“When Xyzal came out, we thought it was going to be this great medication because it’s basically this purified form of Zyrtec,” Dr. Brooks says. He elaborates that while the hope was to harness the benefits of Zyrtec with fewer side effects, he finds the two fairly interchangeable. In general, he usually recommends Zyrtec or Claritin first, since they tend to be more affordable. However, some patients report more symptom improvement from Xyzal—meaning it’s a worthwhile switch if you’re not experiencing relief.
Benadryl (diphenhydramine)
Benadryl Ultratabs Antihistamine Allergy Relief Medicine
While it can be helpful for unexpected allergy attacks, most experts advise against using Benadryl as a daily seasonal allergy defense. “Side effects are more pronounced with older antihistamines such as diphenhydramine (Benadryl),” Dr. Malchuck says. “In general, I tell folks to avoid diphenhydramine altogether and reserve it for severe allergy attacks (such as hives).”
“This is a first-generation antihistamine, which means it’s older, it crosses the blood-brain barrier a lot more, and there are more side effects associated with Benadryl,” Dr. Otsu says. She also notes that this medication stays active for about four to six hours. “It’s not a 24-hour medication, but it’s highly sedating and it can cause impaired motor skills, cognitive dysfunction like brain fog, dry mouth, dry eyes, all sorts of things.”
Dr. Brooks says there’s a common misconception that experiencing side effects means your daily allergy medication is working better—one reason why he suspects patients are “so attached” to Benadryl. “But generally I would rather someone have tried Zyrtec, Claritin, Allegra, or Xyzal first,” he says. Dr. Brooks also notes that some research shows that when people take Benadryl before bed, it reduces their sleep quality in the same way that alcohol does.
Nasal Sprays
Both Dr. Otsu and Dr. Brooks actually recommend intranasal allergy sprays over oral pills as a first line of defense for nose and eye symptoms (also known as allergic rhinitis and rhinoconjunctivitis). But not all sprays are created equal. Ahead, the experts break down the difference between two common types of nasal spray.
Flonase, Nasacort, Nasonex, and Rhinocort are all common steroid nasal sprays. These medications are applied directly to the inner nasal passageways and work to reduce both inflammation and mucus in order to make breathing easier. Dr. Brooks notes that steroid sprays need to be used consistently—at least a week or two at a time—in order to be effective.