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

• Runny nose

• Sneezing

• Nasal congestion

• Post nasal drip

• Red, watery eyes

• Fatigue

Over the Counter Treatment Options

Antihistamines

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
Generic Name	Trade Name (common)
Brompheniramine	Children’s Dimetapp®
Chlorpheniramine	Chlor-Trimeton®
Diphenhydramine	Benadryl®
Dimenhydrinate	Dramaine®
Doxylamine	Unisom®
2nd Generation Oral Antihistamines
​Generic Name	Trade Name (common)
​Cetirizine	Zyrtec®
Fexofenadine	Allegra®
Levocetirizine	Xyzal®
Loratadine	Alavert®, Claritin®

Decongestants

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

• ​Must be 18 years of age

• ​Must provide a photo-ID that shows name and date of birth

• Sales limit of 7,500 mg in 30 days

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.

Intranasal Steroids

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.

​Allergen	Avoidance Strategies
Pollen	Avoid outdoor activities on days when pollen count is high. Promptly remove clothes that have been worn outside. Don't hang laundry outside as pollen can stick to it.
Dust mites	Vacuum carpeted areas at least once a week. A vacuum with a HEPA filter is best for removal of allergens. Wash bedding at least once a week in hot water.
Molds	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!

Sources

1. 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

2. 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

3. https://www.youtube.com/watch?v=h6YcsBIfml0

4. 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

5. 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

6. 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.