Second-generation antihistamines are sometimes referred to collectively as nonsedating antihistamines. However, cetirizine (Zyrtec, generic) and the nasal spray antihistamines (Astelin, Patanase) can cause drowsiness when taken at recommended doses. Loratidine (Claritin, generic) and desloratadine (Clarinex) can cause drowsiness when taken at doses exceeding the recommended dose.

Brand Names. Second-generation antihistamines in pill form include:

• Loratadine (Claritin, generic). Loratadine is available over-the-counter and is approved for children ages 2 and older. Loratine-D (Claritin-D) combines the antihistamine with the decongestant pseudoephedrine. Desloratadine (Clarinex) is similar to Claritin but stronger and longer-lasting. It is available only by prescription.
• Cetirizine (Zyrtec, generic). Cetirizine is approved for both indoor and outdoor allergies. It is the only antihistamine to date approved for infants as young as 6 months. It is available over-the-counter. Cetirizine-D (Zyrtec-D) is a pill that combines the antihistamine with the decongestant pseudoephedrine.
• Fexofenadine (Allegra, generic) is also available over-the-counter.
• Levocetirizine (Xyzal) is a prescription medication approved to treat seasonal allergic rhinitis in patients age 2 years and older. It is available in both pill and liquid form.
• Acrivastine and pseudoephedrine (Semprex-D) is a pill that combines an antihistamine and decongestant.

Second-generation antihistamines in nasal form are as good as or better than the oral forms for treatment of seasonal allergic rhinitis. However, they can cause drowsiness, and are not as effective for allergic rhinitis as nasal corticosteroids. Nasal spray antihistamines are available by prescription and include:

• Azelastine (Astelin, Astepro)
• Oloptadine (Patanase)

Side Effects and Precautions.

• Common side effects include headache, dry mouth, and dry nose. (These are often only temporary and go away during treatment.)
• Drowsiness occurs in about 10% of adults and in 2 - 4% of children. The nasal spray forms of second-generation antihistamines cause more drowsiness than the pill forms.
• Extended-release forms of loratadine and cetirizine have other ingredients that can cause other symptoms, including nervousness, restlessness, and insomnia.

Nasal Corticosteroids

Corticosteroids help reduce the inflammatory response associated with allergic reactions. Nasal-spray corticosteroids (commonly called steroids) are considered the most effective drugs for controlling the symptoms of moderate-to-severe allergic rhinitis. They are often used either alone or in combination with second-generation oral antihistamines. The benefits of nasal spray steroids include:

• Reducing inflammation and mucus production
• Improving night sleep and daytime alertness in patients with chronic allergic rhinitis
• Treating polyps in the nasal passages

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Review Date: 05/03/2011
Reviewed By: Harvey Simon, MD, Associate Professor of Medicine, Harvard Medical School; Physician, Massachusetts General Hospital. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.

A.D.A.M., Inc. is accredited by URAC, also known as the American Accreditation HealthCare Commission (www.urac.org)