Help Prevent and Relieve Allergy Symptoms

In a few weeks, students and teachers across the country will begin returning to the classroom to start a new school year.

Although back-to-school season is exciting, individuals heading back to the classroom who are prone to allergies often face numerous challenges. Symptoms present with varying degrees of severity and often negatively affect an individual’s quality of life by causing fatigue and sleep disturbances and impairing concentration. Allergy symptoms also often contribute to absences from school and work and a loss of productivity.

For individuals who suffer from seasonal allergies, finding relief from the common symptoms, such as headaches, itchy and watery eyes, nasal congestion, and repetitive sneezing, is a top priority. Unfortunately, the selection of a nonprescription allergy product can be overwhelming, particularly for individuals who have other medical conditions and/or take other medications. Pharmacists can be instrumental in guiding patients in the selection and proper use of nonprescription allergy products and directing them to seek further medical care when warranted. Prior to initiation of pharmacologic therapy, a patient’s medical and medication history should be thoroughly assessed to determine whether self-treatment is appropriate and to prevent contraindications and drug interactions.

During this time of year, ragweed pollen is responsible for most symp- toms associated with fall allergies.^1-4 With 17 species of ragweed pollen, peak levels typically occur in mid-September, affecting an estimated 23 mil- lion individuals in the United States.²

Almost 75% of individuals who are allergic to spring plants also expe- rience allergic reactions to ragweed.^1-3 Ragweed pollen can also aggravate asthma symptoms, which can lead to coughing and wheezing.² Other plant allergens that trigger fall allergy symptoms may include mugwort, sagewood, and tumbleweed.

Other possible causes of fall allergy symptoms include dust mites and mold.^2,4,5

Moreover, the American College of Allergy, Asthma, & Immunology (ACAAI) indicates that some students present with allergy symptoms in the fall because of exposure to allergens in the classroom, such as chalk dust and classroom pets.⁶

A study published in the Annals of Allergy, Asthma & Immunology, the scientific journal of the ACAAI, found that 75% of adults with asthma aged 20 to 40 years and 65% of adults with asthma aged 55 years and older have at least 1 allergy.⁷

Available OTC products for the self-treatment and prevention of mild to moderate allergy symptoms include intranasal corticosteroids (INCS), mast cell stabilizers, ocular and oral antihistamines, and oral and topical decongestants. INCS have been shown to be the most effective treatment for most of the symptoms associated with allergic rhinitis.⁸ Pharmacists can also be instrumental in recommending dosage forms that are convenient and easy to use, such as long-acting, once-daily formulations and/or orally disintegrating tablets, especially for pediatric patients.

Recent News

In June, the FDA approved azelastine hydrochloride nasal spray 0.15% (Astepro Allergy; Bayer) as an OTC product for the temporary relief of itchy nose, nasal congestion, runny nose, and sneezing associated with upper respiratory allergies such as hay fever.⁹ Its recent approval makes it the first steroid-free antihistamine nasal spray for indoor and outdoor allergies available over the counter in the United States.

OTC Astepro Allergy is indicated for use in patients 6 years and older.⁹ Each nasal spray delivers a volume of 0.137-mL solution containing 205.5
μg of azelastine hydrochloride. The product may be administered as a once- or twice-daily dosage regimen. The OTC formulation includes flexible dosing that provides up to 24-hour relief from itchy nose, nasal congestion, runny nose, and sneezing caused by indoor and outdoor allergies.

Because of the risk of somnolence associated with the use of azelastine, the label for Astepro Allergy warns consumers to avoid alcoholic drinks and to be cautious when driving a motor vehicle or operating machinery.⁹ Additionally, consumers should avoid sedatives or tranquilizers when using the product.

The 0.15% strength is approved for OTC use, but the 0.1% strength will remain prescription based for perennial and seasonal allergic rhinitis. The manufacturer anticipates that Astepro Allergy will be available at national mass retail locations the first quarter of 2022.⁹

Role of the Pharmacist

Pharmacists can assist patients who suffer from allergy symptoms in the selection and proper use of nonprescription products. They can also provide patients with key information about the most efficacious nonpharmacological and pharmacological measures to prevent or reduce allergy symptoms. Masks have been used to reduce transmission of COVID-19, but some study results have shown that masks may also be helpful in reducing allergy symptoms.

During counseling, patients should be advised to use OTC products as recommended and be aware of potential adverse effects.

Patients experiencing severe allergy symptoms should be encouraged to seek further care from their primary health care provider. They can also make recommendations about patient education resources that teach patients about back-to-school allergy plans such as the Allergy & Asthma Network website (https://allergyasthmanetwork.org/health-a-z/covid- 19/covid-19-school-resources-for-managing-asthma-and-allergies/) and the ACAAI website (https://www.aaaai.org/tools-for-the-public/conditions-library/ asthma/back-to-school-with-allergies-and-asthma).

REFERENCES

1. Asthma and Allergy Foundation of America. Allergy Capitals. Fall 2018. Accessed July 25, 2021. https://www.aafa.org/media/2183/ AAFA-2018-Fall-Allergy-Capitals-Report.pdf
2. Ragweed allergy. American College of Allergy, Asthma, and Immunology. Updated April 23, 2018. Accessed July 25, 2021. https://acaai.org/allergies/types/ragweed-allergy
3. Nall R. Ragweed allergy: what is it and foods to avoid. Medical News Today. April 13, 2018. Accessed July 25, 2021. https://www.medicalnewstoday.com/articles/321490.php
4. More D. What to expect during fall allergy season. Verywell Health. September 30, 2020. Accessed July 25, 2021. https://www.verywellhealth.com/fall-allergies-83184
5. Mold allergy. American Academy of Allergy, Asthma & Immunology. Accessed July 25, 2021. https://www.aaaai.org/conditions-and-treatments/allergies/mold-allergy
6. Four things you might not know about fall allergies. American College of Allergy, Asthma & Immunology. Accessed July 25, 2021. https://acaai.org/news/four-things-you-might-not-know-about-fall-allergies
7. Busse PJ, Cohn RD, Salo PM, Zeldin DC. Characteristics of allergic sensitization among asthmatic adults older than 55 years: results from the National Health and Nutrition Examination Survey, 2005-2006. Ann Allergy Asthma Immunol. 2013;110(4):247-252. doi:10.1016/j.anai.2013.01.016
8. Scolaro K. Disorders related to colds and allergy. In: Krinsky D, Berardi R, Ferreri S, et al. Handbook of Nonprescription Drugs. 19th ed. American Pharmacists Association; 2018.
9. FDA approves Astepro Allergy nasal spray for over-the-counter use in the United States. News release. Bayer. June 17, 2021. Accessed June 17, 2021. https://www.businesswire.com/news/home/20210617005872/en/FDA-Approves-Astepro%C2%AE-Allergy-Nasal-Spray-for-Over-the-Counter-Use-in-the-United-States