Ask the Pharmacist

Q: After reading you latest column, I am convinced that I am suffering from allergies. What can I take to relieve them?

A: Allergies for some people are just a mere nuisance of having to deal with sneezing and a runny nose. Others, however, may find their sleep disrupted and their ability to concentrate seriously affected and if not treated, this state could continue for weeks. Ultimately, allergies could have a negative impact on their work/school life as well as their social life.

In our last column, we reviewed allergies in detail so please refer back to the previous Ask the Pharmacist column if you want to refresh the signs and symptoms associated with allergies and the many tips to help reduce or prevent them from wreaking havoc.

As for treatments, there are both over-the-counter and prescription products available.

Antihistamines: Antihistamines are effective at reducing sneezing, itching and runny nose when they are taken regularly at the time of your maximal symptoms. They may be somewhat helpful for eye symptoms but often have little to no effect for nasal congestion.

Available in various forms, including tablets, liquids, and nasal sprays, antihistamines work by blocking the effects of histamine, a chemical released during allergic reactions. You are best to choose a second-generation antihistamine which is long-acting (once daily dosing) and non-drowsy, such as loratadine, desloratadine, cetirizine, and fexofenadine.

You are best to avoid the first-generation antihistamines, such as diphenhydramine and chlorpheniramine, since they cause more sedation and may impair your cognitive abilities.

Some prescription antihistamines on the market are bilastine (Blexten), rupatadine (Rupall) and cetirizine 20 milligram (mg) (Reactine). Note that cetirizine is available without a prescription in the 5 mg and 10 mg doses.

Intranasal Corticosteroids: Intranasal corticosteroids have become the mainstay therapy for allergic rhinitis that is either moderate to severe or mild but persistent. It has shown to be effective for all symptoms characteristic for allergic rhinitis and not just those symptoms confined to the nose.

Though some might find benefit using these intranasal corticosteroids as required, most people will find they achieve maximal benefits when used continuously for two to four weeks. These nose sprays do increase nasal irritation and the risk for nose bleeds, as well as possible nasal septum perforation.

Some examples of some intranasal corticosteroids sprays that you may find available over-the-counter, are triamcinolone acetonide and fluticasone propionate. Other nasal steroid sprays consist of a stronger steroid and, thus, are available only with a prescription, such as beclomethasone, budesonide, ciclesonide, fluticasone furoate and mometasone furoate.

Intranasal Antihistamine: There is one intranasal antihistamine on the market (levocabastine), available with a prescription. It is considered to be less effective than corticosteroid nasal sprays. but its quick onset of action (within 10 minutes) has some people preferring to use it for their sneezing, itchy and runny nose.

Intranasal Antihistamine and Intranasal Corticosteroid: There is one nose spray that is a combination of a steroid (fluticasone) and an antihistamine (azelastine) called Dymista. This can be considered as a first-line choice for allergies that are either mild and persistent or moderate to severe or for anyone who has found an intranasal corticosteroid spray not effective enough. This combination treatment is superior to using either agent on its own. Though it has a quick onset of action, it can take many days or weeks to reach its peak effect.

Leukotriene Receptor Antagonist: There is one leukotriene receptor antagonist on the market called montelukast and it requires a prescription. Montelukast is often considered for anyone who has not found other treatments effective. It may be used either on its own or in combination with either a steroid nose spray or an oral antihistamine. Though pharmacists can now prescribe treatments for allergic rhinitis, montelukast is not among the list of medications we can prescribe.

Decongestants: Decongestants help reduce nasal congestion by constricting blood vessels in the nasal passages, making breathing easier. However, they should be used with caution and/or avoided by individuals with certain medical conditions, such as high blood pressure, hyperthyroidism, diabetes, angle closure glaucoma and prostatic enlargement. Common oral decongestants include pseudoephedrine and phenylephrine; however, the effectiveness of phenylephrine is not well established.

Some common side effects associated with decongestants, are agitation, insomnia, headache and palpitations. Nasal decongestants work very locally and, therefore, are less of a problem for people with the above medical conditions. However, they are known to cause rebound congestion if used longer than three to five days so aim to keep the duration of their use short.

Eye Drops: For allergy-related eye symptoms, such as itching, redness, and watering, there are ophthalmic antihistamines, including olopatadine and ketotifen, that can provide relief within minutes. There are also ophthalmic mast cell stabilizers, such as cromoglycate and iodoxamide, that are not as quick to work as they may take several days of use to show their effect plus it requires frequent administration.

Another option to choose, are topical ophthalmic vasoconstrictors, such as naphazoline or oxymetazoline. Much like the nasal decongestant sprays, regular use of ophthalmic vasoconstrictors should be avoided due to the potential for rebound vasodilation.

Immuno-therapy: In cases of severe or persistent allergies that don’t respond well to other treatments, allergen immuno-therapy may be recommended. This treatment involves gradually exposing the body to increasing amounts of allergens, helping to de-sensitize the immune system and reduce allergic reactions over time. Immuno-therapy can be administered through allergy shots or sublingual tablets. Immuno-therapy is not within the scope of practice for Ontario pharmacists to prescribe.

Biologic Therapies: For individuals with severe allergic asthma or certain types of allergic rhinitis, biologic therapies targeting specific immune pathways, may offer relief when other treatments have failed. These medications are administered by injection or infusion and work by modulating the immune response to reduce allergic inflammation. Once again, this is not within the scope of Ontario pharmacists.

As you can see, managing allergies involves a multi-faceted approach that may include non-pharmacological methods, over-the-counter treatments, and prescription medications. By identifying and avoiding allergens, whenever possible, with or without utilizing appropriate medications, individuals can effectively control their allergy symptoms and improve their quality of life.

For more information about this or any other health-related questions, contact the pharmacists at Gordon Pharmasave, Your Health and Wellness Destination. Also check the website at www.gordon-pharmasave.com/ and the Facebook page at www.facebook.com/GordonPharmasave/