Help Patients Choose Appropriate Treatments to Survive Allergy Season

Seasonal allergies, also referred to as allergic rhinitis or hay fever, can occur in the spring, whereas some individuals only experience allergies in the fall. Some individuals experience allergy symptoms throughout the year, known as perennial allergies. Allergy symptoms that transpire in the spring generally begin in February and last until early summer as a result of tree pollination earlier in the year and grass pollination later in the spring and summer, according to the American College of Allergy, Asthma and Immunology (ACAAI).¹

The most common culprit for fall allergies is ragweed, which blooms and releases pollen from August to November, according to the ACAAI.¹ In many areas of the country, ragweed pollen levels are highest in early to mid-September.¹ Pollen from airborne mold spores and various grasses, trees, and weeds also cause seasonal allergies.¹ Perennial allergic rhinitis is commonly triggered by sensitivity to animal dander, cockroaches, house dust mites, and/or mold spores.¹

Symptoms may range from mild to severe, and patients with seasonal allergies may present with 1 or more of the following symptoms: coughing, headache, itchy palate, itchy and watery eyes, nasal congestion, postnasal drip, and repetitive sneezing. Many individuals who have allergies have reported that, left uncontrolled, seasonal allergy symptoms can negatively affect overall quality of life by affecting productivity and contributing to sleep disturbances.

In general, the management of allergies includes the following measures in sequential order: allergy avoidance when practical, use of allergy medications, and immunotherapy.² Nonprescription products marketed for the relief of allergy symptoms include intranasal corticosteroids, mast cell stabilizers, intranasal and oral antihistamines, and oral and topical decongestants. There are several multiple-ingredient and single-entity products available in various dosage forms, including immediate- and sustained-release formulations, tablets, capsules, oral-disintegrating and chewable tablets, and flavored liquids for adults and children.

Pharmacists can help patients select appropriate OTC products to relieve seasonal allergy symptoms. They can also help ascertain whether self-treatment is appropriate and direct patients to seek further medical evaluation and care when warranted. Because of their drug expertise, pharmacists can screen for potential drug-drug interactions and contraindications and make clinical recommendations tailored to patient needs. In addition, pharmacists can be instrumental in recognizing patients who may be experiencing nonallergic rhinitis that has been mistaken for allergic rhinitis by reviewing a patient’s medical and medication history.² Examples of this nonallergic rhinitis may include hormonal changes during pregnancy; nasal polyps; septal deviation; sleep apnea for patients who use continuous positive airway pressure therapy; the use of medications, such as angiotensin-converting enzyme inhibitors, β-blockers, and chlorpromazine; and overuse of aspirin, gabapentin, intranasal decongestants, and nonsteroidal anti-inflammatory drugs.²

Prior to selecting a nonprescription allergy medication, many patients may consider its cost, ease of use, frequency of administration, potential adverse effects (AEs), and route of administration.

The American Pharmacists Association Handbook of Nonprescription Drugs: An Interactive Approach to Self-Care indicates that based on efficacy and safety data, second-generation antihistamines are preferred over first-generation antihistamines.² Many patients also prefer long-acting medications, such as once-daily or twice-daily dosing, for intranasal, ocular, and oral allergy medications.

Recent News and Clinical Data

In a report published in 2022 by the US Department of Agriculture, new results demonstrated that pollen seasons begin 20 days earlier, are 10 days longer, and produce 21% more pollen than in 1990.³ In addition, 25.7% of adults have a seasonal allergy, with rates of 29.9% in women and 21.1% in men, according to findings from a recent CDC report. In 2021, 24.7% of individuals aged 18 to 44 years, 27.9% of individuals aged 45 to 64 years, 26.4% of individuals aged 65 to 74 years, and 21.7% of individuals 75 years or older had a seasonal allergy.⁴ Findings from another recent CDC report showed that specifically 18.9% of children had allergies, with 20% of boys and 17.7% of girls.⁵

The CDC also noted that seasonal allergies are the most diagnosed allergic condition in the United States.⁴ Meanwhile, at the next FDA Nonprescription Drugs Advisory Committee meeting, the committee will deliberate about the efficacy data available for oral phenylephrine as a nasal decongestant and whether nasal and oral decongestants phenylephrine bitartrate and phenylephrine hydrochloride should be reclassified as not “generally recognized as safe and effective” because of deficiency of efficacy data.⁶

Preventative Strategies

Some ways to prevent or reduce allergy symptoms include the following:

• Avoid allergens when feasible by avoiding going outside, keeping windows closed, or wearing masks to filter allergens.
• Check air quality and pollen counts using applications that monitor levels based on geographical location.
• Dust and vacuum with devices containing high-efficiency particulate air filters frequently to eliminate dust mites.
• Lower humidity in the home to reduce mold.
• Use air purifiers and/or allergy filters for cooling and heating units in the home or office when practical.
• Wash bedding in hot water weekly, and use allergy covers for mattresses and pillows.

Conclusion

Pharmacists should advise patients about proper use of medications, dosing, recommended duration, potential AEs, and when to seek further medical care from a primary health care provider if symptoms do not improve or worsen. Encourage patients with severe symptoms or those not responding to nonprescription medication therapy to consider prescription options, such as immunotherapy, intranasal antihistamines, and leukotriene inhibitors. Pharmacists can also provide patients with information about nonpharmacological measures to manage allergy symptoms, including the use of aromatherapy with essential oils, nasal saline solutions, nonmedicated nasal strips marketed to clear nasal congestion, and steam inhalation therapy.

References

1. Seasonal allergies. American College of Allergy, Asthma and Immunology. December 28, 2017. Accessed April 11, 2023. https://acaai.org/allergies/allergic-conditions/seasonal-allergies/

2. Scolaro K. Colds and allergy. In: Krinsky DL, Ferreri SP, Hemstreet BA, et al, eds. Handbook of Nonprescription Drugs: An Interactive Approach to Self-Care. 20th ed. American Pharmacists Association; 2021.

3. Yes, allergy seasons are getting worse: blame climate change. US National Institute of Food and Agriculture. May 23, 2022. Accessed April 11, 2023. https://www.nifa.usda.gov/about-nifa/impacts/yes-allergy-seasons-are-getting-worse-blame-climate-change

4. Ng AE, Boersma P. Diagnosed allergic conditions in adults: United States, 2021. NCHS Data Brief. 2023;(460):1-8.

5. Zablotsky B, Black LI, Akinbami LJ. Diagnosed allergic conditions in children aged 0-17 years: United States, 2021. NCHS Data Brief. 2023;(459):1-8.

6. Updated information: April 12, 2023: meeting of the Nonprescription Drugs Advisory Committee meeting announcement. FDA. Updated March 24, 2023. Accessed April 28, 2023. https://www.fda.gov/advisory-committees/advisory-committee-calendar/updated-information-april-12-2023-meeting-nonprescription-drugs-advisory-committee-meeting

About the Author

Yvette C. Terrie, BSPharm, RPh, is a consulting pharmacist and medical writer in Haymarket, Virginia.