Spring is a beautiful time of year, where new growth is evident every day as trees and flowers begin to bloom. However, with the warmer weather and new growth comes pollen and seasonal allergies.
Each year more than 50 million Americans suffer from allergies1. I have suffered from seasonal allergies since college, but this year started earlier and has been worse than past years. The good news is that most first-line options to treat seasonal allergies are now available over-the-counter (OTC). Many providers often recommend patients purchase these OTC medications instead of a prescription because virtually all these medications used to be prescription only.
Symptoms of seasonal allergies include sneezing, runny nose, itchy nose, nasal congestion, and itchy, watery eyes. Most people who have seasonal allergies are allergic to the pollen from various trees, grasses, weeds, and spores from fungi and molds, which are also known as triggers. Monitoring the pollen count during the spring and fall can be helpful in avoiding outdoor activities when counts are high. Some patients with seasonal allergies also experience a dry cough due to post-nasal drip. When patients treat their allergy symptoms, then the cough stops.
Treatment Options
The first-line option for treating seasonal allergies is intranasal steroid sprays. These medications are first-line because they can treat all the symptoms including nasal congestion.
Currently, Flonase® (fluticasone propionate), Flonase SensimistTM (fluticasone furoate), Nasacort® (triamcinolone), and Rhinocort® (budesonide) are all available OTC. All of these agents were formerly available by prescription only. Claritin® recently came out with their own version of fluticasone propionate called ClariSpray®.
Flonase SensimistTM is the newest agent on the market and it’s the OTC version of Veramyst®. Veramyst® was often prescribed by medical providers because it worked best for patients with nasal symptoms and itchy, watery eyes. Flonase SensimistTM and Nasacort® both are scent-free and less likely to have an aftertaste. These medications block various inflammatory pathways that are triggered by pollen and spores. These medications should be administered after blowing your nose, shaking the bottle, and spraying away from the center of the nose while gently sniffing. Patients can administer 1 or 2 sprays in each nostril daily and most start out with 2 sprays in each nostril daily and decrease to 1 spray in each nostril daily once symptoms are reduced. Some patients find that using 1 spray in each nostril in the morning and at bedtime helps control their symptoms more effectively.
The next best option are oral antihistamines, which include Zyrtec® (cetirizine), Claritin® or Alavert® (loratadine), Allegra® (fexofenadine), and soon to be on the OTC market Xyzal® (levocetirizine). Xyal® should be on pharmacy shelves at any moment since the company stated it would be available spring of 2017. All of these medications work by blocking the histamine pathway and treat sneezing, runny nose, and itchy nose, but not nasal congestion. All of these medications are taken once daily and are non-drowsy compared to the older antihistamines like Benadryl® (diphenhydramine) and Chlor-Trimeton® (chlorpheniramine).
For nasal congestion, Sudafed® (pseudoephedrine) behind the counter and Sudafed PE® (phenylephrine) are available in various strengths, which relates to how long the product works in your body. However, these medications are not recommended for long-term use because they can raise blood pressure and can cause difficulty urinating for men with an enlarged prostate.
There are combination products of antihistamines and pseudoephedrine available behind the counter at the pharmacy. Afrin® (oxymetazoline) and Neo-Synephrine® (phenylephrine) are both decongestant nasal sprays but should not be used for more than 3 days due to rebound congestion. Rebound congestion is when the nose is constantly congested unless the product is used, which is often very difficult to treat once it has occurred.
NasalCrom® (cromolyn) nasal spray has been on the market a long time and works by interfering with the allergy cells ability to release natural chemicals (such as histamine) that cause inflammation. However, it is best administered before symptoms start and must be used 3 to 4 times daily with a maximum of 6 times daily.
For treatment of itchy, watery eyes ketotifen, which is the active ingredient in Zaditor® or Alaway®, is the preferred antihistamine eye drop and was once available only by prescription. One drop of this medication should be administered in each eye twice daily and stopped once the trigger is no longer present.
It’s not uncommon for patients to have to use a combination of products to control their allergy symptoms. The most common is using an intranasal steroid such as Flonase® and oral antihistamine such as Zyrtec®. Personally, that’s my combination of choice that I use every year.
If you are have seasonal allergies and you have not tried an intranasal steroid, then you should! It treats all the symptoms in one medication, especially now with Flonase Sensimist® which can also treat itchy, watery eyes.
If you have additional questions, or would like to speak with a pharmacist, please stop by Sona Pharmacy today!
Tasha Michaels, PharmD, BCACP
