Fighting Allergy Symptoms

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Does your nose get stuffy and runny around pets, dust or every spring and fall (pollen seasons)? These symptoms sound like allergic rhinitis and can become bothersome to the point of interfering with daily life. Luckily, there are medications available to treat these symptoms.


Allergic rhinitis is the inflammation of nasal mucosa after you breathe in an allergen that stimulates your immune system. This causes sneezing, runny or stuffy nose, and itchy nose or palate. Accompanying symptoms include allergic conjunctivitis (itchy, red, watery eyes), itchy throat and a feeling of pressure over the cheeks and forehead.


“Seasonal allergies” is a term that refers to allergic rhinitis, but symptoms of allergic rhinitis can also occur year-round. Most seasonal allergies are caused by pollen, whereas persistent allergies are commonly caused by dust mites, cockroaches, animals or mold.


Tips for Everyone


Avoid tobacco smoke, insect sprays, air pollution and fresh paint; these are irritants that worsen symptoms in most people.


Avoid specific allergens and implement prevention strategies according to the allergen that causes your symptoms. For example, limit outdoor exposure during periods of high pollen counts and don’t dry clothing outdoors if pollen causes symptoms. If you’re allergic to dust mites, avoid carpeting your bedroom and keep humidity between 40-45%.


Use a nasal saline spray or irrigation (e.g., NeilMed Sinus Rinse). This will wash allergens from your nasal passages and help with nasal symptoms. You can use it as needed or every day (up to twice a day), and alone or in addition to other medications.


Oral Antihistamines


Use oral antihistamines (desloratadine, fexofenadine, cetirizine, loratadine) if your symptoms are mild (ie. they don’t interfere with sleep or daily activities) and occur less than 4 days per week or less than 4 weeks at a time.


Products: Reactine, Aerius, Allegra, Claritin

  • Effective for runny nose, sneezing, nasal itch (not congestion)

  • Take the antihistamine at least 2 hours before allergen exposure and continuously for as long as you are in contact with the allergen for maximum efficacy

  • Avoid first-generation antihistamines (diphenhydramine (Benadryl), chlorpheniramine (Clor-Tripolon)) to avoid major side effects (drowsiness, psychomotor and cognitive impairment, dry mouth, constipation)

  • Can be used in children older than 2 years (children <2 should be assessed by a physician)


For congestion relief, use a product that contains an antihistamine and a decongestant (pseudoephedrine).


Products: Reactine Complete, Aerius Double Action, Allegra-D, Claritin Allergy + Sinus

  • Risk of side effects (insomnia, headache, fatigue, dry mouth)

  • Can be used in children older than 6 years

  • Use in caution if you have hypertension or hyperthyroidism

  • Do not use if you are taking a monoamine oxidase inhibitor


Corticosteroid Nasal Spray


Use an intranasal corticosteroid spray if your symptoms impair daily activities, disturb sleep, or if you have persistent symptoms that last 4 or more days per week and more than 4 weeks at a time.


Products: Flonase, Nasacort, Nasonex (prescription only)

  • Effective for runny nose, congestion, sneezing, nasal itch (more effective than antihistamines)

  • Relieves symptoms within 6-8h of first dose but maximum effect can take 2 weeks

  • Using it regularly is recommended and is more effective than intermittent use

  • Can use in children older than 4 years


If there’s not enough symptom relief, use a nasal spray with corticosteroid AND an antihistamine.


Products: Dymista (contains azelastine and fluticasone) – prescription only

  • More effective than an corticosteroid spray alone

  • Higher cost, higher risk for side effects

  • Can use in those older than 12 years old


Alternatively, you can also add a nasal decongestant spray (oxymetazoline, xylometazoline) if you have congestion despite regular use of the corticosteroid nasal spray.


Products: Claritin Allergy Decongestant, Otrivin

  • Do not use continuously for more than 3-5 days; this can cause rebound congestion

  • Can be used in children older than 6 years old

  • Use with caution if you have hypertension, diabetes, cardiovascular disease, hyperthyroidism

  • Do not use if you are taking a monoamine oxidase inhibitor


Conclusion


Allergic rhinitis is sometimes left untreated, even though symptoms can become quite troublesome. Keep these medications in mind for the next time your allergies are acting up!


*Always check with your doctor or pharmacist before using any medications to ensure it is appropriate for you.



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References

  1. DeShazo RD, Kemp, SF. Pharmacotherapy of allergic rhinitis. UpToDate. Updated. August 4, 2020. Accessed December 23, 2020. https://www-uptodate-com.proxy.lib.uwaterloo.ca/contents/contraception-issues-specific-to-adolescents/print?search=contraception&source=search_result&selectedTitle=2~150&usage_type=default&display_rank=2

  2. Keith PK. Allergic Rhinitis. In: Compendium of Therapeutic Choices. Canadian Pharmacists Association. Updated August 1, 2018. Accessed December 23, 2020. https://myrxtx-ca.proxy.lib.uwaterloo.ca/search

  3. Kendrick J. Allergic Rhinitis. In: Compendium of Therapeutics for Minor Ailments. Canadian Pharmacists Association. Updated August 1, 2018. Accessed December 23, 2020. https://myrxtx-ca.proxy.lib.uwaterloo.ca/search

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