Is There a Best Allergy Medicine for Seniors and Which Ones to Avoid

There are some medications that older adults should avoid due to their risk of side effects. This includes some of the most well-known allergy medications. But that doesn’t mean you have to avoid all allergy medications if you’re over the age of 65. There are plenty of treatment options that are still safe and effective for older adults with seasonal allergies.

What different types of allergy medications are available?

Before choosing an allergy treatment, it helps to know what your options are. Here’s a quick overview of the main types of allergy medications that are available over-the-counter (OTC).

Antihistamines 

Antihistamines are available as eye drops, nasal sprays, and oral formulations, such as pills or liquids. Antihistamines block histamine, a chemical your body releases during an allergic response. It’s what’s responsible for pesky allergy symptoms, such as sneezing, coughing, and itching eyes.

But when it comes to oral antihistamine medications, it’s important to know that there are three types (called generations): first-, second- and third-generation. First-generation antihistamines are older and tend to cause drowsiness. You’ll often find them included in nighttime cold medications. Second- and third-generation antihistamines are newer and often labeled as “non-drowsy.”

Steroid nasal sprays

When used for allergies, corticosteroids (steroids) help calm your body’s response to allergens. They’re also powerful tools to treat a stuffy nose. You can find OTC steroids for allergies sold as nasal sprays.

Decongestants

Decongestants tighten blood vessels to treat swelling in the nasal passages. And when used as eye drops, they help reduce redness. All types of decongestants are typically meant for short-term use only. You can find them OTC as nasal sprays, eye drops, or as oral formulations, such as pills and liquids.

Mast cell stabilizers 

Mast cell stabilizers also affect histamine. But they work further upstream than antihistamines. They help stabilize certain immune cells (called mast calls) to prevent your body from releasing histamine. Most mast cell stabilizers are available by prescription only. But a nasal spray is available OTC.

6 of the best allergy medicines for seniors

There isn’t just one best allergy medicine for older adults. You have a choice between lots of safe, effective options. Let’s take a look at safe allergy treatment options.

Steroid nasal sprays

• Flonase (fluticasone propionate)
• Flonase Senismist (fluticasone furoate)
• Nasonex (mometasone)
• Nasacort (triamcinolone)
• Rhinocort (budesonide)

Antihistamine nasal spray

• Astepro (azelastine)

Oral antihistamines (second- and third-generation) 

• Allegra (fexofenadine)
• Claritin (loratadine)
• Xyzal (levocetirizine)
• Zyrtec (cetirizine)

Mast cell stabilizer 

• Nasalcrom (cromolyn) nasal spray

Antihistamine eye drops 

• Alaway (ketotifen 0.025%)
• Extra Strength Pataday Once Daily Relief (olopatadine 0.7%)
• Pataday Once Daily Relief (olopatadine 0.2%)
• 8Pataday Twice A Day Relief (olopatadine 0.1%)
• Zaditor (ketotifen 0.025%)

Decongestant nasal sprays

• Afrin (oxymetazoline)
• Neo-Synephrine (phenylephrine)
• Sinex (oxymetazoline)

1. Steroid nasal sprays

Steroid nasal sprays are a first-choice option for treating allergies and are safe for older adults. They’re the most effective option for treating multiple allergy symptoms, including eye symptoms. But you’ll need to use them daily, and it may take up to 2 weeks to see their full effect. So if you know when your allergies tend to start, you should begin using a steroid nasal spray about 2 weeks before to help prevent symptoms.

Steroid nasal sprays include:

• Flonase Allergy Relief
• Flonase Senismist — a finer, gentler spray than regular Flonase Allergy Relief
• Nasonex
• Nasacort
• Rhinocort

2. Astepro nasal spray

Astepro (azelastine) is the only antihistamine nasal spray available OTC, and it can be a first-choice option for treating allergies. It works fast — within 15 to 30 minutes — and is safe for older adults. It treats multiple allergy symptoms and may work better than oral antihistamines, especially for treating congestion.

It’s unclear how Astepro compares to steroid nasal sprays. Some studies show they’re similarly effective, while others suggest Astepro works better.

3. Non-drowsy oral antihistamines

Newer, second- and third-generation antihistamines are also first-choice options for treating allergies. They’re generally considered safe for most older adults. They start working about 1 to 3 hours after you take them and last for about 24 hours. They treat multiple allergy symptoms but may be less effective than the nasal sprays listed above.

Non-drowsy antihistamine pills and liquids include:

• Allegra
• Claritin
• Xyzal
• Zyrtec

Just be sure to avoid any products that have a “-D” after their name, such as Allegra-D (fexofenadine / pseudoephedrine). These contain an oral decongestant. And as we’ll detail later on, oral decongestants aren’t considered a safe allergy medicine for older adults.

Good to know: Even though these are labeled as non-drowsy antihistamines, they can still cause mild sleepiness for some people. This is especially true for Zyrtec, which is more likely than the others to cause drowsiness. Consider trying Allegra first, as it’s the least likely of all antihistamines to make you sleepy.

4. Nasalcrom nasal spray

Nasalcrom nasal spray is a safe choice for older adults when it comes to preventing and treating allergy symptoms. But it’s less effective than other options and takes up to 4 weeks to start working. It’s recommended to start it at least a month before you expect allergy symptoms to start. It may be an option if you can’t tolerate the medications discussed above.

5. Antihistamine eye drops

Sometimes allergy symptoms only affect the eyes (called allergic conjunctivitis). If you’re just treating red, itchy eyes, consider trying an antihistamine eye drop. These drops are also sometimes labeled as “antihistamine / mast cell stabilizer” eye drops since they work like both antihistamine and mast cell stabilizer medications.

Examples of antihistamine eye drop brands include:

• Alaway
• Pataday
• Zaditor

When choosing an allergy eye drop, look out for combination products. These often include a decongestant. Decongestant eye drops only treat red-looking eyes, not allergy symptoms. And they should only be used for up to 3 days in a row. Using them longer than this can cause redness to be worse when you stop using them (“rebound redness”).

6. Decongestant nasal sprays

Short-term use of decongestant nasal sprays is generally considered safe for most older adults. But they only treat congestion, not other types of allergy symptoms. They work very fast (within 10 minutes). But you should only use them for up to 3 days in a row. After that, there’s a risk of rebound congestion (worsening congestion when you stop using them).

Consider saving decongestant nasal sprays for just when you have severe congestion. You can find them OTC under many brand and generic names. A few popular examples are:

• Afrin
• Neo-Synephrine
• Sinex

Good to know: There’s conflicting information on whether decongestant nasal sprays raise blood pressure. To be safe, ask a healthcare professional before using one if you’ve been diagnosed with high blood pressure or other heart problems.

Which allergy medications aren’t recommended for older adults?

Steer clear of older, first-generation antihistamines, such as Benadryl (diphenhydramine). These older antihistamines don’t work any better than newer ones. And they come with more drug interactions and side effects, such as dizziness and a higher risk of falls.

Older adults should also avoid oral decongestants, such as Sudafed (pseudoephedrine). Decongestant pills and liquids aren’t recommended for older adults because they can raise heart rate and blood pressure. They can also be risky if you have certain health conditions, such as thyroid problems, glaucoma, or an enlarged prostate.

Can you treat allergies without medication?

Yes, there are some medication-free options for managing allergies. If possible, avoid or limit your exposure to allergens. Strategies for this might include more frequent vacuuming, using air purifiers, or keeping the windows of your house closed to keep pollen out.

Nasal saline can also help soothe nasal passages and clear mucus. You can find it OTC it in many forms including nasal sprays, rinses, or drops. Any type of nasal saline can be helpful. And since it doesn’t contain medication, it can be used as often as needed. Just be sure to use distilled water if you’re using a saline rinse (neti pot). Using tap water can lead to infections.

For eye allergies, consider using artificial tears. These don’t contain medication and can be used to rinse out allergens and soothe irritated eyes. Other tips for eye allergies include wearing sunglasses or a wide-brimmed hat when outdoors to prevent allergens from getting into your eyes.