Counsel Patients About Self-Care Measures, OTC Treatments for Seasonal Allergies

Although many individuals look forward to warmer temperatures as spring approaches, many individuals also dread this time of year because of 1 or more of the bothersome symptoms often associated with seasonal allergies, also known as hay fever or allergic rhinitis (AR). These symptoms can include rhinorrhea, watery and itchy eyes, repetitive sneezing, postnasal drip, coughing, headaches, and sinus pressure.¹

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Seasonal allergies are most commonly triggered by plant pollen, mold, grass, and ragweed.¹ Although there are triggers for both spring and fall allergies, pollen from plants and grass are common in spring and peak in the evening, while allergic reactions to mold and ragweed are common in fall and peak in the morning.² Some individuals experience allergy symptoms year-round.

According to the CDC, more than 50 million individuals in the US experience seasonal allergies annually and seasonal allergies are the sixth most common cause of chronic illness in the country.³ Additionally, according to the CDC’s National Health Interview Survey, an estimated 25.7% of adults and 18.9% of children experience seasonal allergies, while 6.2% and 5.8% of adults and children, respectively, experience food-related allergies.⁴ Data also reveal that women are more prone to seasonal allergies compared with men, at 29.9% and 21.1%, respectively.² Additionally, seasonal allergies account for more than 4.1 million visits annually to physicians’ offices for evaluation and treatment.⁴

The severity of allergy season varies each year, and the type and degree of symptoms vary from person to person. In years with warmer winter temperatures, some individuals begin to experience seasonal allergy symptoms before the official spring season begins. Various studies have demonstrated that the symptoms associated with seasonal allergies can have a negative impact on patient productivity and overall health-related quality of life and often cause absenteeism from work and school, concentration difficulties, and disruptions in sleep patterns if not adequately treated.¹

In a press release from the American College of Allergy, Asthma and Immunology (ACAAI), Gailen Marshall, MD, PhD, president of the ACAAI, stated: “Spring allergens such as pollen, mold spores, and other airborne particles not only trigger nasal allergies but also can have a profound effect on a variety of allergic conditions including asthma and eczema. Understanding how all the allergic responses are interconnected is crucial for effectively managing and improving the overall quality of life for people who are affected.”⁵

Marshall noted that seasonal allergies could also trigger seasonal allergic conjunctivitis, which is the most common type of ocular allergy and causes very bothersome symptoms, including itching, erythema, burning, and clear watery discharge.⁵

Another recent study published in Otolaryngology–Head and Neck Surgery revealed that patients with chronic rhinosinusitis (CRS) are often misdiagnosed as having AR. The study involved 219 individuals believed to have nasal allergies, and each patient underwent a nasal endoscopy and testing to measure the severity and type of their sinus/nasal symptoms. Results revealed that although 91.5% did have some environmental allergy, 45.2% also tested positive for CRS. The authors noted that CRS and AR have significant clinical overlap, which often results in 1 condition being mistaken for the other or leading to not considering the concurrent incidence of the 2. The authors also noted that the treatments for CRS and AR are very different, and not confirming a diagnosis can delay effective therapy.⁶

In general, treatment may entail 1 or more of the following measures: allergen avoidance when feasible, use of allergy medications when no contraindications are present, and immunotherapy.¹ The therapy goals should be patient centered but, in general, include the reduction of symptoms, which in turn will improve patient productivity and overall well-being. When devising a treatment plan, patient education about allergy triggers, avoidance measures when applicable, nonpharmacological measures, and shared decisionmaking when selecting an appropriate therapy are integral to effective management.

Numerous nonprescription products, including intranasal corticosteroids; mast cell stabilizers; ocular antihistamines; oral antihistamines; nasal antihistamine spray; and oral, ocular, and nasal decongestants, are marketed to relieve allergy symptoms. There are also saline nasal sprays to ease nasal congestion. Some individuals may experience postnasal drip, which can cause them to cough. Using humidifiers, aromatherapy with essential oils, nonmedicated nasal strips, steam inhalation, and vaporizers may be beneficial in alleviating some seasonal allergy symptoms. Allergy experts indicate that when no contraindications are present, intranasal steroids are an optimal choice for patients with persistent allergy symptoms.¹ Second-generation antihistamines are also a popular treatment used by consumers.

There are several single-entity and multipleingredient products available in numerous dosage forms, including immediate- and sustained-release formulations, tablets, capsules, oral-disintegrating and chewable tablets, flavored liquids, nasal sprays, and ophthalmic drops to meet the needs and preferences of both adult and pediatric patient populations. Factors to consider when selecting an appropriate allergy treatment include the patient’s medical and medication history, dosing intervals, route of administration, potential adverse effects, and costs. Many patients also prefer to use long-acting medications with once-daily or twice-daily dosing, which lessen the need to take medications continually throughout the day.

Role of the Pharmacist

Pharmacists can be instrumental in ascertaining the appropriateness of self-treatment by screening for potential contraindications and drug-drug interactions, especially in patients with other medical conditions and those taking other medications. Due to their expertise, pharmacists can identify causes of nasal congestion not related to allergies, including medications (eg, aspirin or nonsteroidal anti-inflammatory drugs, ß-blockers, angiotensinconverting enzyme inhibitors, or overuse of topical decongestants) or other causes (eg, hormonal changes during pregnancy, thyroid disorders, nasal polyps, or use of continuous positive airway pressure therapy for the treatment of sleep apnea).¹

Pharmacists can guide patients in selecting available OTC allergy medications and encourage patients to seek further medical evaluation and therapy when necessary. Patients should be advised of the proper use, recommended dosage, duration of use, and potential adverse effects. During counseling, pharmacists can recommend nonpharmacological measures such as staying inside during peak pollen times; using air purifiers with high-efficiency particulate air filters; routine dusting and vacuuming of furniture, floors, carpets, and drapes to reduce dust mites; and using allergy covers for pillows and mattresses if needed.

References

1. Scolaro K. Colds and allergy. In: Krinsky DL, Ferreri SP, Hemstreet BA, Hume AL, Rollins CJ, Tietze KJ, eds. Handbook of Nonprescription Drugs: An Interactive Approach to Self-Care. 20th ed. American Pharmacists Association; 2021.

2. Tong R, Fang C. Do seasonal allergies cause rash? What patients need to know. Pulmonary Advisor. February 2, 2024. Accessed February 28, 2024. https://www.pulmonologyadvisor.com/home/topics/allergies/seasonal-allergy-rash/

3. Highly allergic travelers. CDC. Reviewed May 1, 2023. Accessed February 14, 2024. https://wwwnc.cdc.gov/travel/yellowbook/2024/additional-considerations/highly-allergic-travelers

4. National Health Interview Survey. CDC. Reviewed February 29, 2023. Accessed February 28, 2024. https://www.cdc.gov/nchs/nhis/index.htm

5. Spring allergies attack more than just your nose. American College of Allergy, Asthma, and Immunology. February 15, 2024. Accessed February 28, 2024. https://acaai.org/news/spring-allergies-attackmore-than-just-your-nose/

6. Houssein FA, Phillips KM, Sedaghat AR. When it’s not allergic rhinitis: clinical signs to raise a patient’s suspicion for chronic rhinosinusitis. Otolaryngol Head Neck Surg. Published online January 31, 2024. doi:10.1002/ohn.646