The most commonly used nasal allergy and sneezing pills are oral antihistamines, and the newer second-generation types are usually preferred because they cause much less drowsiness; they ease sneezing, a runny nose and an itchy nose and eyes well. A blocked nose, however, usually responds better to a steroid nasal spray than to pills, and a doctor may add leukotriene receptor antagonist tablets or a decongestant in specific cases. The right type, and how it is used, should be chosen by a doctor or pharmacist based on age, pregnancy, long-term conditions and other medicines.
When do you need emergency help before thinking about any pill?
Nasal allergy on its own is rarely an emergency, but some symptoms that can come with it point to an asthma attack, a severe allergic reaction (anaphylaxis) or a serious infection. Call an ambulance or go to the nearest emergency department immediately, without waiting for any medicine to work, if any of the following appears:
- Difficulty breathing or shortness of breath, wheezing, or chest tightness or chest pain.
- Swelling of the lips, tongue, throat or face, difficulty swallowing or speaking, or a suddenly hoarse voice.
- Dizziness, fainting or feeling about to faint, pale or blue-tinged skin or lips, a child who becomes floppy or unresponsive, repeated vomiting or severe abdominal pain, especially if it comes on suddenly after a food, a medicine or an insect sting, whether or not there is a widespread rash or intense itching.
- Swelling, redness or pain around the eye, vision that becomes blurred, reduced or double, a severe or sudden headache, a stiff neck, or confusion, whether or not there is a fever.
- A heavy nosebleed that will not stop, or clear watery fluid dripping from one nostril after a head injury.
See a doctor soon, though not as an emergency, if symptoms continue despite treatment, one side of the nose is blocked most of the time, blood-streaked discharge keeps coming from one side, your sense of smell fades, facial pain and pressure come with thick coloured discharge that does not improve, night-time coughing or snoring becomes troublesome, or symptoms disturb your sleep, school or work.
What nasal allergy is, and why it makes you sneeze
Nasal allergy, or allergic rhinitis, is an exaggerated immune response to substances that are harmless in themselves, such as house dust, dust mites, pollen, cat and dog dander, mould and sometimes cockroach droppings. When these are breathed in, the body releases histamine and other inflammatory substances, which cause bouts of repeated sneezing, a watery runny nose, itching of the nose, the roof of the mouth and the eyes, and a blocked nose. The allergy may be seasonal, flaring when the seasons change and dusty winds blow, or it may last all year when the trigger is inside the home, a difference that affects the choice of treatment.
Types of nasal allergy and sneezing pills, and what each one does
No single pill suits everyone. The choice depends on the most troublesome symptom (sneezing and itching, or blockage), on how severe and how frequent the symptoms are, and on whether there is asthma or another condition. Below are the main drug classes, without brand names, because choosing between them is a medical decision.
Oral antihistamines: the best-known option for sneezing and a runny nose
These medicines block the effect of histamine, the substance largely responsible for sneezing, itching, a watery runny nose and watery eyes. They fall into two groups:
- First generation (older): effective, but they make many people drowsy and slow their concentration, and they can cause a dry mouth, constipation and difficulty passing urine. For that reason they are usually not preferred for older adults or for anyone who drives or operates machinery.
- Second generation (newer): clearly less sedating and longer acting, so they are usually preferred for nasal allergy. Some people still feel mildly sleepy, so it is wise to know how one affects you before driving.
A limitation of this class is that it does less for a blocked nose than for sneezing and a runny nose. Important cautions: do not combine two antihistamines; avoid alcohol and sedatives with the drowsy types; and ask a doctor first in the situations listed later in this article.
Leukotriene receptor antagonist tablets
These tablets block leukotrienes, inflammatory substances other than histamine. A doctor may prescribe them especially when nasal allergy and asthma occur together. For nasal symptoms alone, however, they are usually less effective than steroid nasal sprays, so they are not the first choice for every patient. In some people they can cause changes in mood, sleep or behaviour, such as nightmares, anxiety or depression, and rarely thoughts of self-harm. Contact a doctor straight away if any of these changes appear, and seek emergency medical help at once for thoughts of self-harm.
Oral decongestants and combination "cold and allergy" pills
Decongestants narrow the blood vessels in the lining of the nose and so relieve blockage for a while. They are often found in combination "cold and allergy" tablets together with an antihistamine or a painkiller. They can raise blood pressure, speed up the heart and cause insomnia and restlessness, so they should not be used without a doctor's advice by people with high blood pressure, heart disease, glaucoma, an overactive thyroid or an enlarged prostate, nor by pregnant women or young children, nor alongside some antidepressants. Before taking any combination pill, read the ingredients carefully so the same active substance is not repeated in two different products.
Steroid tablets and the long-acting "allergy injection"
Some people turn to steroid (cortisone) tablets or to the long-acting cortisone injection popularly known as the "allergy injection" to calm symptoms quickly. These medicines act on the whole body, and repeated use can raise blood sugar and blood pressure, cause weight gain, weaken the bones and affect immunity and the eyes. They are therefore not a routine treatment for nasal allergy, and their use is limited to specific situations a doctor decides on after weighing benefit against harm. They are completely different from steroid nasal sprays, which act inside the nose in very small amounts.
Why pills alone may not be enough: sprays and drops
Many patients look for a pill for sneezing, yet medical guidelines indicate that some sprays can work better, especially when blockage is the main symptom or symptoms are present on most days of the week.
- Steroid nasal sprays: among the most effective treatments for moderate and persistent nasal allergy, because they reduce the inflammation itself and so ease blockage, sneezing and a runny nose together. Improvement builds gradually with the regular use a doctor sets. They can cause dryness or minor nosebleeds, which are less likely with the right technique: aim the nozzle towards the outer side of the nose, away from the septum.
- Antihistamine nasal sprays: act quickly on sneezing and itching, and a doctor may combine one with a steroid in a single spray for more severe cases. A bitter taste is a common side effect.
- Mast cell stabiliser sprays: prevent histamine release and work best when used before an expected exposure to the trigger. They are relatively safe but weaker.
- Decongestant nasal sprays: open the nose within minutes, but using them for longer than advised can cause rebound congestion that leaves the nose more blocked and creates dependence on the spray, so use them only for the short period a doctor or pharmacist sets.
- Saline rinses: wash allergens and mucus out of the nose and can be used alongside any other treatment, provided you use a sterile solution or boiled and cooled water and clean the rinsing device well.
- Anti-allergy eye drops: help when itchy, watery or red eyes are troublesome.
How a doctor chooses the right treatment
A doctor usually asks about the nature, timing and triggers of the symptoms and examines the nose, and may request skin-prick allergy tests or a blood test to identify the trigger, or a nasal endoscopy if polyps, a deviated septum or sinusitis are suspected. In general:
- When symptoms are mild and occasional and mostly sneezing, a runny nose and itching, a second-generation antihistamine used as a doctor or pharmacist advises may be enough.
- When symptoms are moderate, persistent or mainly blockage, a steroid nasal spray is usually preferred, sometimes with another treatment added.
- When allergy and asthma occur together, a doctor may consider leukotriene receptor antagonist tablets and manage the asthma and the nose together.
- When symptoms do not improve despite appropriate treatment, the doctor reassesses and may suggest immunotherapy.
These points do not replace a medical assessment, because similar symptoms can come from non-allergic rhinitis, sinusitis, nasal polyps or the side effects of some medicines.
Is it an allergy or a cold?
The two can start in the same way, but some differences help you understand what is going on, without replacing a doctor's opinion. Nasal allergy usually brings itching of the nose and eyes, repeated sneezing and a clear watery discharge, and it returns with exposure to the same trigger, such as dust, animals or certain seasons; it can last for weeks as long as the exposure continues. A cold may come with a mild fever, body aches and a sore throat, and it usually improves within a few days. Antibiotics do not treat nasal allergy or viral colds, and they are used only if a doctor finds a bacterial infection.
Who should talk to a doctor before taking any allergy pill?
- Children: a doctor chooses the type and form that suit the child's age, and combination cold and allergy medicines or older sedating antihistamines should not be given to young children without medical advice.
- Pregnant and breastfeeding women: some antihistamines and nasal sprays have been studied more than others in pregnancy and a doctor chooses the most suitable one; oral decongestants are usually avoided, especially in the early months of pregnancy.
- Older adults: they are more prone to dizziness, confusion, falls and difficulty passing urine with the sedating types.
- People with long-term conditions: such as high blood pressure, heart disease, glaucoma, an enlarged prostate, liver or kidney disease and epilepsy.
- People taking other medicines: especially sedatives, sleeping pills and some antidepressants and heart medicines.
Immunotherapy: a long-term option for some patients
When the trigger has been identified by allergy testing and medicines are not enough to control the symptoms, an allergy specialist may suggest immunotherapy. It is given as injections or as tablets placed under the tongue that contain gradually increasing amounts of the allergen, with the aim of reducing the immune system's response to it over time. Treatment continues for a long period set by the doctor and starts under medical supervision because an allergic reaction is possible; in some patients it can reduce the need for medicines.
Steps that reduce sneezing without medicine
- Cut down house dust and dust mites: wash bedding in hot water regularly, use protective covers on mattresses and pillows, and keep carpets, heavy curtains and stuffed toys in the bedroom to a minimum.
- Keep windows closed on dusty, windy days and in pollen seasons, and shower and change your clothes after coming in from outside.
- Keep pets out of the bedroom if they trigger your allergy.
- Deal with damp and mould in the bathroom and kitchen, and get rid of cockroaches.
- Stay away from cigarette smoke, incense, strong scents and harsh cleaning products; they are irritants that worsen symptoms even when they are not the cause of the allergy.
Does nasal allergy go away with treatment?
For many patients nasal allergy is a long-term condition: symptoms may settle for a while and then return with exposure to the trigger or as the seasons change, and in some people they ease over time. The realistic aim of pills and sprays is to control the symptoms so that the person can live, sleep and work normally, while avoiding triggers and, in suitable cases, immunotherapy may reduce the severity of the allergy over the long term. Treating nasal allergy regularly may also help control asthma in people who have both.
Frequently Asked Questions
What is the treatment for nasal allergy and sneezing?
Treatment of nasal allergy and sneezing rests on avoiding triggers as far as possible, using the right medicines, and immunotherapy in selected cases. The best-known medicines are oral antihistamines, which ease sneezing, a runny nose and itching, and steroid nasal sprays, which are among the most effective treatments when blockage is marked or symptoms are persistent, along with saline rinses. A doctor chooses the right option, and how to use it, based on how severe the symptoms are, the person's age and whether there is asthma or another condition.
Can nasal allergy and sneezing medicine be bought without a prescription?
Some antihistamines and saline rinses are sold in many pharmacies without a prescription, but that does not make them suitable for everyone. It is wise to ask a doctor or pharmacist before first use, and essential for people with long-term conditions or who take other medicines, and for children, pregnant or breastfeeding women and older adults. Steroid tablets and long-acting cortisone injections should be used only when a doctor prescribes them, even once, and decongestant nasal sprays only for the short period a doctor or pharmacist advises.
Do nasal allergy and sneezing pills cause drowsiness?
It depends on the type. First-generation antihistamines make many people drowsy and slow their concentration, while second-generation ones do so much less, although some people still feel mildly sleepy. Know how a medicine affects you before driving or operating machinery, avoid alcohol and sedatives with it, and see a doctor if drowsiness persists or affects work or study.
Is it safe to take allergy pills long term?
A doctor may prescribe some second-generation antihistamines for regular use during the allergy season or when symptoms are persistent, but how long and how they are used is for the doctor to decide. If you find you need pills on most days of the year, or they no longer work well enough, that is a reason to be reassessed: a steroid nasal spray or immunotherapy may suit you better, and the symptoms may have another cause, such as nasal polyps or a deviated septum.
Can a pregnant woman take nasal allergy pills?
A pregnant or breastfeeding woman should not take any allergy pill without asking her doctor. Some antihistamines and nasal sprays have been studied more than others in pregnancy, and the doctor chooses the most suitable one after weighing benefit against harm, while oral decongestants are usually avoided, especially in the early months of pregnancy. A blocked nose is also common in pregnancy even without allergy, and saline rinses and reducing exposure to triggers can help.
Are nasal allergy pills suitable for children?
Some antihistamines come in forms made for children, but the right type and form are chosen by a doctor according to the child's age and condition, and adult medicines should not be given to children. Combination cold and allergy medicines and older sedating antihistamines should not be given to young children without medical advice. A child who snores, breathes through the mouth all the time or has repeated ear infections needs a doctor's assessment.
Is the long-acting cortisone allergy injection safe?
A long-acting cortisone injection acts on the whole body, not just the nose, and repeated injections can raise blood sugar and blood pressure, cause weight gain, weaken the bones and affect immunity and the eyes. It is therefore not a routine treatment for nasal allergy and should be given only when a doctor decides it is needed in a specific situation. In most cases a steroid nasal spray is a safer alternative because it acts inside the nose in very small amounts.
What is the difference between allergy pills and a nasal spray?
Antihistamine pills act throughout the body and help most with sneezing, a runny nose, itching and eye symptoms, but they do little for a blocked nose. Steroid nasal sprays act directly on the inflammation inside the nose and are among the most effective treatments for blockage and persistent symptoms, but they work gradually and need regular use as a doctor directs. A doctor may combine the two in some cases.
Does nasal allergy get better with treatment?
Many patients find their nasal allergy symptoms improve with the right treatment and by avoiding triggers, but for many people it is a long-term condition whose symptoms can return with exposure to the trigger or as the seasons change. The realistic aim is to control the symptoms so that sleep and daily life are normal, and in suitable patients immunotherapy may reduce the severity of the allergy over the long term.
When should I see a doctor about sneezing and nasal allergy?
Call an ambulance or go to the nearest emergency department immediately, without waiting for any medicine to work, if any of the following appears: difficulty breathing or shortness of breath, wheezing, or chest tightness or chest pain; or swelling of the lips, tongue, throat or face, difficulty swallowing or speaking, or a suddenly hoarse voice; or dizziness, fainting or feeling about to faint, pale or blue-tinged skin or lips, a child who becomes floppy or unresponsive, repeated vomiting or severe abdominal pain, especially if it comes on suddenly after a food, a medicine or an insect sting, whether or not there is a widespread rash or intense itching; or swelling, redness or pain around the eye, vision that becomes blurred, reduced or double, a severe or sudden headache, a stiff neck, or confusion, whether or not there is a fever; or a heavy nosebleed that will not stop, or clear watery fluid dripping from one nostril after a head injury. See a doctor soon, though not as an emergency, if symptoms continue despite treatment, one side of the nose is blocked most of the time, blood-streaked discharge keeps coming from one side, your sense of smell fades, facial pain and pressure come with thick coloured discharge that does not improve, night-time coughing or snoring becomes troublesome, or symptoms disturb your sleep, school or work.