Help Patients Prepare for Allergy Season

Recent research suggests that climate change is making things worse for patients who suffer from allergies, which can cause symptoms including a cough resulting from postnasal drip, to headache, itchy eyes and throat, nasal congestion, sneezing, and watery eyes.

Left unmanaged, these symptoms can significantly affect an individual’s quality of life and productivity. An estimated 60 million individuals deal with allergy symptoms annually, according to the CDC. Up to 30% of the general population experiences ocular allergies and up to 70% experiences allergic rhinitis.¹ Additionally, individuals with respiratory issues such as asthma usually are more sensitive to pollen.¹

Pharmacists can guide patients in selecting OTC products for the prevention and treatment of seasonal allergies, such as intranasal corticosteroids, mast cell stabilizers, ocular and oral antihistamines, and oral and topical decongestants. Pharmacists also can counsel patients about the proper use of these products and make clinical recommendations based on a patient’s medical and medication history while taking into consideration factors such as cost, ease and frequency of use, potential adverse effects, and route of administration. They should direct patients to seek further evaluation and medical care from allergy specialists when warranted.

Recent News and Clinical Studies

Results of a study by investigators from the University of Michigan (UM) showed that allergy season will likely become longer and more intense because of climate change.^2,3 The investigators noted that the annual amount of pollen emitted each year could increase by up to 200% because of rising temperatures and expanding carbon dioxide levels. Hotter temperatures may increase the amount of pollen produced by grass, trees, and weeds. By the end of the century, they noted, pollen emissions could start 40 days earlier in the spring than observed between 1995 and 2014 and allergy season may last an additional 19 days before high pollen counts wane. The investigators developed a predictive model that assessed 15 of the most common pollen types and how their production will be affected by projected changes in precipitation and temperatures. They combined climate data with socioeconomic scenarios, correlating their modeling with data from 1995 through 2014. They then used their model to predict pollen emissions for the first 2 decades of the 21st century.

“Pollen-induced respiratory allergies are getting worse with climate change. Our findings can be a starting point for further investigations into the consequence of climate change on pollen and corresponding health effects,” Yingxiao Zhang, a UM graduate student research assistant in climate and space sciences and engineering and lead author of the study,² said in an interview.

“The modeling developed by the team could eventually allow for allergy season predictions targeted to different geographical regions,” said Allison Steiner, the study’s other author and a professor of climate and space sciences at UM.

The National Science Foundation supported the project.^2,3

In other news, on March 17, 2022, Perrigo announced that its intranasal corticosteroid, Nasonex 24HR Allergy, had received final FDA approval for OTC use. Nasonex 24HR Allergy is indicated for the management of nasal symptoms of allergic rhinitis, nasal congestion associated with seasonal allergic rhinitis, nasal polyps, and the prophylaxis of seasonal allergic rhinitis. This is the first OTC formulation for Nasonex, and it will be available in full prescription strength. Each nasal spray delivers 50 g of mometasone furoate monohydrate. Perrigo expects the OTC product to be available later in 2022.⁴

On March 15, 2022, Allergan announced that Lastacaft (alcaftadine ophthalmic solution 0.25%) now is available without a prescription for the estimated 40% of Americans with ocular allergies. The FDA approved the switch to OTC in December 2021. The histamine receptor antagonist is indicated in patients 2 years and older for the temporary relief of itchy eyes resulting from animal hair, dander, pollen, and ragweed allergies. In clinical trials, 1 drop of Lastacaft worked in as little as 3 minutes to provide relief from itchy eyes and lasted
for 16 hours. Lastacaft is available in a 5-mL multidose bottle containing a 60-day supply, as well as a twin pack with two 5-mL multidose bottles for a 120-day supply.⁵

Meanwhile, the American College of Allergy, Asthma & Immunology (ACAAI) said recently that because COVID-19 symptoms, especially for the Omicron variant, often resemble symptoms commonly associated with allergies, patients should get tested if they suspect they have the virus. The ACAAI noted that allergies rarely cause a fever. The ACAAI also suggested that individuals with seasonal allergies identify their triggers if possible and discuss other therapies if OTC allergy medications are not managing symptoms.⁶ The ACAAI provides tips for managing spring allergies on its website.⁶

Role of the Pharmacist

Pharmacists can suggest the use of various mobile applications that monitor the pollen counts across the United States to help patients manage symptoms.

Pharmacists can help patients with seasonal allergy symptoms select and properly use nonprescription products. They can also counsel patients about the most efficacious means of preventing or reducing allergy symptoms. In addition, pharmacists can screen for potential contraindications and drug/drug interactions before recommending the use of OTC allergy medications. Patients with other medical conditions and/or those taking prescription medications should consult their primary health care providers to ascertain appropriateness of use. Pharmacists should encourage patients with severe or unmanaged allergy symptoms to seek further care from their primary health care providers.

Conclusion

Treatment of allergy symptoms may include a combination of allergen avoidance and environmental control measures when feasible, as well as immunotherapy and pharmacologic therapy. Many patients try several options before finding the most effective treatment.

About The Author

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

References

1. Allergens and pollen. CDC. August 21, 2020. Accessed March 28, 2022. https://cdc.gov/climateandhealth/effects/allergen.htm

2. Zhang Y, Steiner AL. Projected climate-driven changes in pollen emission season length and magnitude over the continental United States. Nat Commun. 2022;13(1):1234. doi:10.1038/s41467-022-28764-0

3. Longer, more intense allergy seasons could result from climate change. University of Michigan. March 16, 2022. Accessed March 28, 2022. https://news.umich.edu/longer-more-intense-allergy-seasons-could-result-from-climate-change/

4. Perrigo announces US FDA approval for OTC use of Nasonex 24hr Allergy. Perrigo. News release. March 17, 2022. Accessed March 18, 2022. https://www. prnewswire.com/news-releases/perrigo-announces-us-fda-approval-for-otc-use-of-nasonex-24hr-allergy-301505410.html

5. Now available over the counter, Lastacaft provides eye allergy itch relief in minutes that lasts through 16 hours. AbbVie. News release. March 15, 2022. Accessed March 15, 2022. https://www.prnewswire.com/news-releases/now-available-over-the-counter-lastacaft-provides-eye-allergy-itch-relief-in-minutes-that-lasts-through-16-hours-301501288.html

6. Covid’s not gone, and spring allergies could hit hard. American College of Allergy, Asthma, & Immunology. February 22, 2002. Accessed March 28, 2022. https:// acaai.org/news/what-allergists-want-you-to-know-about-the-2022-spring-allergy-season/