Seasonal Allergies in Canada: Antihistamine Tablets vs Nasal Sprays
Short answer: for sneezing, a runny nose and itchy, watery eyes, a non-drowsy (second-generation) antihistamine tablet such as cetirizine, loratadine or desloratadine is a simple, as-needed option. For a blocked nose that keeps coming back all season, a steroid nasal spray such as fluticasone generally does more, but it works best when used every day, and its full effect builds over several days. Saline sprays add no medicine; they moisten the nose and help clear mucus and can be used alongside either. Older, drowsy antihistamines such as diphenhydramine are no longer the first choice: the Canadian Society of Allergy and Clinical Immunology (CSACI) recommends the newer ones first.
Tablets vs nasal sprays at a glance
| Option | Examples (medicinal ingredient) | Best for | Onset and use | Main drawbacks |
|---|---|---|---|---|
| Non-drowsy antihistamine tablet | cetirizine, loratadine, desloratadine | Sneezing, runny or itchy nose, itchy watery eyes, hives | Once a day; can be taken as needed or daily through the season | Less effect on a blocked nose; some people still feel drowsy |
| Drowsy (first-generation) antihistamine | diphenhydramine | Not a first choice for allergies | Follow the label directions exactly | Drowsiness, slower thinking, dry mouth; no driving or alcohol |
| Steroid nasal spray | fluticasone propionate | Ongoing congestion plus sneezing and runny nose through the season | Once a day; some relief from day one, full effect after several days of regular use | Nose dryness, stinging or nosebleeds; must be used regularly |
| Saline spray or rinse | salt water, no medicine | Dryness, thick mucus, rinsing after time outdoors | Any time, as often as needed | Does not treat the allergic reaction itself |
Non-drowsy vs drowsy antihistamines
Antihistamines block histamine, the chemical your body releases when it reacts to pollen, dust mites, pet dander or mould. Older (first-generation) antihistamines such as diphenhydramine cause drowsiness and can affect alertness and thinking, so you shouldn't drive or drink alcohol while taking them. In its 2019 position statement, the CSACI concluded that newer (second-generation) antihistamines are safer and should be the first-line antihistamines for allergic rhinitis (hay fever) and hives.
"Non-drowsy" is not a guarantee. The Reactine page notes that cetirizine is less sedating than older antihistamines but some people still feel drowsy, and the Aerius page says the same for desloratadine. See how a new antihistamine affects you before you drive.
Steroid nasal sprays: why they work differently
Instead of blocking histamine, a corticosteroid nasal spray calms the inflammation inside the nose, which is why it can help a stuffy nose as well as sneezing and a runny nose. Canada's 2024 focused allergic rhinitis practice parameter notes that guidelines generally favour intranasal corticosteroids as first-line treatment, while a second-generation antihistamine tablet is also a reasonable first choice depending on your symptoms and preference. The catch is timing: the Flonase page says relief can start on day one but the full effect builds over several days of regular use, so it suits a whole season better than a bad afternoon.
Don't confuse steroid sprays with medicated decongestant sprays such as xylometazoline (Otrivin). Decongestant sprays open a blocked nose quickly but are for short-term use only; follow the day limit on the label.
Saline sprays and rinses
Saline is salt water with no medicine in it. It moisturizes dry, irritated nasal passages and thins mucus so the sinuses can drain, and because it contains no decongestant it won't cause rebound congestion. Many people use it after time outdoors in pollen season or in dry winter air. If you use a rinse bottle rather than a ready-made spray, follow its directions for the water to use.
Examples in stock at Healthy Hub
- Reactine Extra Strength: cetirizine hydrochloride 10 mg per tablet; for adults and children 12 and older, once a day.
- Aerius 5 mg, 10 tablets: desloratadine 5 mg; adults and teens 12 and older, one tablet per 24 hours.
- Claritin Rapid Dissolve 24HR: loratadine 10 mg that dissolves on the tongue, no water needed; adults and children 6 and older; contains aspartame.
- Flonase Allergy Relief, 60 sprays: fluticasone propionate 50 mcg per spray; for adults 18 and older in Canada.
- Salinex Nasal Spray for Adults: non-medicated saline mist, about 300 sprays per 30 mL bottle.
Always follow the dose and age range on the package. Browse the full range in our Allergy collection and Sinus & Nasal collection.
A note about children
Children's allergy medicines come as liquids, syrups and chewables, each labelled for specific ages; pick by the age range on the package and use the dosing device that comes with it. Health Canada advises that over-the-counter cough and cold medicines, including those containing antihistamines such as diphenhydramine or chlorpheniramine, should not be given to children under 6, and that children should never be given products labelled only for adults. For a child younger than the youngest age on the label, ask a doctor or pharmacist first. Saline drops and sprays made for babies and children are a medicine-free option for a stuffy nose.
When to see a doctor or pharmacist
- Get emergency help (call 911) for swelling of the lips, tongue or throat, or trouble breathing.
- Wheezing, coughing or chest tightness with your allergies, or if you have asthma.
- No improvement after about a week of a steroid spray (the Flonase label says to stop and see a doctor if there's no improvement in 7 days), or symptoms that disrupt sleep, work or school.
- Sinus symptoms lasting more than 10 days, or with a fever or facial swelling.
- If you are pregnant or breastfeeding, have glaucoma, an enlarged prostate, liver or kidney disease, or take other medicines: ask a pharmacist before choosing.
An allergist can test for your triggers and discuss options such as allergy shots if over-the-counter products are not enough.
Related guides: Cold & Flu Medicine in Canada: Decongestant, Expectorant or Cough Suppressant? · Children's Fever and Pain in Canada: Acetaminophen vs Ibuprofen · How to Check an NPN or DIN on Health Canada's Database
Sources
- Canadian Society of Allergy and Clinical Immunology. CSACI position statement: Newer generation H1-antihistamines are safer than first-generation H1-antihistamines and should be the first-line antihistamines for the treatment of allergic rhinitis and urticaria. Allergy Asthma Clin Immunol. 2019. Full text.
- Focused allergic rhinitis practice parameter for Canada. Allergy Asthma Clin Immunol. 2024. Full text.
- Health Canada. Health Canada reminds parents not to give cough and cold medication to children under 6 years old.
- Health Canada. Health Canada releases decision on the labelling of cough and cold products for children (archived; lists the antihistamines covered).
- Product details: the Canadian product pages linked above (Reactine, Aerius, Claritin, Flonase, Salinex).
This guide is general information, not medical advice. Ask your pharmacist or doctor about your own situation.