In the elderly, H1-antihistamine therapy is commonly prescribed for treatment of rhinitis, conjunctivitis, pruritus, eczema, urticaria, and for prophylaxis of anaphylactoid reactions. Second-generation H1-receptor antagonists provide excellent, safe, and effective alternatives to first-generation antihistamines in this population, as in younger patients. As with all medications, the choice of which agent to use must be tailored to the needs of the individual. Treatment should be planned with consideration of concomitant medications and potential drug-drug interactions and drug-disease interactions. First-generation antihistamines should not be used for treatment of allergic rhinitis or urticaria in the elderly. Age-related physiological changes can enhance or complicate the actions of H1-receptor antagonists, especially when these drugs are taken concurrently with other medications and/or in the presence of comorbid disease. Adjustments in dosages are necessary when some agents are used in patients with renal and/or hepatic disease; however, overall, the use of the newer nonsedating antihistamines is safe, effective, and gratifying in the elderly.