What Can Be Prescribed for Seasonal Allergies?

October 14, 2025 •

5 min read

Approximately 81 million people in the U.S. experience allergy symptoms annually, and for those with severe symptoms unresponsive to non-prescription remedies, knowing what can be prescribed for seasonal allergies is crucial for finding relief. A healthcare provider can offer a personalized treatment plan that moves beyond common over-the-counter options, addressing persistent and severe allergic rhinitis.

Quick Summary

This guide details various prescription-strength options for seasonal allergies, including advanced oral and nasal antihistamines, combination nasal sprays, leukotriene modifiers, and long-term immunotherapy treatments to desensitize the immune system.

Key Points

Advanced Antihistamines: Prescription-strength oral antihistamines like Clarinex and older sedating options like Vistaril may be used when OTC alternatives fail.
Leukotriene Modifiers: Montelukast (Singulair) can be prescribed for allergic rhinitis and asthma, but due to potential neuropsychiatric side effects, it is not a first-line treatment.
Combination Nasal Sprays: Combination products like Dymista (azelastine/fluticasone) and Ryaltris (olopatadine/mometasone) offer enhanced efficacy by combining an antihistamine and a steroid.
Immunotherapy Options: Long-term solutions like allergy shots and sublingual tablets (for specific allergens) work by desensitizing the immune system and can provide lasting relief.
Targeted Eye Drops: For severe eye allergy symptoms, doctors can prescribe more potent antihistamine, steroid, or NSAID eye drops.
Specialist Consultation: Seeing an allergy specialist is recommended for chronic or severe symptoms that do not respond to initial treatments.

Seasonal allergies, also known as allergic rhinitis or hay fever, can cause a range of debilitating symptoms, from incessant sneezing and nasal congestion to itchy eyes and throat. While many people find relief with over-the-counter (OTC) medications, those with more persistent, severe, or complex cases may require a doctor's prescription for more targeted treatment. When OTC options are not enough, a healthcare provider can evaluate your symptoms and recommend a more potent medication or a long-term solution like immunotherapy.

Prescription Oral Medications

For systemic relief, a doctor may prescribe oral medications that act on the body's allergic response. These treatments go beyond the standard OTC formulas to provide stronger or more specific action.

Advanced Oral Antihistamines

While many second-generation antihistamines like cetirizine (Zyrtec) and loratadine (Claritin) are available over the counter, some require a prescription for stronger or unique formulations.

Desloratadine (Clarinex): This third-generation antihistamine is similar to loratadine but can be more effective for some individuals and requires a prescription.
Hydroxyzine (Vistaril): This is an older, first-generation antihistamine that is more sedating than modern versions. It is effective but often reserved for bedtime use due to drowsiness.

Leukotriene Modifiers

This class of medication works differently from antihistamines by blocking leukotrienes, inflammatory chemicals released by the body during an allergic reaction.

Montelukast (Singulair): Prescribed as a daily oral tablet, montelukast is approved for managing allergic rhinitis and can also help with allergic asthma. It is not a first-line treatment and is often considered after nasal steroids have been tried. There are rare but serious mental health side effects to be aware of.

Oral Corticosteroids

For very severe, short-term allergic reactions, a doctor may prescribe a short course of oral corticosteroids to reduce inflammation throughout the body. Due to potential side effects like cataracts and osteoporosis, these are not a long-term solution. Examples include prednisone and methylprednisolone.

Prescription Nasal Sprays

For many with seasonal allergies, localized treatment with a nasal spray is the most effective approach. Prescription nasal sprays can be more potent than their OTC counterparts.

Intranasal Steroids

While some nasal steroids have moved to OTC status, certain formulations or dosages still require a prescription. These are highly effective for reducing nasal inflammation.

Qnasl (beclomethasone): This is a prescription-only nasal steroid.
Xhance (fluticasone propionate): A higher-dose fluticasone formulation designed specifically for chronic sinusitis, which may be associated with allergies.

Prescription Antihistamine Sprays

These sprays provide rapid, targeted relief directly to the nasal passages.

Azelastine (Astelin, Astepro): Azelastine is a prescription-strength antihistamine nasal spray that provides fast relief for sneezing, itching, and runny nose.
Olopatadine (Patanase): This nasal spray is also a powerful antihistamine for nasal symptoms.

Combination Sprays

For patients with a mix of symptoms, combination sprays offer the benefits of two different drug classes in one product, often yielding greater efficacy than either medication alone.

Dymista (azelastine/fluticasone): Combines an antihistamine and a steroid for comprehensive relief.
Ryaltris (olopatadine/mometasone): Another combination product that offers potent antihistamine and steroid action.

Prescription Eye Drops

For the intense itching and watering associated with seasonal allergies, prescription eye drops can offer targeted relief.

Antihistamine and Mast Cell Stabilizer Drops

These drops block histamine or prevent the release of inflammatory chemicals from mast cells, offering quick relief for itchy eyes.

Azelastine (Optivar): Prescription-strength antihistamine eye drops for allergic conjunctivitis.
Epinastine (Elestat): An antihistamine eye drop that can prevent itchy eyes.

Corticosteroid and NSAID Drops

These are reserved for more severe ocular inflammation and require close monitoring by an eye doctor due to potential side effects.

Alrex (loteprednol etabonate): A steroid eye drop used for short-term, temporary relief of severe seasonal eye allergies.
Ketorolac (Acular): A nonsteroidal anti-inflammatory drug (NSAID) eye drop.

Allergy Immunotherapy

For those seeking a long-term solution that addresses the root cause of their allergies, immunotherapy is an option. It involves gradually desensitizing the immune system to specific allergens.

Allergy Shots (Subcutaneous Immunotherapy)

Allergy shots are a long-term treatment that can significantly reduce or even eliminate allergy symptoms.

Process: The treatment consists of two phases: a build-up phase with weekly or bi-weekly shots, followed by a maintenance phase with monthly injections for 3 to 5 years.
Benefits: Can decrease immune sensitivity to allergens and is the most effective form of immunotherapy.

Sublingual Immunotherapy (SLIT) Tablets

For certain allergies, tablets placed under the tongue offer an alternative to injections. They are taken daily at home after the first dose is administered under medical supervision.

Availability: Specific tablets are available for certain allergens, such as grass (Grastek, Oralair) and ragweed (Ragwitek).
Convenience: Offers a convenient way to build tolerance for those with busy schedules or a fear of needles.

Prescription vs. OTC Allergy Medication Comparison


Feature	Prescription Options	Over-the-Counter (OTC) Options
Potency & Efficacy	Generally higher potency and can be more effective for severe, persistent symptoms, especially combination nasal sprays and oral corticosteroids.	Effective for mild to moderate symptoms. Many strong options like nasal steroids (Flonase) are now OTC.
Relief Speed	Varies. Some, like antihistamine sprays, are fast-acting, while oral leukotriene modifiers take days to weeks.	Varies. Oral antihistamines act in 1-2 hours, while nasal steroids can take days to achieve full effect.
Treatment Duration	Can be for short-term use (oral steroids), daily long-term use (oral medications, some sprays), or multi-year treatment (immunotherapy).	Most oral antihistamines and nasal steroids are safe for daily, long-term use during allergy season. Decongestant sprays should be short-term only.
Side Effects	May include drowsiness (older antihistamines), headache, or in rare cases, neuropsychiatric effects (montelukast). Long-term oral steroids have significant risks.	Generally milder side effects, with older antihistamines causing more drowsiness. Some people report drowsiness with cetirizine.
Suitability	Best for severe or chronic allergies unresponsive to OTC treatments, or for those with complex needs like allergic asthma.	Best for mild to moderate allergies, or as a first step in treatment.

Conclusion

For individuals with seasonal allergies that aren't adequately controlled by OTC products, a variety of prescription-strength options exist. From more potent oral and nasal antihistamines to combination sprays and leukotriene modifiers, healthcare providers can offer more advanced pharmacological treatments. For those seeking a long-term fix, immunotherapy, through either shots or sublingual tablets, provides a way to retrain the immune system and potentially achieve lasting relief. Consulting with a doctor or an allergist is the best way to determine the most effective and personalized course of action for your specific allergy needs. The optimal treatment will depend on the severity and specific nature of your symptoms.

Learn more about finding the right allergy treatment plan for you from the American College of Allergy, Asthma, and Immunology (ACAAI).

Note: The content provided is for informational purposes only and does not constitute medical advice. Always consult with a qualified healthcare provider for diagnosis and treatment.

Frequently Asked Questions

If your seasonal allergy symptoms are persistent, severe, or not adequately controlled by over-the-counter medications, you should consult a doctor. This is especially true if your allergies significantly impact your quality of life, sleep, or daily activities.

Not necessarily better in all cases, but prescription options often offer stronger or more specialized treatment for severe, persistent, or complex allergy symptoms. For example, combination nasal sprays can be more effective than individual OTC sprays.

Immunotherapy is a long-term treatment that involves gradually exposing the body to small amounts of an allergen to build up tolerance. It is suitable for people who have severe allergy symptoms that are not well-managed by other medications and who want a potentially lasting solution.

Side effects vary depending on the medication type. Older antihistamines can cause drowsiness and dry mouth. Leukotriene modifiers carry a risk of neuropsychiatric side effects. Oral steroids have more significant side effects, especially with long-term use, such as cataracts and osteoporosis.

You may start to notice benefits within the build-up phase, but it can take 6 to 12 months to see significant results. The full course of treatment, including the maintenance phase, typically lasts 3 to 5 years.

Yes, many prescription allergy medications are safe for children. The appropriate medication, dosage, and age suitability must be determined by a pediatrician or allergist. Some evidence suggests that allergy shots may prevent children from developing new allergies or asthma.

If cost is an issue, you can talk to your doctor or pharmacist about lower-cost generic alternatives, patient assistance programs, or discount cards. Many prescription allergy medications are now also available as lower-cost generics.