Is there a best allergy medicine for seniors? Safe medications 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.

In this article, GoodRx, a platform for medication savings, explains which allergy medications are considered safer for older adults and which ones to avoid

Key takeaways:

• Preferred allergy medications for older adults are corticosteroid (steroid) nasal sprays, such as Flonase Allergy Relief (fluticasone propionate), and antihistamine nasal sprays, such as Astepro (azelastine). Nondrowsy oral antihistamines, such as Claritin (loratadine), are also safe options.
• NasalCrom (cromolyn) nasal spray and antihistamine eye drops, such as Zaditor (ketotifen), are also safe for older adults. But they may be less effective for managing allergies.
• Older adults should avoid antihistamines that cause drowsiness, such as Benadryl (diphenhydramine), and oral decongestants, such as Sudafed (pseudoephedrine). These come with a risk of serious side effects, such as a higher risk of falls or high blood pressure.
• There are ways to save on your allergy medications. Many options are available as lower-cost generics.

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 over-the-counter (OTC) allergy treatment options.

1. Steroid nasal sprays

Corticosteroid (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 two weeks to see their full effects. So if you know when your allergies tend to start, you should begin using a steroid nasal spray about two weeks before to help prevent symptoms.

OTC steroid nasal sprays include:

• Flonase Allergy Relief
• Flonase Sensimist — a finer, gentler spray than regular Flonase Allergy Relief
• Nasonex 24HR Allergy
• Nasacort Allergy 24HR
• Rhinocort Allergy — brand name no longer available

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.

Good to know: Astepro can cause drowsiness for some people who use it. Make sure you use it when you don’t have to drive or perform tasks that require attention until you know how it makes you feel.

3. Nondrowsy or less-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 one to three 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 for chronic symptoms.

Nondrowsy or less-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 this article details later on, oral decongestants aren’t considered a safe allergy medicine for older adults.

Good to know: Even though these are labeled as nondrowsy 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 may take up to six weeks to be fully effective. 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 (comes in three different doses)
• 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 three 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 three days in a row. After that, there’s a risk of rebound congestion, which is 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 that you take by mouth, 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 in many forms, including nasal sprays, rinses, or drops. Any type of nasal saline can be helpful. And since it doesn’t contain medication, you can use it 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.

Frequently asked questions

Can Allegra cause diarrhea?

Allegra shouldn’t cause diarrhea. This isn’t a listed side effect for the medication. But it’s possible that you may be sensitive to one of the inactive ingredients in the product.

If you experience diarrhea after taking Allegra, try switching the dosage form you’re taking, such as switching from tablets to capsules. Or try changing to a different manufacturer, such as switching from brand-name Allegra to generic fexofenadine. Different products may contain different inactive ingredients. And you may tolerate one better than others.

Can Claritin cause nosebleeds?

People taking Claritin have experienced nosebleeds. But this doesn’t mean that the medication definitely caused it. Nasal congestion due to allergies is a common cause of nosebleeds. There are also other medications that are more likely to cause this side effect, such as steroid nasal sprays.

Using a saline nasal spray or gel can help keep the nasal passages moist. This can help limit or prevent nosebleeds. If you’re experiencing frequent nosebleeds or they last for longer than 10 minutes, contact a healthcare professional. This isn’t typical, and you should be evaluated.

Why do allergies get worse as you get older?

If your allergies seem to be worse now than when you were younger, you’re not alone. Many people develop new or worse allergies as they get older. This happens because of how your immune system changes with age. Some immune functions, such as responding to vaccinations, decrease over time. But others, such as reacting to allergens, can increase.

The bottom line

Corticosteroid (steroid) nasal sprays, such as Flonase Allergy Relief (fluticasone propionate), are some of the best allergy medicines for older adults. Astepro (azelastine) nasal spray and nondrowsy oral antihistamines, such as Allegra (fexofenadine), are also first-choice options. All of these allergy medications are safe for older adults.

NasalCrom (cromolyn) and antihistamine eye drops, such as Zatidor (ketotifen), are also safe but may be less effective. Older adults should avoid older antihistamines, such as Benadryl (diphenhydramine), and oral decongestants, such as Sudafed (pseudoephedrine). They have a greater risk of more serious side effects.

This story was produced by GoodRx and reviewed and distributed by Stacker.