• Allergies

Decongestant vs. Antihistamine: Which is Better?

Medically reviewed and edited by Payel Gupta, MD, FACAAI

Published: November 04, 2021
Updated: March 14, 2025
4 mins

There isn’t necessarily a single allergy symptom that feels worse than the other. With that said, we think there’s a mutual agreement that nasal congestion is the most frustrating of them all.

Sinus pressure can feel uncomfortable and claustrophobic. Not to mention, it can affect your ability to taste food properly. Now that’s a problem.

When you’ve used up the entire box of tissues trying to unplug your clogged nostrils, it’s time to go for the heavy hitters. But should you use decongestants or antihistamines for the best effect? Let’s find out.

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What Causes Congestion?

Sometimes, it feels like you’re about to pop a blood vessel from how much you’re blowing your nose, yet nothing seems to be coming out. Your nose feels clogged, and it’s tough to breathe properly. This is nasal congestion or sinusitis.

Nasal congestion is caused by anything that inflames or irritates that nasal passageway. Colds and the flu are common causes, though allergic rhinitis (allergies) are another potential factor influencing your nostril health.

What are Antihistamines?

Most things that cause allergies, like pollen or pet dander, are actually entirely harmless. But for some people, the immune system falsely believes that these things are foreign invaders entering your airways to hurt you. To get them out, your body produces histamines, which are chemicals that cause many of the symptoms of allergies, like congestion.

Antihistamines are medications that inhibit the production of histamines from lessening the severity of your allergy symptoms. They can be taken orally as a pill, or they can come in the form of nasal sprays.

Nasal spray antihistamines are the most commonly used to address nasal congestion, as they can shrink the blood vessels and tissues in the sinuses to relieve stuffy noses and postnasal drip.

What are Decongestants?

Decongestants are medications that are purely meant to help with sinus congestion. They work by eliminating some of the fluid in the lining of your nose.

You can take decongestants in an oral pill form, but there are also nasal sprays available as well. Some decongestants are even in the form of inhalable vapors that can help to clear your sinuses.

Which Works Best to Decongest?

Antihistamines and decongestants both have their pros and cons. If you’re looking to get rid of nasal congestion, a decongestant may work a little better and may be a bit stronger than a typical antihistamine. The thing is, taking a decongestant too often can make your symptoms harder to treat.

While decongestants can temporarily decrease congestion, they also create a slight increase in blood pressure. Not to mention, using non-prescription nasal decongestants for three days or more can cause even worse congestion than you had prior.

In general, we recommend antihistamines as opposed to decongestants for a few reasons. For one, they can help with more symptoms than just congestion. Since they inhibit the production of histamines rather than just the fluid in your nose, they can help alleviate coughing, sore throat, itchy eyes, and other frustrating allergy symptoms.

Additionally, nasal spray antihistamines are extremely effective at reducing the stuffiness in your nostrils, and there’s no harm in using them often.

It’s Not a Phase

There are some other ways to address sinus congestion without the need for antihistamines or decongestants. Here are some home remedies that can help mute your mucus effectively.

Humidifiers

Adding humidity to the air can be exactly what your clogged nose needs to feel free. Moisture can help to thin mucus in your nose. Cool mist humidifiers are effective and safe; however, make sure you keep them clean to avoid mold and bacteria growth, making your sinuses feel even worse. However, make sure to keep humidity levels below 50%, mold likes humidity too!

Nasal irrigation

One of the best lines of defense against impending nasal doom is physically getting in there and flushing everything out.

Using a nasal saline rinse, like a neti pot is a great solution to get relief from even the most inundating sinus pressure.

Steamy showers

One of the more simple ways to help get your nose running is by taking a hot (but not too hot) shower. The steam works similarly to a humidifier, moisturizing the inside of the nose to help break up mucus and help flush it all out.

How LifeMD Can Help

Nasal congestion is one of the more uncomfortable allergy symptoms of them all, but there are options for addressing it. Antihistamines can help by inhibiting the production of symptom-causing chemicals, and decongestants work by reducing the amount of fluid in the nose.

While they’ll both help, antihistamines may be a bit better because they can address multiple symptoms rather than just one. Additionally, prolonged use of decongestants can do more harm than good, so you might as well stick with the safer choice.

With LifeMD, you can speak with a licensed healthcare provider to help you determine which medication option is best for your symptoms.

Book an appointment today to get started.

Payel Gupta, MD, FACAAI

Dr. Gupta holds certifications from the American Board of Allergy and Immunology, American Board of Internal Medicine, and American Board of Pediatrics. With a deep interest in global health, she’s volunteered her clinical skills across many continents.

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