Katilyn Nihiser, PharmD
Nip Sniffles in The Bud: Seasonal Allergies and How to Treat Them
According to the Centers for Disease Control (CDC), seasonal allergies can affect up to 60 million people per year in the United States.¹ Allergies, also known as hay fever or allergic rhinitis, are essentially the result of an immune response to a particular allergen. Some common allergens include pollen, dust mites, molds, and animal dander.
Pathophysiology of Allergies
Our immune system is responsible for defending our body. When the immune system recognizes an allergen as foreign it elicits an immune response. Upon initial exposure to the allergen, our immune system works to create antibodies specific to the allergen. These antibodies attach themselves to mast cells, a prevalent cell type that is part of our immune system. The next time the allergen is present in our body, it binds to the antibodies on mast cells and causes them to burst open, releasing the chemicals stored within them, called “mediators.” These mediators include histamine, prostaglandins and leukotrienes; all of which cause inflammation and the resulting allergy symptoms.
Common Allergy Symptoms ²
Itchy eyes, nose, and throat
Post nasal drip
Red, watery eyes
Over the Counter Treatment Options
These agents work by binding to histamine receptors, which prevents histamine from binding and exerting its effects. Antihistamines are classified into two groups. The original, or first-generation antihistamines, are able to cross the blood-brain barrier. Because of this, a common side effect that occurs when taking them is sedation. In fact, these agents are used in several products marketed as sleep aids. The newer, or second-generation, antihistamines do not readily cross the blood-brain barrier and thus are non-sedating.
Some side effects associated with antihistamines include dry eyes or mouth, difficulty urinating, and constipation. Patients who are over 65 years old, have prostate enlargement, thyroid disorders or other medical conditions please consult with your pharmacist or physician before using.
For more localized treatment, there are antihistamine eye drops as well as nasal sprays. The available OTC eye drops are ketotifen (Zaditor®, Alaway®), olopatadine (Pataday®), and pheniramine/naphazoline (Naphcon A®). The nasal sprays currently still require a prescription, so they will not be mentioned in this article.
1st Generation Oral Antihistamines
Trade Name (common)
2nd Generation Oral Antihistamines
Trade Name (common)
These products work by binding to their receptors located on blood vessels, causing them to constrict which results in decreased swelling of the mucosal tissue of the nose, allowing oxygen to pass more freely (image below)³.
The available oral decongestants include ephedrine (Bronkaid®), phenylephrine (Sudafed PE®), and pseudoephedrine (Sudafed®). All are available without a prescription, but the state of Illinois has certain restrictions in place that control how and when ephedrine and pseudoephedrine are sold. Patient and product information are collected and logged in a database with each purchase (table below).
Psudoephedrine & ephedrine purchase restrictions⁴
Because of the way that these medications work, the most common side effects are increased blood pressure and heart rate. Patients who have high blood pressure, cardiac conditions or conditions that increase the pressure of their eyes should consult with a pharmacist or physician before taking.
For local treatment of nasal symptoms, there are phenylephrine (Neo-Synepherine®) and oxymetazoline (Afrin®) nasal sprays. It is recommended that decongestant nasal sprays not be used longer than three days in a row, due to the risk of rebound congestion occurring.
The way in which these agents work is complex, but the result is a reduction in inflammation of the nasal tissue. Currently available OTC products include budesonide (Rhinocort®), fluticasone (Flonase®), mometasone (Nasonex®) and triamcinolone (Nasacort AQ®). The most common side effect is local irritation of the nose or throat.
Mast Cell Stabilizer
As previously mentioned, the mast cells are a part of the immune system which contain the chemicals responsible for producing an allergic reaction. By stabilizing these cells, it prevents the cell from breaking open and therefore prevents the release of the chemical substances that causes allergic reactions.⁶ The only available product that can be purchased OTC in this class of medications is cromolyn sodium nasal spray (NasalCrom®).
Non-medication Treatment Options
Identification and avoidance of your allergen is the primary nonpharmacologic treatment option. Avoidance strategies are specific to the particular allergen that you are allergic to.
Indoor: use a dehumidifier to keep indoor air dry, remove houseplants.
Outdoor: avoid disturbing decaying plants (ex. raking).
If you have any questions about this article or any of your medications in general always be sure to ask your pharmacist. We are here and happy to help!
Allergens and Pollen | CDC. (2020). Centers for Disease Control and Prevention (CDC). Retrieved May 18, 2022, from https://www.cdc.gov/climateandhealth/effects/allergen.htm#:%7E:text=Symptoms%20of%20allergic%20rhinitis%20can,year%20in%20the%20United%20States
Hay fever - Symptoms and causes. (2020, July 16). Mayo Clinic. Retrieved May 16, 2022, from https://www.mayoclinic.org/diseases-conditions/hay-fever/symptoms-causes/syc-20373039
720 ILCS 648/ Methamphetamine Precursor Control Act. (n.d.). Illinois General Assembly. Retrieved May 18, 2022, from https://www.ilga.gov/legislation/ilcs/ilcs3.asp?ActID=2756&ChapterID=53#:%7E:text=25.,of%20this%20Section%20are%20satisfied
Practical Aspects of OTC Intranasal Corticosteroid Use: Important Educational Points to Share with Patients. (2021, March 8). Pharmacy Times. Retrieved May 16, 2022, from https://www.pharmacytimes.com/view/rd362_july2015
Berardi, R. R., Kroon, L. A., McDermott, J. H., Newton, G. D., Oszko, M. A., Popovich, N. G., Remington, T. L., Rollins, C. J., Shimp, L. A., & Tietze, K. J. (2006). Handbook of Nonprescription Drugs (15th ed.). APhA Publications.