Have You Renewed Your Allergy Meds?

By Katherine Wang, Legacy Pharmacist

Is your allergy medication not as effective or not seemingly working at all? Legacy Pharmacist, Katherine Wang breaks down the why and how you can fix this.

April is here and that means allergy season is tagging along with it. For Texans, however, there is no allergy season. Due to Texas’ dry and mild winters, allergies last throughout the year making the state one of the worst places to stay for those suffering from allergies. The Asthma and Allergy Foundation of America conducted a survey involving 100 U.S. cities where the higher the city scored, the worse it was for allergy sufferers. Houston ranked 12^th for cities with the worst allergies in the country.

As many Texans face the discomfort of itchy eyes and runny noses, it’s important to address an often-overlooked aspect of managing allergies: renewing medication and selecting the right treatment. To help guide allergy-prone patients through this process, Legacy Pharmacist Katherine Wang answers common questions and offers expert advice on choosing the best allergy medication.

1. How often should we renew allergy medication?

If you only experience occasional symptoms, you can usually just use allergy medications as needed for a brief period.

However, if you tend to suffer from seasonal allergies that persist for a few months, it’s generally a good idea to start your allergy medication before your symptoms start or before they progress too much.  If you know what you’re allergic to, you can try to start your medication right before or around that “pollen season”.  Pollen tends to have three major “seasons.”

Some websites can provide real-time pollen counts for your area.

https://pollen.aaaai.org/#/ <- List of pollen count services across the nation.

https://www.houstonhealth.org/services/pollen-mold <- For Houston-specific pollen/mold counts, the Houston Health Department provides updates Monday through Friday (except for the City of Houston holidays).

2. Which antihistamines or medications are most effective? How long do they last?

Allergy medications tend to fall into three major categories:

Typically, just using a nasal steroid for seasonal allergies tends to be the recommended starting point, since it is very effective and has few side effects.  However, if you prefer not to use this and want another option, an oral antihistamine can be considered.  Generally, antihistamines are similar in effectiveness. However, major differences arise when you look at side effects and how long they last.

Antihistamines are split into two groups: first-generation and second-generation. First-generation antihistamines tend to cause more drowsiness and sedation, which can impair performance at school or work and can be dangerous while driving. They can also cause other side effects like dry eyes, dry mouth, constipation, urinary hesitancy, and urinary retention. These side effects are more likely to occur in older adults.  First-generation antihistamines also do not last as long, typically needing to be dosed every four to six hours, whereas second-generation medications can be given once or twice daily.

 

Generic name	Brand name(s)	Frequency of Doses	Side Effects
First generation
Diphenhydramine	Benadryl®	Every 4-6 hours	Drowsiness, sedation, dry eyes, dry mouth, constipation, urinary hesitancy, and urinary retention
Chlorpheniramine	Chlor-Trimeton®
Brompheniramine	Available in Bromfed® and other combination medications
Second generation
Loratadine	Claritin®	Once daily or twice a day	Some drowsiness, but less than in first generation antihistamines
Desloratadine	Clarinex®
Cetirizine	Zyrtec®
Levocetirizine	Xyzal®
Fexofenadine	Allegra®

 

3. In addition to medication, what else can people take to mitigate allergy symptoms?

Nasal rinses and nasal saline sprays are a great way to clear allergens out of the nose.  If you’re using tap water to prepare a nasal rinse, you must boil it for one to five minutes and then let it cool before using.  Artificial tears may similarly rinse allergens out of the eyes for those who experience eye allergy symptoms.

4. What’s the difference between allergy symptoms and a common cold?

Although some symptoms of the common cold can be very similar to allergies, there are some key differences to help you tell them apart.

 

5. Are there specific allergy medications that individuals with certain health conditions should avoid?

There are a few conditions that have special precautions when it comes to the selection of allergy medication:

• Dementia – These patients should avoid first-generation antihistamines and decongestants because they may worsen this condition.
• Pregnancy – Pregnant women should avoid decongestants during the first trimester because exposure during this time has been associated with several birth defects.
• HIV – Persons with HIV who are taking a ritonavir or cobicistat regimen should avoid using a nasal steroid, particularly fluticasone nasal sprays. There have been cases of Cushing’s syndrome and adrenal suppression reported due to this combination. Speak to your pharmacist or provider for other options.

As a class of medication, oral decongestants could potentially worsen quite a few health conditions, so caution should be exercised in patients with the following:

• History of cardiac arrhythmia
• Angina pectoris
• Cerebrovascular disease
• Uncontrolled hypertension
• Bladder outlet obstruction
• Glaucoma
• Hyperthyroidism
• Tourette’s syndrome

6. Does age play a factor in the need for allergy medication changes?

Older adults and children do have special considerations that should be considered for allergy medications.

 

7. What is your perspective on allergy shots as a good treatment alternative?

Allergy immunotherapy may be a good long-term treatment to decrease symptoms in certain patients.  Although typically done as allergy shots, there are now a few treatments available as tablets that are dissolved under the tongue.  Patients who may be particularly good candidates for allergy immunotherapy are those with moderate to severe allergies that did not adequately improve with allergen avoidance and medications.  Patients with health conditions that may be exacerbated by allergies, like asthma, may also benefit from immunotherapy as it may help prevent the progression or reduce the severity. Other patients may wish to explore this treatment to reduce their need for other allergy medications and subsequently avoid the associated side effects and costs from them.

 

References:

1. ACAAI Public Website. American College of Allergy, Asthma and Immunology. Published 2014. https://acaai.org/
2. Allergy & Asthma Network: Breathe Better Together. Allergy & Asthma Network. https://allergyasthmanetwork.org/
3. American Academy of Allergy, Asthma, & Immunology. American Academy of Allergy, Asthma & Immunology. Published April 4, 2019. https://www.aaaai.org/
4. Dykewicz M, Wallace D, Amrol D, et al. Rhinitis 2020: A Practice Parameter Update. https://www.aaaai.org/Aaaai/media/Media-Library-PDFs/Allergist%20Resources/Statements%20and%20Practice%20Parameters/Rhinitis-2020-A-practice-parameter-update.pdf
5. Dykewicz MS, Wallace DV, Baroody F, et al. Treatment of seasonal allergic rhinitis. Annals of Allergy, Asthma & Immunology. 2017;119(6):489-511.e41. doi:https://doi.org/10.1016/j.anai.2017.08.012
6. Houston Pollen and Mold Reports. Houston Health Department. Accessed March 28, 2024. https://www.houstonhealth.org/services/pollen-mold

University of Liverpool. Liverpool HIV Interactions. www.hiv-druginteractions.org. https://www.hiv-druginteractions.org/checker