“I've never met anyone who wants to take a pill, but sometimes, like in allergy season, you just have to.”
Sarah A. Taylor-Black, MDYou might be reaching for your medicine cabinet as spring allergy symptoms—like itchy eyes, a runny nose, sneezing and coughing—flare up.
Antihistamines, which block histamines and stop allergy symptoms, are over-the-counter medications you can find in any drug store aisle. Benadryl is one of the most recognized brands, and it became the first FDA-approved prescription antihistamine in 1946.
But as newer antihistamines have become available over the past two decades, first-generation medications like Benadryl are no longer recommended for regular allergy treatment.
That's because second-generation antihistamines—like Zyrtec, Allegra and Claritin—come with fewer side effects. They last longer, too.
“We definitely don't recommend Benadryl for chronic daily use,” says Allergist and Immunologist Sarah A. Taylor-Black, MD, of Dartmouth Hitchcock Medical Center (DHMC). “There are so many good options now, and second-generation antihistamines are less sedating, they last all day and are equally as effective.”
The pros and cons of Benadryl
First-generation antihistamines like Benadryl cross the blood-brain barrier, which is why they cause drowsiness and other side effects. When taken in high doses, Benadryl can also increase your heart rate and cause agitation. Research has suggested that first-generation antihistamines like Benadryl may increase your dementia risk.
But one upside of Benadryl is that it’s fast-acting, which can be helpful in emergencies related to food allergies or bee stings.
“For a one-time treatment for something acuteçlike a child with a nut allergy accidentally eating a nut—I’ll use Benadryl,” Taylor-Black explains. “Something like Zyrtec can take 30 minutes to work, but Benadryl will take effect within 10 to 15 minutes.”
She says that Benadryl can also help treat sleep disruption in children with serious eczema, but it's not a long-term solution.
“If a child can't sleep and they're scratching themselves all night, using Benadryl for a couple of weeks is a situation where the pros probably outweigh the cons,” Taylor-Black says. “But you don't want somebody taking it daily for their entire life.”
The difference between Benadryl and second-generation antihistamines
Benadryl, Claritin, Zyrtec and Allegra all tackle allergy symptoms. But they each have different side effects and start to work at different times.
Effectiveness
- Benadryl (diphenhydramine): Fast-acting, effective for acute allergic reactions.
- Claritin (loratadine): Good for seasonal allergies, slower onset.
- Zyrtec (cetirizine): Stronger than Claritin with a quicker onset.
- Allegra (fexofenadine): Similar to Zyrtec but does not cross the blood-brain barrier.
Sedation and side effects
- Benadryl: High, very sedating. Side effects include drowsiness, dry mouth and dizziness.
- Claritin: Low, usually non-drowsy. Side effects include headache and dry mouth.
- Zyrtec: Low to moderate. Side effects include fatigue and dry mouth.
- Allegra: Very low to none, the least sedating. Side effects can include headache or, in rare cases, nausea.
Duration of action
- Benadryl: 4-6 hours
- Claritin: Up to 24 hours
- Zyrtec: Up to 24 hours
- Allegra: Up to 24 hours
“I think Allegra is probably your best choice because it doesn't cross the blood-brain barrier,” Taylor-Black says. “Claritin is the weakest one and it’s slightly better than a placebo. Yes, it’s better than a placebo, but it’s not like taking Allegra or Zyrtec.”
Other treatments for common allergies
Spring is one of the worst allergy seasons for New Hampshire and Vermont residents as trees produce pollen from early March to late May. Once the leaves are out in May, pollen allergies tend to decline in June. Pollen is a microscopic allergen from flowering trees, weeds and grass, and it’s a common trigger of allergy symptoms.
One way to avoid pollen allergies is to simply reduce your exposure to allergens.
Experts suggest the following:
- Avoid early mornings: Pollen levels are highest immediately after sunrise, so try to stay indoors during the early morning to minimize exposure.
- Rain is a good thing: Rain can wash out pollen from the air. An ideal time to enjoy the outdoors during allergy season is after a rainstorm or heavy downpour when pollen counts are lower.
- Keep your windows closed: Closing your windows and regularly changing air filters in your home will help your home circulate pollen-free air throughout the year.
- Change your clothes: After spending time outside, change your clothes immediately to prevent spreading allergens indoors. More alternatives to antihistamines
If you would like to avoid taking an antihistamine, Taylor-Black suggests some alternatives.
Nasal saline rinses or neti pots can clear mucus and flush out allergens and germs, including pollen, mold, dirt, dust and pet dander.
Allergy eye drops can treat symptoms of eye allergies, like itchiness or dry eye.
Eating local honey is another option, although Taylor-Black says no evidence supports honey's effectiveness in alleviating allergies.
“I’ve had people swear by local honey,” she says. “It’s not going to hurt you, and you’re probably also helping to support a local farmer by buying honey.”
Taylor-Black says if these remedies aren’t giving you the relief you need, don’t fret about taking an antihistamine, especially a second-generation one.
“I think if any of us had the choice, we would rather not take any medication,” Taylor-Black says. “I've never met anyone who wants to take a pill, but sometimes, like in allergy season, you just have to.”
