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Pharmacy Times
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Symptoms occur when airborne irritants enter the eyes, nose, and throat, causing an allergic reaction.
Nearly 26% of adults and 19% of children experience seasonal allergies in the United States.1 Spring allergies, also known as hay fever or allergic rhinitis, are an immune system response to airborne allergens entering the body. Pollen produced by trees, grass, and weeds is the primary allergen in the spring.1
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As nature thaws and the days get longer, flora come alive and pollen and mold spores are dispersed, becoming airborne and depositing on outdoor surfaces. Spring allergies occur when the body overreacts to these allergens, causing an immune response.
Kathleen Kenny, PharmD, RPh, earned her doctoral degree from the University of Colorado Health Sciences Center in Aurora. She has more than 30 years of experience as a community pharmacist and works as a clinical medical writer based in Homosassa, Florida.
The human body can overreact to a harmless substance and treat it as a threat. When this occurs, IgE antibodies are produced that trigger the release of histamine and other chemicals from mast cells.2 This response leads to allergy symptoms such as sneezing, rhinorrhea, congestion, cough, sore throat, facial pressure, and itchy, watery eyes.
Allergy management is highly individualized and based on the patient’s medical history, allergy test results, and severity of symptoms. Allergic symptoms can be prevented by reducing exposure to allergens. They can also be treated with OTC and prescription medications and may be reduced through immunotherapy.
To reduce exposure to allergens, advise patients to monitor pollen counts and stay indoors on dry, windy days. The best time to go outside is after it rains, which washes pollen from the air. Avoid outdoor chores that stir up allergens, such as lawn mowing and weed pulling. Upon reentering the house, remove clothes worn outside and shower to remove pollen. Avoid drying laundry outside because pollen can stick to those items. Finally, patients can wear a face mask outdoors to further reduce irritants.3
Allergy medications are available OTC and by prescription. They include pills, liquids, inhalers, nasal sprays, and eye drops. H1 receptor antihistamines block the effects of histamine released during an immune response by blocking histamine receptors. H1 receptors are responsible for allergy symptoms such as rhinitis, sneezing, and eye irritation. Antihistamines are broken down into first-generation and second-generation antihistamines. First-generation antihistamines more easily cross the blood-brain barrier than second-generation antihistamines and therefore have more adverse effects, such as drowsiness.4
Nasal corticosteroids reduce the swelling in the nasal mucosa associated with an allergic reaction. This can help alleviate symptoms such as congestion, sneezing, and rhinitis. Although well tolerated, nasal corticosteroids may cause nosebleeds, headache, sore throat, and cough.5 Nasal corticosteroids are available as single ingredient formulations or with nasal antihistamines or mast cell stabilizers.
Nasal mast cell stabilizers inhibit the degranulation of mast cells, thereby inhibiting the release of histamine. These are preventive medications and should be used regularly beginning approximately 2 weeks before exposure. Like corticosteroids, mast cell stabilizers are available as single-ingredient formulations or in combination with corticosteroids, antihistamines, or leukotriene inhibitors. Common adverse effects include hoarseness, cough, and a bitter taste.6
Nasal decongestants activate α-adrenergic receptors in the nasal mucosa, constricting the blood vessels and shrinking swollen tissue. These should only be used for short periods because prolonged use may lead to rebound congestion. Common adverse effects include headache, nervousness, sleep difficulties, and high blood pressure. Patients with hypertension, glaucoma, and prostate enlargement should not take decongestants.7
Finally, leukotriene inhibitors decrease the action or production of leukotrienes, signaling molecules involved in the inflammatory response to an allergen. These medications help reduce inflammation and mucus production and prevent airway constriction. Common adverse effects include nausea, vomiting, and diarrhea.8
Immunotherapy is a process by which the immune system is trained not to react to certain allergens. This is accomplished by gradually increasing exposure to those allergens. As exposure increases, the immune system becomes less sensitive to the substance. Allergy immunotherapy is available as a series of injections, sublingual tablets, and drops, although sublingual drops are not FDA approved.9
Immunotherapy can be a long-term, effective way to reduce the severity of allergy symptoms and improve quality of life, especially for allergens that cannot be avoided. More than 1 allergen may be treated simultaneously with immunotherapy. Immunotherapy may also decrease the consumption of medications used to treat allergy symptoms.9
Patients may have allergic reactions to immunotherapy, and therefore, all injectable allergens are administered in a physician’s office, as are the first few doses of oral therapy, and patients must be monitored for 30 minutes. Patients may have to wait 6 to 12 months before the benefits are experienced, and therapy usually continues for 3 to 5 years.10
Approximately 80% of patients experience significant symptom improvement, and approximately 60% experience permanent benefits after 3 to 5 years.10
Early diagnosis and proactive management of seasonal allergies can vastly improve patients’ symptoms and quality of life. Many remedies are available to treat mild to severe allergy symptoms in even the patients with the most complex cases.
Pharmacists can explain medication dosages and schedules and provide patients with guidance on which OTC products may work best for them. They can help patients get the most out of their medications by demonstrating how to properly use inhalers, nasal sprays, and eye drops. Pharmacists can also help reduce costs by reducing redundancies and suggesting reliable generic medications, rebate promotions, and drug cards.
Spring allergies are a common yet costly occurrence. A wide variety of treatments are available to reduce symptoms and improve quality of life. Allergies are treated with the avoidance of allergens and medications, including corticosteroids, antihistamines, decongestants, mast cell stabilizers, and leukotriene inhibitors. Patients unable to avoid allergens or with severe symptoms may benefit from immunotherapy.
