one can take other oral anti-histamines such as claritin, allegra, xyzal based on cost, side effects, etc. Although the directions state to take only once a day, if you have particularly bad allergy symptoms, it is fine to take such oral allergy medication twice a day (morning and evening)! Benadryl can also be taken every 4-6 hours if a very severe allergy flareup occurs. Additionally, applying an over-the-counter steroid ointment (Cortizone 10 Ointment) to the affected skin can resolve itching and inflammation more quickly. Strong consideration should be made to get allergy testing done and if a candidate, start allergy shots.
Allergies Worse at Night
If allergy symptoms are worse at night, it is possible you have a dust mite allergy. Given dust mites are highly concentrated in the bed, using allergy bedding encasements around the pillow and mattress before putting the sheets on is VERY beneficial. Such encasements dramatically reduce dust mite found in the bed thereby reducing allergic reactions to this allergen. If you have a pet, never allow the pet to be present in the bedroom. Also get a portable HEPA filter like the Dyson Pure, Molekule, or Alen Filter Unit and place it near your bed. Other environmental controls can also be pursued to minimize exposure to whatever is triggering your symptoms. Strong consideration should be made to get allergy testing done and if a candidate, start allergy shots.
RESPONSES WILL APPEAR HERE in colored boxes as you check off your symptoms above!
When taking multiple combination of allergy medications, be sure to try and take no more than 1 medication of the same type. Though they all try to get your symptoms under control, different medication classes do it by different mechanisms which when taken altogether, can work even better than by itself.
So, using the table below, a patient can generally take one medication from each column at the same time (but not more than one medication contained within a column unless directed by your doctor). For example (highlighted in
Anti-Histamine Pill |
Steroid Nasal Spray |
Anti-Histamine Nasal Spray |
Leukotriene Inhibitor |
Saline |
Cromolyn Nasal Spray |
Vitamins |
| Zyrtec (cetirizine) Xyzal (levocetirizine) Clarinex (desloratidine) Caritin (loratidine) Benadryl (diphenhydramine) |
Nasacort AQ Rhinocort AQ Flonase (fluticasone) Veramyst
Omnaris |
Accolate Zyflo (asthma) |
Vitamin D3 |
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