The best medicine for severe allergies depends on your specific symptoms, but experts currently recommend intranasal steroids as the first-choice treatment for people with persistent symptoms. For life-threatening reactions, epinephrine (like EpiPen) is the only medicine that can save your life.
Dealing with severe allergies can feel overwhelming. Your eyes water, your nose runs, and you can’t seem to catch a break. The good news is that there are many effective treatments available today. This guide will help you understand your options and find the right medicine for your severe allergy symptoms.
Understanding Severe Allergies
Severe allergies affect millions of people every day. According to the CDC’s National Health Interview Survey, in 2021, 31.8% of adults had a seasonal allergy, eczema, or food allergy, making allergies one of the most common health conditions in America.
When you have severe allergies, your immune system overreacts to harmless substances like pollen, dust, or certain foods. This reaction releases chemicals like histamine, which cause the symptoms that make you miserable.
Signs Your Allergies Are Severe
You might have severe allergies if you experience:
- Trouble breathing or wheezing
- Swelling of face, lips, or throat
- Severe skin reactions or hives
- Nausea, vomiting, or diarrhea
- Dizziness or fainting
- Symptoms that don’t improve with regular allergy medicines
Up to 20% of patients with allergies live with a severe debilitating form of their condition, and struggle daily with the fear of a possible asthma attack, anaphylactic shock, or even death from an allergic reaction, according to Allergy UK research.
Top Prescription Medicines for Severe Allergies
When over-the-counter medicines aren’t enough, your doctor might prescribe stronger treatments.
Nasal Corticosteroids (Steroid Sprays)
These are often the first medicine doctors recommend for severe nasal allergies. According to the Mayo Clinic, nasal corticosteroids are very effective on their own for treating ongoing or seasonal hay fever. A review of multiple studies suggests Nasonex may be the most effective for seasonal allergies. The same review found Rhinocort to be the most effective for year-round allergies.
Popular prescription nasal steroids include:
- Nasonex (mometasone)
- Veramyst (fluticasone furoate)
- Beconase (beclomethasone)
- Omnaris (ciclesonide)
These medicines work by reducing inflammation in your nasal passages. They can take 1-2 weeks to reach full effectiveness, so patience is key.
Prescription Antihistamines
For severe symptoms, your doctor might prescribe stronger antihistamines:
- Clarinex (desloratadine) – A newer version of Claritin that may work better for some people
- Xyzal (levocetirizine) – Often effective for people who don’t respond well to other antihistamines
- Astelin (azelastine) – A nasal spray antihistamine that works quickly
Corticosteroid Pills
For the most severe allergy flare-ups, doctors sometimes prescribe oral steroids like prednisone or prednisolone. Oral corticosteroids are used to treat severe symptoms caused by all types of allergic reactions. These are powerful medicines that can have serious side effects, so they’re only used for short periods.
Leukotriene Inhibitors
Singulair (montelukast) is a prescription pill that blocks chemicals called leukotrienes. This oral medicine relieves asthma and hay fever and is available by prescription only. It’s especially helpful for people who have both allergies and asthma.
Best Over-the-Counter Medicines
Many effective allergy medicines are available without a prescription. Here’s what works best for severe symptoms:
Second-Generation Antihistamines
These are usually the first choice because they work well without making you drowsy:
- Zyrtec (cetirizine) – Works fast and lasts 24 hours
- Claritin (loratadine) – Good for daily prevention
- Allegra (fexofenadine) – Least likely to cause drowsiness
- Xyzal (levocetirizine) – Available over-the-counter and very effective
Zyrtec tends to start working slightly faster, but has a higher chance of causing drowsiness, than Claritin or Allegra.
Over-the-Counter Nasal Steroids
These powerful sprays are now available without a prescription:
- Flonase (fluticasone) – Very effective for nasal congestion
- Rhinocort (budesonide) – Good for year-round allergies
- Nasacort (triamcinolone) – Works well for seasonal allergies
Some studies imply that steroid nasal sprays may also help with eye symptoms even when used in the nose.
Combination Medicines
For severe symptoms involving congestion, you might need a combination medicine:
- Zyrtec-D – Contains cetirizine plus pseudoephedrine decongestant
- Claritin-D – Combines loratadine with pseudoephedrine
- Allegra-D – Pairs fexofenadine with pseudoephedrine
Important note: Decongestants shouldn’t be taken long term and can raise blood pressure.
Specialized Treatments for Severe Allergies
When regular medicines aren’t enough, there are specialized treatments available.
Immunotherapy (Allergy Shots)
Immunotherapy (allergy shots) helps reduce hay fever symptoms in about 85% of people with allergic rhinitis. This treatment involves getting regular injections of small amounts of your allergens to build up tolerance over time.
Allergy shots work best for:
- Seasonal allergies (pollen)
- Dust mite allergies
- Pet allergies
- Insect sting allergies
The treatment usually takes 3-5 years but can provide long-lasting relief even after stopping.
Sublingual Immunotherapy (Under-the-Tongue Tablets)
The FDA has approved several under-the-tongue immunotherapy tablets that can be taken at home. The prescription tablets, called Grastek, Oralair, and Ragwitek, treat hay fever and work the same way as shots.
These tablets are convenient because you can take them at home, but they still require a doctor’s prescription and monitoring.
Biological Medicines
For severe asthma and allergies, newer biological medicines are available:
- Dupixent (dupilumab) – Treats severe asthma and eczema
- Xolair (omalizumab) – Helps with severe asthma and chronic hives
- Nucala (mepolizumab) – For severe asthma with eosinophils
These are expensive medicines given by injection, usually reserved for the most severe cases.
Emergency Medicine for Life-Threatening Allergies
Epinephrine Auto-Injectors
For severe allergic reactions (anaphylaxis), epinephrine is the only medicine that can save your life. Epinephrine shots are used to treat a sudden, life-threatening allergic reaction.
Common brands include:
- EpiPen and EpiPen Jr.
- Auvi-Q
- Adrenaclick
Rapid treatment with epinephrine (adrenaline) within minutes of the onset of anaphylaxis symptoms is necessary and crucial to successfully treating an anaphylactic reaction.
If you have severe food allergies, insect sting allergies, or have had anaphylaxis before, your doctor will prescribe an epinephrine auto-injector. Always carry two with you and know how to use them.
Choosing the Right Medicine for Your Severe Allergies
Finding the best medicine for your severe allergies often takes some trial and error. Here’s how to approach it:
Start with Your Symptoms
For nasal congestion and runny nose: Try a nasal steroid spray first For itchy, watery eyes: Consider antihistamine eye drops For multiple symptoms: Start with a daily antihistamine For severe seasonal symptoms: Begin treatment 2 weeks before allergy season
Consider Your Lifestyle
If you drive a lot: Choose non-drowsy antihistamines like Allegra If you have high blood pressure: Avoid decongestants If you’re pregnant: Talk to your doctor about safe options If you have asthma: You might need specialized treatments
Work with Your Healthcare Provider
Work with your care team to choose the safest and most effective allergy medicine for you. Your doctor or pharmacist can help you:
- Identify your specific triggers
- Choose the right combination of medicines
- Adjust doses as needed
- Monitor for side effects
When to See a Doctor About Severe Allergies
You should see a healthcare provider if you have:
- Symptoms that don’t improve with over-the-counter medicines
- Trouble breathing or wheezing
- Frequent sinus infections
- Allergies that interfere with sleep or daily activities
- Symptoms that last more than 10 days
- Any signs of anaphylaxis
On average, the Asthma and Allergy Foundation of America reports that anaphylaxis (a severe allergic reaction) results in 45,000-50,000 emergency room visits in the United States each year.
Managing Severe Allergies Beyond Medicine
While medicine is important, you can also take steps to reduce your exposure to allergens:
For Seasonal Allergies
- Keep windows closed during high pollen days
- Shower after being outside
- Use air purifiers with HEPA filters
- Check daily pollen counts
For Indoor Allergies
- Use dust mite covers on bedding
- Wash sheets in hot water weekly
- Keep humidity below 50%
- Remove carpeting if possible
For Food Allergies
- Read all food labels carefully
- Carry emergency medicines at all times
- Have an action plan
- Educate family and friends
Finding Affordable Allergy Medicines
Many effective allergy medicines are available as generics, which cost less than brand names. Your local pharmacy can help you find the most affordable options.
Money-saving tips:
- Ask about generic versions
- Look for store brands
- Check for manufacturer coupons
- Consider 90-day supplies
- Use pharmacy discount programs
The Role of Compounding for Severe Allergies
For people with severe allergies who can’t tolerate standard medicines, compounding pharmacies can create custom formulations. This might include:
- Preservative-free versions
- Different strengths
- Alternative forms (liquids instead of pills)
- Combinations not available commercially
Custom compounding can be especially helpful for children or people with multiple allergies who react to inactive ingredients in standard medicines.
Final Thoughts
Severe allergies don’t have to control your life. With the right medicine and management plan, you can find relief and enjoy better quality of life. The key is working with your healthcare provider to find the best combination of treatments for your specific situation.
Remember that the “best” medicine for severe allergies is the one that works for you with the fewest side effects. This might take some trial and error, but don’t give up. Many people with severe allergies find excellent relief with the right treatment plan.
If you’re struggling with severe allergy symptoms, talk to your pharmacist about your options. They can provide personalized advice and help you find the most effective and affordable treatments for your needs.
Whether you need prescription medications, over-the-counter treatments, or specialized compounding, there are many options available to help you manage your severe allergies effectively.