Antihistamines vs Decongestants
written by
Veronica Max, APRN, FNP-C
reviewed by
Bailey, APRN, FNP-BC
What do I take for head congestion? An antihistamine or decongestant?
TLDR: For true cold symptoms (associated with fever, bodyaches, or general malaise), you’re more likely to get relief from a decongestant like Sudafed. However, if your “cold” symptoms occur at the same time each year and/or are associated with sneezing, red/itchy/watery eyes; you most likely have allergies that could benefit from an antihistamine medication (i.e. Claritin, Zyrtec, Allegra, etc).
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You didn’t sleep great last night. You kept clearing your throat. And this morning, your throat is scratchy.
You don’t feel rested like you normally do.
The day goes on and you start feeling like a bag of bricks.
Runny nose? Check.
Sinus pressure? Check.
Sore throat? Check.
Head congestion? Check.
Fever, bodyaches, chills? Check. Check. Check.
You don’t have time to be sick. You’ve got a work deadline approaching and the kids aren’t going to feed themselves. Do you need an antihistamine? A decongestant? Both?
Head congestion can accompany both viral colds and allergies; which often makes it difficult to parse out the source of your problem and decide what to do.
If you have an UltraPersonal Healthcare membership, the decision making is easy. You simply text us and one of your providers, who is familiar with you, your unique history and preferences, will reply back with education and guidance on what to do.
Don’t have an UltraPersonal Healthcare membership? Keep reading to learn more about decongestants, antihistamines, and other strategies to address the head congestion that often accompanies allergies and viral colds.
If you don’t have UltraPersonal Healthcare in your back pocket like our members do, I’ve got good news for you - whether you’re suffering with a cold, allergies, the flu or even COVID; treatment is generally aimed at managing symptoms and supporting the immune system.
Before we continue any further; I must disclose that I believe your body is infinitely wise - much wiser even than the Petter Attia’s or Andrew Huberman’s of the world. What I’ve learned in more than a decade of treating patients is that your body will communicate to you what it needs. All you need to do is LISTEN.
Laying the foundation for recovery
Rest
When you’re sick and feeling tired; the number one thing you can do is REST. And yes, gym lovers - this does include taking a break from strenuous exercise!
Extra sleep helps your immune system function at its best and can shorten the duration of your illness.
Don’t have time to rest? Either find time now or your body will force you to rest later. And that means you’ll be sick longer. The choice is yours.
Rest is the best “medicine”.
Get Sunlight
Morning sunlight (sunrise to approximately 10am) and evening light (before sunset) is full of red/infrared light and is especially healing, but any time of day will do. Get outside without sunglasses, glasses or contacts and as few clothes as you can get away with. Pay attention not to burn. That’s not the point of this exercise. Read more about how sunlight enhances the immune system.
Hydrate and Humidify
Drink water, warm tea (SporTea anyone?!), and/or bone broth to increase your fluids. Aim for at least 100 ounces of fluids daily WITH electrolytes. Some of our favorite electrolytes include Quinton Isotonic, LMNT, and ReLyte.
If you’re feeling congested in your head or chest, spend some time in a warm, steamy bathroom. Close the door and let the shower run hot.
If the air in your home is dry, you find it difficult to breathe through your nose or you just can’t stop coughing, run a humidifier or vaporizer in the room where you’re resting. You can find our favorite CarePod One humidifier (and get $25 off) here. It is both plastic-free and easy-to-clean!
Now that we’ve covered the basics, let’s talk about some strategies for kicking your head congestion.
Strategies for treating head congestion
Sinus Irrigation
It will come as no surprise to our patients that our No. 1 strategy for head congestion isn’t a medication at all — it’s a shower for your sinuses.
This is known as sinus irrigation. It helps by directly washing out pollen and other contaminants.
You can find sinus irrigation kits at your local pharmacy or online. You’ll find many different designs, but they typically look like a small teapot or a squeeze bottle.
Sinus irrigation is best done after a hot, steamy shower.
Make sure to use distilled water (trust me when I say you don’t want an amoeba in your brain!), and include sea salt. If the mucus is really thick, consider the addition of a biofilm disruptor like xylitol (ie XLear Packets).
Breathe Right Nasal Strips
Skip this step if you care more about looking sexy than being able to breathe out of your nose.
However, if you’d like a good night of sleep aided by a patent nasal passageway, pick up a box of Breathe Right Nasal Strips.
Nasal strips are a type of nasal dilator – a device used to open the nostrils or nasal passages to improve airflow through the nose.
Applied to the outside of the nose, nasal strips work by pulling the nostrils and sides of the nose open. This can help ease breathing through your nose and may even reduce snoring. For you mouthbreathers out there, this can be a gamechanger for your sleep quality and overall health. Also moonlights as birth control 😉 (please do not take this literally).
Steroid Nasal Spray
Nasal steroids are powerful tools to open the nasal passages, calm local inflammation, and stem the tide of postnasal drip.
While many people use steroid nasal spray everyday to keep seasonal allergies at bay, it’s also a great option to treat congestion from colds and sinus infections. It calms inflammation in your nasal passages and makes it easier to clear mucus.
These medications have low systemic absorption, meaning you don’t have to worry about the side effects typically associated with oral steroids. Better yet, there are several options that no longer require a prescription (i.e. Flonase and Nasocort).
Decongestants
If none of the above have helped to relieve your congestion and your head or sinuses feel like they are about to explode, it’s time to consider a decongestant.
Decongestants are available over the counter, but don’t waste your time on the decongestants in the cold and flu aisle (Phenylephrine/Sudafed PE); go directly to the pharmacy counter and flash your ID for this one (Pseudophedrine/Sudafed).
They work to constrict or narrow the blood vessels in the nose, thereby reducing swelling and congestion; and result in the small miracle of being able to breathe out of your nose!
Because of this mechanism of action, decongestants can cause problems for people with heart disease, high blood pressure, glaucoma, diabetes, or an overactive thyroid. Decongestants may also interact with some drugs, such as certain antidepressants and high blood pressure medicines. Read the package carefully or ask your pharmacist or healthcare provider to help you choose the best decongestant for you.
Antihistamines
If you lack fever and general malaise, if you have symptoms of itchy/water eyes or sneezing, and/or if you always develop these symptoms at the same time each year; it is likely that you may be suffering from seasonal allergies as opposed to a cold virus. In this situation, you might find relief with an oral antihistamine.
This class of drugs works by blocking a chemical called histamine, which is released by the body in response to allergens (ie. pollen, pet dander, smoke, etc).
Antihistamines include Benadryl, but because of sedating side-effects, second generation antihistmaines like Zyrtec, Xyzal, Allegra, Claritin are typically preferred. Keep in mind, it typically takes about 2 weeks to reach maximum therapeutic benefit.
For those of you who tend to lean a bit more “crunchy”, there are also natural options available!
D-Hist by Orthomolecular is a favorite amongst our patients, and comes in a “Junior” (pediatric) formulation tool. It contains quercetin, bromelain, stinging nettles and NAC.
Lymphatic Self-Massage
Your lymphatic system plays a crucial role in your immune health. Lymphatic massage (or lymphatic drainage massage) is a tool to help keep the lymphatic system healthy and moving, which can assist in decreasing congestion and pressure, as well as swollen lymph nodes.
If you’re new to lymphatic massage, check out our friend, Austin, TX clinic neighbor and lymph expert and educational champion - Leah Levitan of @lymphloveclub.
On her instagram page, you’ll find short videos on how the lymphatic system works and the best technique for nose and ear lymphatic self-massage.
When to call the doctor:
It’s time to call your healthcare provider if:
Your symptoms get worse or won’t go away.
You have a high fever:
100.4 degrees Fahrenheit or higher for an infant,
or 102 degrees or higher in children or adults
or if your fever lasts for more than three days.
You are vomiting, wheezing or have periods with shortness of breath or chest discomfort.
You develop a painful earache or have drainage from your ear.
You have pain in your face or forehead with thick yellow or green mucus for more than a week.
We are available for your primary care needs in Austin & Dripping Springs, Texas.
Call or text at: 512-489-9813
Ready to have a highly qualified healthcare provider on speed dial, that you can call or text just like a personal friend?
Veronica Max, Founder & Primary Care Practitioner with a patient.