Don't Let Nature Get the Best of You

Your OTC Guide to Seasonal Allergies

This is my first time living on the West coast and apparently my body was not ready for the different types of blooms and pollen that came along with the arrival of spring here. Both my husband and I have had all the sneezing, itching, sniffling, watery eyes and congestion typical of seasonal allergies. I think he sneezed about one hundred times before leaving for work this morning! I know we are not alone in our suffering though. In fact, allergies are the 6th leading cause of chronic illness in the United States with an annual cost estimated at $18 billion and affecting more than 50 million Americans each year(1). Allergies can not only affect quality of life and productivity, but can also have major effects on other comorbid conditions, such as asthma. Therefore, treatment is important for well-being and happiness.

From a pharmacist's perspective, there are several factors to consider when choosing a treatment for myself, family member, or for a patient. The age of the person, severity of symptoms, the medication’s effectiveness and onset of action, cost and potential side effects are some of the biggest factors that play a role in my recommendations.

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First: Avoidance of Allergen

The first step in the treatment of allergies is education and avoidance of the allergen, if known. Here are some suggestions:

· Stay indoors on dry, windy days

· Delegate outdoor chores (lawn-mowing, gardening) or wear a mask

· Check for pollen forecasts and levels. When pollen counts are high, close doors and windows and avoid outdoor activity

· Keep indoor air clean by using the AC, high-efficiency air filters, dehumidifiers, and by vacuuming often

Although all of this sounds great, most of the items on this list are just not possible for me. I live in a house with no A/C in southern California. Therefore, my windows and doors are always open to help keep the house cool. I also have a rambunctious toddler that loves to play outside, and let’s be real, we NEED to go outside so he can run around and burn off some energy. He’s currently running circles around our kitchen table as a write this… I don’t think I’d keep my sanity if we stayed indoors all day. Thankfully, my husband takes care of the lawn, but he suffers from allergies too so knowing our treatment options is important.

Second: Saline Sprays and Rinses

The guidelines like to go straight to the corticosteroids, but I LOVE to try a good saline spray or sinus rinse first. Some find these gross, but to me, it’s so satisfying to see and feel all the gunk in your sinuses come flowing out (I know, I'm weird). I also have been pregnant or breastfeeding for the majority of the last 2 years so I’m always cautious when using medications that could potentially affect my milk supply or my baby and prefer to use more natural remedies. These are both great options for pregnant or nursing mothers. My only issue with these sinus rinses or sprays is that it's only a temporary fix and they do not prevent allergies.

Third: Intranasal Corticosteroids and Antihistamines

Intranasal corticosteroids (Flonase, Nasacort, Rhinocort) are my second choice when it comes to relieving my allergies. They have shown to be more efficacious than oral antihistamines at relieving the major symptoms of seasonal allergies. Because they are administered in the nose with minimal absorption into the body, they tend to have less side effects than other treatment options, such as antihistamines. The downside to these is that they can take several hours to days to start working and therefore, must be taken consistently in order to work.

If the nasal corticosteroids just aren’t cutting it, my next go-to are the oral antihistamines such as Claritin, Allegra, and Zyrtec. These have a faster onset of action, making them ideal for quick alleviation of symptoms or for those requiring “as needed” treatment. Although these are considered to be non-drowsy, Zyrtec personally knocks me out, and Claritin had my husband stumbling around Costco half asleep. My choice in this category is Allegra.

Benadryl and chlorpheniramine are older medications in the antihistamine class and are not an option for me because they cause sedation. I actually take Benadryl when I am having trouble sleeping. Fun fact, it’s the active ingredient in Zzzquil.

Other Options:

Decongestants

Decongestants include Sudafed, Sudafed PE, and Afrin. Honestly, Sudafed is one of my favorite recommendations for quick relief of congestion caused by seasonal allergies. It’s a great medication that works well and is also formulated in combination with oral antihistamines and some pain relievers. The “D” in Allegra-D, Claritin-D, Zyrtec-D, Advil-D, Mucinex-D, etc. stands for “Decongestant” and is a good sign that the product contains Sudafed. However, it is kept behind the pharmacy counter and its sale is limited because of its role in the making of methamphetamine. To make things more confusing, Sudafed and Sudafed PE are NOT the same drug. The active ingredient in Sudafed is pseudoephedrine, while Sudafed PE contains phenylephrine, a weaker less-efficacious decongestant. Phenylephrine is the decongestant found in many of the products on the shelf in a pharmacy. Marketing and labeling of products can get confusing and it’s always a good idea to talk to your pharmacist if you are unsure of what is in a product.

Afrin is another decongestant but is formulated as a nasal spray to act locally at the site of congestion.

Decongestants also carry some warnings and are not safe for everyone, especially those with high blood pressure. Side effects include insomnia, high blood pressure, anxiety, urinary retention, and headaches. Just a warning: if used for longer than 3 days, decongestants can cause rebound congestion that is worse and less responsive to treatment.

Nasalcrom

Nasalcrom is another option that is relatively good for preventing nasal symptoms (stuffy nose, runny nose, sneezing) but must be started one to two weeks before contact with allergens and may also take two to four weeks to start working. I don’t know about you, but I don’t want to wait weeks for a medication to start helping.

Eye Drops

For those who suffer from itchy, watery, red eyes, a topical decongestant like Visine can help, but should only be used for a maximum of three days just like the other decongestants. Use for longer can make eye symptoms worse.

There are also antihistamine eye drops such as Zaditor or Alaway that can help with eye symptoms of allergies and can be used for long-term.

Babies

I am very conservative when it comes to treatment of my one-year old and am even more careful when making recommendations for other babies and young children. If symptoms are moderate-to-severe (e.g. the child is wheezing or having difficulty breathing), please consult your child's pediatrician. Here is how I treat my son's mild congestion:

• Saline drops - these help loosen up mucus in the nose and then I use the bulb syringe to suction it out. He hated this when he was younger, but now he thinks it's the most hilarious thing ever because I laugh when I do it :)

• Nose Freida - GREAT at clearing out mucus so baby can breathe better

• Humidifier - moistens baby's airways and reduces congestion

• Tylenol if fever is present. Please please please verify dosing with your pharmacist or pediatrician

Always consult your pediatrician or pharmacist before giving your baby medication or if symptoms persist or get worse. All of the above is general information and should not be used in place of reaching out and obtaining advice from your doctor.

Hope this helps you breathe a little easier this allergy season!

Sincerely,

Ray

References:

1. "Allergies." Centers for Disease Control and Prevention

2. Denise KC, Plesa ML. "Treatment of Allergic Rhinitis." American Family Physician. 2015 Dec 1; 92(11): 985-92.

3. Lexicomp Online. Hudson, Ohio: Lexi-Comp, Inc.