Help Patients Prevent and Manage Seasonal Allergies

SPRING ALLERGIES, ALSO KNOWN AS HAY FEVER, cause uncomfortable symptoms, such as headaches, itchy or watery eyes, nasal congestion, and repetitive sneezing.

Allergy symptoms can interfere with an individual’s productivity at school or work, as well as overall quality of life, because of difficulty concentrating and fatigue due to sleep disturbance.

More than 24.4 million individuals—19.2 million adults and 5.2 million under the age of 18 years—in the United States experience varying degrees of seasonal allergies, according to the most recent data from the CDC.¹

The CDC also indicates that seasonal allergies account for an estimated 12 million visits to primary care providers annually.¹

Patients may find selecting an OTC solution to seasonal allergies daunting because of the large number of products available. Choosing the right product may be even more difficult for individuals who are lactating, pregnant, or taking other medications. OTC products include intranasal corticosteroids, mast cell stabilizers, ocular and oral antihistamines, and oral and topical decongestants. Pharmacists can provide education and guidance on these products 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.

Recent News

In a recent publication, health experts indicated that the use of masks during the coronavirus disease 2019 (COVID-19) pandemic has helped individuals with seasonal allergies because the masks filter out pollen.²

At the beginning of the COVID-19 pandemic, investigators explored the effects of face masks on allergy symptoms in nurses who reported chronic allergic rhinitis symptoms. They assessed the impact of masks on allergy symptoms via the use of multicenter questionnaire data.³ Results from the 2020 study were published in the Journal of Allergy and Clinical Immunology. The investigators noted that face masks not only provide filtration of allergens, but also may diminish allergy symptoms by increasing the humidity and temperature of breathed air, which may in turn prevent nasal responses to allergens.³ They also noted that both N95 respirators and standard surgical masks can filter out airborne allergens. The investigators concluded that face mask usage may diminish allergic rhinitis symptom severity in chronically affected individuals with intermittent disease and that a larger study is warranted to examine the potential contribution of face masks for decrease or relief of allergy symptoms.³

On February 17, 2021, the American College of Allergy, Asthma and Immunology (ACAAI) issued a statement about its practice guidelines for allergists and health care workers regarding new recommendations for managing hay fever.

In the statement, Luz Fonacier, MD, the ACAAI president, said, “The guideline highlights the fact that cough is a common symptom of hay fever. Many people aren’t aware of that, and especially as we face another spring with COVID-19, people should be aware that a cough isn’t necessarily a COVID-19 symptom—it can just be part of allergies”⁴

Additional recommendations in the new guidelines include as follows:

• First-generation antihistamines, such as chlorpheniramine and diphenhydramine, should be avoided because of adverse effects, including constipation, drowsiness, dry eyes, and xerostomia.4 The ACAAI recommends the use of nonsedating antihistamines such as cetirizine, fexofenadine, levocetirizine, and loratadine instead.
• Intranasal corticosteroids, such as fluticasone and triamcinolone acetonide, are effective to treat persistent allergy symptoms and may even help alleviate symptoms associated with
  ocular allergies.
• Although the decongestant pseudoephedrine is effective, it is associated with several adverse effects and should be used with caution and should not be used by pregnant women.4

Role of the Pharmacist

Pharmacists are well positioned to help patients navigate the OTC medications available for the management, prevention, and treatment of seasonal allergy symptoms. Before recommending any OTC medications, pharmacists can assess if self- treatment is appropriate and can be instrumental in screening for potential drug-drug contraindications and interactions. They should also encourage individuals who find no relief using OTC allergy medications, patients with other comorbidities, or those with severe allergy symptoms to seek further medical care from their primary health care providers. Pharmacists can also educate patients about the potential adverse effects associated with these medications and provide information about nonpharmacological measures that may alleviate allergy symptoms, such as avoidance of allergens when practical, air purifiers with high-efficiency particulate air filters, essential oils, and steam inhalation therapy.

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

REFERENCES

1. Allergies and hay fever. Updated March 1, 2021. Accessed March 5, 2021. https://www.cdc.gov/nchs/fastats/allergies.htm
2. Pratt E. How COVID-19 face masks can reduce outdoor allergy symptoms. Healthline. February 28, 2021. Accessed March 10, 2021. https://www.healthline.com/health-news/how-covid-19-face-masks-can-reduce-outdoor-allergy-symptoms#Outdoor-pollen
3. Dror AA, Eisenbach N, Marshak T, et al. Reduction of allergic rhinitis symptoms with face mask usage during the COVID-19 pandemic. J Allergy Clin Immunol Pract. 2020;8(10):3590-3593. doi:10.1016/j.jaip.2020.08.035
4. Update: what you need to know about 2021 spring allergies. News release. American College of Allergy, Asthma and Immunology. February 17, 2021. Accessed March 9, 2021. https://acaai.org/news/update-what-you-need-know-about-2021-spring-allergies