Pharmacists Play Critical Role in Targeted Allergy, Asthma Treatment

Allergies have become increasingly severe in recent years, leading to a shift in treatment approaches that focus on identifying and avoiding specific allergen triggers, according to Derek Webb, PharmD, pharmacy manager at Food City Pharmacy in Abingdon, Virginia, and member of the Virginia Board of Pharmacy. Pharmacists play a critical role in this process, providing recommendations for over-the-counter medications and coordinating with physicians on prescription options, including the newer biologic treatments that target specific immunoglobulins. Pharmacists also help patients manage the link between allergies and asthma, ensuring they use rescue inhalers properly and take steps to prevent allergen-induced asthma attacks. Importantly, pharmacists work to make treatments affordable, exploring options like copay cards and alternative medications to fit patients' budgets.

Allergies, Asthma, Biologic Treatment, Pharmacists | Image Credit: Pixel-Shot | stock.adobe.com

Pharmacy Times®: Going into 2025, what are the most important updates for allergy treatment and allergy management recommendations?

Derek Webb, PharmD: Over the past couple of years, allergies have no doubt become, or perceivably, seem to be worse and worse, and with those worsening symptoms of seasonal allergies, the paradigm has kind of shifted, and the focus is now really geared towards specific treatment for targeted allergens that people may come into contact with. So we're really trying to take a specific approach towards allergy treatment, things like increasing the use of HEPA filters indoors. I mean, really, once you learn those triggers, try to find ways to avoid the afflicting allergens that you may come into contact with. And, of course, as all else fails, you can use over the counter treatments, as well as some of the newer products that are on the market.

Pharmacy Times: What are some of the recent advancements or developments that pharmacists should be aware of?

Webb: So over the past couple of years, as I alluded to with the specificity and allergy treatment now, biologics have come onto the market. Most notably, there's a product called Xolair [Genentech, Novo Nordisk] that most people are familiar with. I'll try to say the name omalizumab. But with the biologics, we are targeting specific allergens in afflicting allergens. So the Xolair actually targets IgE, the immunoglobulin E, which is the one that actually causes most of the unwanted side effects that we have with allergies.

Pharmacy Times: Are there any new or emerging treatments for allergies that are now recommended?

Webb: The newest drugs on the market are the biologics, like we talked about with Xolair. Those are very targeted treatments, but they're also working on some fairly interesting things in to replace allergy shots. This is called SLIT therapy, which is sublingual immunotherapy, and that's, as it sounds, drops under the tongue instead of the shot. Another one is EPIT, which is epicutaneous immunotherapy, and if you're not familiar with that one, it's a patch that you put on that has the allergens on it instead of taking the shots. So those are good products that should be available fairly soon for people who have needle phobias and things of that nature.

Pharmacy Times: How are asthma and allergies associated with one another, and does this affect treatment plans for patients?

Webb: So the reason allergies and asthma are so commonly associated with one another or linked is when you come into contact with allergens, the side effects, such as runny nose, increased mucus production and so on and so forth, that can actually lead to an exacerbation of an asthma attack, the worsening of not being able to breathe, and swollen airways and so on and so forth. So because those 2 kind of come hand-in-hand, or they're kind of associated, for most people. Now, having that for treatment plans, it absolutely makes difference, because for people who are are affected by asthma in a in a very negative way, we want to do everything We can to prevent those allergens from causing a precipitation of one of those attacks.

Pharmacy Times: What is the pharmacist's role in allergy treatment and management?

Webb: I mean, pharmacists play a very critical role, primarily because we're right there on the front lines. We're the most accessible health care provider, so it's very frequent that people come to the pharmacy asking for recommendations over the counter. If they can't go to the doctor, don't want to go to the doctor. So, we're obviously there able to make those recommendations because there's a lot of useful products that are over the counter. Now, if we can't make a recommendation for an over the counter product, we can certainly chat with their physician to see if we can get them some prescription, but the beauty of the pharmacist being there on the front lines is that we can check for drug interactions and possible [adverse] effects to try to pinpoint a therapy that may be most beneficial for patients with asthma or allergies.

Pharmacy Times: What is the best way for pharmacists to educate patients on allergies and asthma, especially when it comes to treatment plans?

Webb: Treatment plans specifically focus on identifying triggers and figuring out how to avoid those triggers, if at all possible. So pharmacists really need to take an active role of paying attention to what their patients are saying about those triggers, trying to help them pinpoint what it is this cause and those reactions. So first and foremost, just being involved with their treatment plan. But also, once we figure out how to avoid those things and what for them to take in the event that they are around those afflicting allergens, we can actually help patients pick those OTC medications and counsel them on how and when to use those, how to store them, and of course, if they have if asthma, then they're likely going to have rescue inhalers and things of that nature. It's very important to know when and how to use those inhalers appropriately, because if you don't use them correctly, they're just not going to work very well.

Pharmacy Times: How can pharmacists best counsel patients on cost of their medication?

Webb: So often nowadays, cost is in the forefront with the news media. Everybody knows that drugs have gotten very expensive across the board. There's almost nothing that isn't expensive nowadays. So it's really important for pharmacists, again, to take that active role. If it's an over-the-counter product, then oftentimes, we can go out help a patient pinpoint a product that actually is within their budget. If it's a prescription product, then it's a little more tricky, because we don't always have control over the cost of those products, but in the event that their insurance has an expensive copay, it's possible we can help them find a copay card or a discount card that would help with those copays. And then ultimately, if it's a product that's not covered too expensive, not their budget, then we can get in touch with their [physician] and actually see if we can change it to something that would be comparable, but maybe in their budget. So there's all sorts of different scenarios where pharmacists can really take an active role to help their community to really be able to afford things that they need for allergies and asthma.

Pharmacy Times: Is there anything else you would like to add?

Webb: The only thing I would say, I think we touched on most all of the the highs and lows for allergies and asthma, but again, I challenge the pharmacist just to be in there, be active in their communities, to try to help their patients as much as they can. You just never know when somebody may need an over-the-counter recommendation, and just doesn't, for whatever reason, feel comfortable asking. So you really have to pay attention to the mood of the crowd to sort of see if you help those people that maybe don't usually ask questions.