Corticosteroid nasal (nose) sprays
These types of nasal sprays reduce inflammation (swelling) in the nose and block allergic reactions from developing. They are the most effective medicine type for allergic rhinitis (nose allergy symptoms) because they can reduce all nasal symptoms, including congestion (stuffiness). They can also provide some relief for eye allergy symptoms. Nasal corticosteroids have few side effects such as headache, nose bleeds, or irritation. Many are available over the counter without prescription.^1,2,3

Corticosteroid creams or ointments relieve itchiness and stop the spread of rashes. See your doctor if your rash does not go away after using this cream for a week. These may be available by prescription or over the counter and come in a variety of strengths and formulations.⁴

Oral corticosteroids (OCS) may be prescribed to reduce swelling and stop severe allergic reactions. OCS medicines ^[4] can cause serious side effects and should not be used long term.^2,5

Antihistamines relieve sneezing and itching in the nose and eyes. They also reduce a runny nose and, to a lesser extent, nasal stuffiness. Look for a long-acting, non-drowsy antihistamine. The newer forms do not carry the risk of toxicity (like feeling drowsy) that has been associated with older antihistamines like diphenhydramine.⁶ Certain antihistamines may come as nasal sprays.

• Pregnancy
  Cetirizine (ZYRTEC®) and loratadine (Claritin®) are the antihistamines of choice for use during pregnancy. They have established safety profiles and are effective in treating allergy symptoms during pregnancy.^7,8
• Antihistamine Warning
  Do not use short-acting antihistamines to treat allergies. These include diphenhydramine (Benadryl®), promethazine (Phenergan®), and hydroxyzine (Vistaril®). These are not good choices for allergy symptoms because of their short-term action to manage symptoms and several known negative side effects. The major side effects of these older antihistamines include drowsiness, sedation, dry mouth/eyes, and fatigue. Use of these antihistamines can impair alertness, concentration, multitasking, and memory. In turn, these antihistamines can affect important functions, such as learning and test performance in children, as well as operation of machinery and cars in adults. As these medicines can impair you, they can affect work performance and safety. Side effects may get worse with higher dosing that is used for other conditions such as chronic hives. Diphenhydramine and older generation antihistamines are also associated with an increased risk for dementia with long-term use in older adults.^6,9,10 According to Food and Drug Administration (FDA), newer oral antihistamines are technically not non-drowsy, but most people are able to take these medicines without any drowsiness.

Decongestants help shrink the lining of the nasal passages and relieve nasal stuffiness.

Some allergy medicines combine an antihistamine with a decongestant.

Decongestant Warning

Nasal decongestants should only be used for a short time (usually no more than 3 days). Extended use of decongestant nasal sprays can cause a rebound effect that worsens your congestion. Read the instructions carefully and do not use them for extended amounts of time. Make sure you talk with your doctor about the appropriate use of decongestants, limitations, and potential side effects.¹¹​

Check with your doctor before using decongestants if you have high blood pressure, heart disease, glaucoma, diabetes, thyroid disease, or trouble urinating. They may cause issues if you have any of these conditions and they may interact with other prescription medicines.¹¹

Federal Regulations on Decongestants

The oral form of phenylephrine (PE) is a common active ingredient in many OTC decongestants. In 2024, an expert panel of the FDA reviewed studies which showed oral PE is not effective at relieving nasal congestion in commonly used doses. The FDA is proposing to end use of oral PE. This would remove these products from the U.S. market. The change would not affect the nasal spray forms of PE.¹²

Certain types of combo medicines (such as the ones that contain pseudoephedrine as the decongestant) are available “behind the counter.” Behind-the-counter products are available without a prescription but have limits on purchases due to state and federal laws. Talking with pharmacy staff and showing ID is generally necessary to obtain these types of allergy medicines.¹¹

Cromolyn sodium is a mast cell stabilizer that comes in a nasal spray. It blocks your body from releasing chemicals that cause allergy symptoms, including histamine and leukotrienes. This medicine has few side effects, but you must take it 3 to 6 times a day. For best results, this medicine should be used daily during your allergy season. You can start it up to 1 week before your allergy season begins.¹³

Leukotriene receptor antagonists (or modifiers) block the action of important chemical messengers (other than histamine) that are involved in allergic reactions. These medicines help manage asthma and allergic rhinitis symptoms. They are taken orally (by mouth). How often you take them depends on the specific drug. Discuss the appropriate use of these medicines with your doctor, including the risks and benefits of therapy.¹⁴

BLACK BOX WARNING
Montelukast (brand name SINGULAIR®) has a black box warning because it can cause serious mental health side effects. This is a safety warning from the FDA. This means you need to be aware of a drug’s side effects or important instructions for safe use of the drug. We encourage you to speak with your health care provider before, during, and after the start of any new medicine. If your doctor recommends montelukast, talk with them about possible risks and concerns.

Biologic drugs (or biologics) are complex medicines that are made by using living things, such as animals, plants, or bacteria. Many of these biologics are antibodies, which are proteins that are designed to block specific molecules (tiny particles) in the human body.¹⁵ Allergy and asthma biologics work by targeting cells and molecules involved in the body’s immune system and inflammation process. Unlike most drugs that are made with chemical synthesis, biologics are made with biotechnology and other cutting-edge technologies. They may offer the most effective means to treat conditions that are not well controlled by conventional treatment. Currently, the only allergy and asthma biologic drugs available are administered by injection (shot) or infusion (IV).

• Omalizumab (Xolair® and Omlyclo) is a monoclonal antibody and is indicated in adults and children aged 1 year and older for the reduction of allergic reactions to food allergens, including anaphylaxis (a severe allergic reaction). People prescribed omalizumab should still avoid the food allergen while taking the medicine. Omalizumab should not be used for the emergency treatment of allergic reactions, including anaphylaxis. Omalizumab is also approved as treatment for moderate to severe allergic asthma, chronic rhinosinusitis with nasal polyposis, and chronic spontaneous urticaria (chronic hives).¹⁶

Immunotherapy is a treatment option for some types of allergies. There are different types of immunotherapy:

• Allergy shots involve giving injections of allergens in an increasing dose over time. The person becomes progressively less sensitive to that allergen. Allergy shots can work well for some people with allergies to pollen, pets, dust, mold, bees or other stinging insects, as well as asthma. Allergy shots do not work for allergies to food and should not be used to treat food allergies. While allergy shots are fairly safe, there is a chance for a severe, life-threatening allergic reaction to the injections, so they must always be given in an allergist’s office under observation from a medical professional.^17,18
  
• Sublingual immunotherapy (SLIT) is another way to treat certain allergies without injections. Allergists give patients small doses of an allergen under the tongue. This exposure improves tolerance to the substance and reduces symptoms. SLIT is fairly safe and effective for the treatment of nasal allergies and asthma. SLIT tablets are currently available for dust mites (Odactra), grass (Grastek and Oralair), and ragweed (Ragwitek). Talk to your allergist if you want to learn more about SLIT.¹⁹
• Oral immunotherapy (OIT) is a food allergy treatment that retrains your immune system to respond differently to food. It is not a cure for food allergies. The goal of OIT is to reduce the changes of allergic reactions.  OIT should only be done with the guidance and supervision of an allergist. For more information: kidswithfoodallergies.org/oit ^[5]

Epinephrine comes in a self-injectable device or a nasal spray. It is the most important medicine to give during a serious allergic reaction known as anaphylaxis. To work properly, you must give epinephrine within minutes of the first signs of serious allergic reaction to food, stinging insects, latex, and drugs/medicines.²⁰ For more information:

• Food Allergy Emergency Care Plan (under age 3) from the Asthma and Allergy Foundation of America – English ^[6], Spanish ^[7] 
• Food Allergy Emergency Care Plan (age 3 and over) from the Asthma and Allergy Foundation of America – English ^[8], Spanish ^[9] 

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2. Dykewicz, M. S., Wallace, D. V., Amrol, D. J., Baroody, F. M., Bernstein, J. A., Craig, T. J., Dinakar, C., Ellis, A. K., Finegold, I., Golden, D. B. K., Greenhawt, M. J., Hagan, J. B., Horner, C. C., Khan, D. A., Lang, D. M., Larenas-Linnemann, D. E. S., Lieberman, J. A., Meltzer, E. O., Oppenheimer, J. J., … Wang, J. (2020). Rhinitis 2020: A practice parameter update. Journal of Allergy and Clinical Immunology, 146(4), 721-767. https://doi.org/10.1016/j.jaci.2020.07.007 ^[15]
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4. Gabros, S., Nessel, T. A., & Zito P. M. (2025, April 26). Topical Corticosteroids. In StatPearls. StatPearls Publishing. Retrieved February 17, 2026, from: https://www.ncbi.nlm.nih.gov/books/NBK532940/ ^[17]
5. Hodgens, A. & Sharman, T. (2023, May 1). Corticosteroids. In StatPearls. StatPearls Publishing. Retrieved February 17, 2026, from: https://www.ncbi.nlm.nih.gov/books/NBK554612/ ^[18]
6. Farzam, K., Sabir, S., & O’Rourke MC. (2025, December 13). Antihistamines. In StatPearls. StatPearls Publishing. Retrieved February 17, 2026, from: https://www.ncbi.nlm.nih.gov/books/NBK538188/ ^[19]
7. Naqvi, A., Patel, P., & Gerriets, V. (2024, May 6). Cetirizine. In StatPearls. StatPearls Publishing. Retrieved February 17, 2026, from: https://www.ncbi.nlm.nih.gov/books/NBK549776/ ^[20]
8. Patel, P. & Akhondi H. (2025, December 13). Loratadine. In StatPearls. StatPearls Publishing. Retrieved February 17, 2026, from: https://www.ncbi.nlm.nih.gov/books/NBK542278/ ^[21]
9. Sicari, V., Patel, P., & Zabbo, C. P. (2025, March 27). Diphenhydramine. In StatPearls. StatPearls Publishing. Retrieved February 17, 2026, from: https://www.ncbi.nlm.nih.gov/books/NBK526010/ ^[22]
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11. Cleveland Clinic. (2023, April 20). Nasal Decongestant. My Cleveland Clinic. Retrieved February 17, 2026, from: https://my.clevelandclinic.org/health/drugs/24923-nasal-decongestant ^[24]
12. U.S. Food and Drug Administration. (2024, November 7). Key Information about Nonprescription, Over-the-Counter (OTC), Oral Phenylephrine. Retrieved February 17, 2026, from: https://www.fda.gov/drugs/understanding-over-counter-medicines/key-information-about-nonprescription-over-counter-otc-oral-phenylephrine ^[25]
13. Minutello, K. & Gupta V. (2024, October 28). Cromolyn Sodium. In StatPearls. StatPearls Publishing. Retrieved February 17, 2026, from: https://www.ncbi.nlm.nih.gov/books/NBK557473/ ^[26]
14. Choi, J. & Azmat, C. E. (2023, June 4). Leukotriene Receptor Antagonists. In StatPearls. StatPearls Publishing. Retrieved February 17, 2026, from: https://www.ncbi.nlm.nih.gov/books/NBK554445/ ^[27]
15. U.S. Food and Drug Administration. (2018, February 6). What Are “Biologics” Questions and Answers. Retrieved February 17, 2026, from: https://www.fda.gov/about-fda/center-biologics-evaluation-and-research-cber/what-are-biologics-questions-and-answers ^[28]
16. Genentech (2024). Xolair. Prescribing Information. http://www.gene.com/download/pdf/xolair_prescribing.pdf ^[29]
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