Spring is in the air and so is the airborne pollen from trees, grass, and weeds. As a result, you may have noticed that you’ve been suffering from some of the symptoms associated with seasonal allergies in the spring and fall. Fortunately, there are a number of treatments available for seasonal allergies which I will explore in this week’s blog.
Guest Author: Nancy Ng. Nancy is the pharmacist at The Station Apothecary. The Station Apothecary is a full service pharmacy conveniently located in the Medical Station clinic.
How Do I know if I’m Experiencing Seasonal Allergies?
If you have a supersensitivity to pollen, you may experience any one or more of the symptoms associated with seasonal allergies. These include:
- Runny or stuffy nose
- Itchy watery eyes
- Itchy throat
- Fatigue & irritability
Treatments for Seasonal Allergies
Oral Antihistamines are the mainstay of seasonal allergy treatment. Available over-the-counter, oral antihistamines work by blocking histamine in the body. Histamine is the chemical in the body that triggers allergy symptoms when exposed to an allergen. Benadryl® (diphenhydramine) and chlorpheniramine are common antihistamines that are taken in response the allergic reactions caused by certain foods, drugs, pet dander, bug bites, and other allergens.
While Benadryl® can be taken for seasonal allergies, it is not optimal because it must be taken several times a day and can cause drowsiness. Claritan® (loratadine), Aerius® (desloratadine), Reactine®, (cetirizine), and Allergra® (fexofenadine) are non-sedating antihistamines that can be taken once a day. Reactine® is the only antihistamine which is covered by most insurance plans as a prescription. There are, however, some reports that Reactine® may cause sedation at high doses.
While antihistamines are effective in treating sneezing, runny nose, nasal itching, and itchy watery eyes, they are less effective in treating nasal congestion. This is why some antihistamines are combined with oral decongestants, such as pseudoephedrine and phenylephrine. These antihistamine-decongestant combination products are not recommended for people with high blood pressure, hyperthyroidism, or heart disease or those currently taking certain antidepressants.
Over the counter nasal decongestants in the form of a nose spray can relieve congestion temporarily, but they are not recommended for seasonal allergies because they can actually worsen nasal congestion when used long term. The maximum number of days a decongestant spray should be used is up to a week before rebound congestion occurs.
Nasal Steroid Sprays
An effective treatment for nasal congestion, when taken in combination with an antihistamine, is a nasal steroid spray. There are a variety of these sprays available by prescription. They are generally safe and well tolerated, but may cause some burning sensation on application or nose bleeds. People with nasal polyps should not use nasal steroid sprays. Nasocort®, a once daily dosed steroid nasal spray that was previously available by prescription only, was made available and can be purchased over-the-counter.
If oral antihistamines are insufficient to treating itchy and watery eyes, there are various eye drops that can be used. Cromolyn® is available over-the-counter. It works by preventing the release of histamine upon exposure to an allergen. Usually it takes several weeks of treatment with Cromolyn® before results can be seen. Other eye drops for are available by prescription.
More Severe Seasonal Allergy Symptoms
Sometimes when allergy symptoms are severe and cannot be treated with a standard antihistamine and steroid spray, or if asthma is involved, a prescription may be written for Singulair® (montelukast). Singulair® is a once daily oral tablet that helps to relieve allergy symptoms by preventing inflammation of airways. There are several studies which indicate that it is helpful in relieving ophthalmic symptoms as well.
Immunotherapy is another approach to treating seasonal allergies. Grastek® is used for treating grass pollen and Ragwitek® is used for ragweed. Both are oral sublingual tablets that must be taken 12 weeks before the onset and for the duration of the pollen season. Pollinex-R® is an injectable treatment for ragweed that consists of a series of four injections that must be administered separately with a minimum of 7 days between each injection. None of these treatments provide immediate relief of allergy symptoms, but they do help to lessen their severity.
The very first dose of Grastek®, Ragwitek®, and Pollinex-R® must be taken in the doctor's office so that the patient can be observed for a minimum of 30 minutes in case they experience an anaphylactic reaction to the drug. Patients on certain types of blood pressure medications and antidepressants may be more at risk of anaphylaxis.