Antihistamines are the most commonly used medications for hay fever. In the Netherlands, three non-sedating (non-drowsy) antihistamines are available without prescription: cetirizine, loratadine and fexofenadine. All three are effective, but they differ in side effects, efficacy profile and practical applicability.

How do antihistamines work?

In hay fever, the immune system produces histamine in response to pollen. Histamine causes sneezing, runny nose, itchy eyes and swelling. Antihistamines block the histamine receptors (H1) and thus prevent histamine from exerting its effect. They reduce symptoms but do not address the allergy itself.

The three antihistamines compared

Cetirizine (Zyrtec, Reactine)

Onset: within 1 hour, lasts 24 hours.
Strength: the most potent of the three.
Drowsiness: slightly higher chance (5--10%), take it in the evening.
Dosage: 10 mg, once daily.
Food: no interaction.

Loratadine (Claritine, Allerfre)

Onset: within 1--3 hours, lasts 24 hours.
Strength: good for mild to moderate symptoms.
Drowsiness: very low risk.
Dosage: 10 mg, once daily.
Food: no interaction.

Fexofenadine (Telfast, Allegra)

Onset: within 1--3 hours, lasts 24 hours.
Strength: good for moderate to severe symptoms.
Drowsiness: lowest risk, comparable to placebo.
Dosage: 120--180 mg, once daily.
Food: caution -- fruit juice reduces absorption by up to 40%.

Fexofenadine and fruit juice: take fexofenadine with water, not with grapefruit, orange or apple juice. These juices can reduce absorption by up to 40%, making the medication less effective.

Which one should you choose?

Mild symptoms, first time

Start with loratadine. Widely available, affordable, virtually no side effects. A good first choice.

Stronger symptoms

Try cetirizine. Slightly more potent than loratadine, but a slightly higher chance of mild drowsiness.

Drowsiness unacceptable

Choose fexofenadine. Best choice for drivers or professionals, but avoid fruit juice when taking it.

One medication not working?

Try another. Effectiveness varies from person to person. Just because loratadine does not work does not mean cetirizine will not work either.

Practical tips

  • Start early: begin daily use 1--2 weeks before the expected start of the pollen season.
  • Take it daily: not only on days with symptoms. Regular use provides better protection.
  • Combine with nasal spray: for severe nasal symptoms, a nasal corticosteroid (budesonide, fluticasone) is more effective than an antihistamine alone.
  • Eye drops: for itchy eyes, you can add anti-allergic eye drops (cromoglicate or azelastine).

Are antihistamines safe?

All three medications have been on the market for decades and are considered safe for normal use. They are available without prescription at pharmacies and drugstores. If in doubt (pregnancy, breastfeeding, use of other medications), always consult your doctor or pharmacist.

For children, cetirizine and loratadine are suitable from age 2 -- read more in our article on hay fever in children.