Q: Every spring I end up with sneezing, a runny nose, congestion, and itchy, watery eyes. I have tried a few over-the-counter allergy medications, but they never seem to work very well. What are the best treatment options for seasonal allergies, and is this something pharmacists can prescribe for?
Seasonal allergies, also known as allergic rhinitis or hay fever, affect many New Brunswickers each spring and summer. Common symptoms include sneezing, a runny or congested nose, postnasal drip, watery eyes, coughing, and itching of the nose, throat, mouth, and eyes. These symptoms occur when the immune system overreacts to allergens in the environment such as pollen from trees, grasses, and weeds, as well as mold spores. People with asthma and eczema may also notice a worsening of their symptoms during allergy season.
Many people have noticed allergy seasons becoming longer and more intense. Warmer temperatures can cause plants to bloom earlier and remain in bloom longer, increasing the amount of pollen in the air. Wetter conditions can also promote mold growth and increase the release of airborne spores. Combined, these factors can lead to more severe and persistent allergy symptoms.
Pharmacists in New Brunswick can assess and prescribe treatment for allergic rhinitis and allergic conjunctivitis. There are a variety of effective treatments available both over the counter and by prescription. For best results, some allergy medications should be started one to two weeks before your typical symptoms begin and continued throughout the allergy season.
For many people, nasal corticosteroid sprays are the most effective treatment for seasonal allergies, particularly when nasal congestion is a major concern. These sprays reduce inflammation inside the nasal passages and can improve congestion, sneezing, runny nose, and itching. Unlike decongestant nasal sprays, which should only be used for a few days due to the risk of rebound congestion, corticosteroid sprays are safe for continued daily use and often work best when used consistently throughout the allergy season. Fluticasone and triamcinolone are two common over-the-counter options. Although they have similar effectiveness, I generally recommend triamcinolone because the spray is scent-free.
Antihistamines are also commonly used to relieve sneezing, itching, runny nose, and watery eyes. They work by blocking the effects of histamine, one of the chemicals responsible for allergy symptoms. Several non-drowsy antihistamines are available without a prescription, including cetirizine, desloratadine, and loratadine. These are generally preferred over older antihistamines because they last longer and cause less drowsiness, making them more suitable for daily use.
If symptoms are not adequately controlled with over-the-counter treatments, pharmacists may prescribe additional options. These include prescription-strength antihistamines, including higher doses of cetirizine or newer agents such as bilastine or rupatadine, as well as prescription corticosteroid nasal sprays and combination nasal sprays such as Ryaltris®, which contains both an antihistamine and a corticosteroid. These treatments can be particularly helpful for people with moderate to severe symptoms or those who continue to struggle despite appropriate use of over-the-counter medications.
Seasonal allergies commonly affect the eyes as well. Allergic conjunctivitis is caused by allergens such as pollen, dust, or pet dander coming into contact with the eyes. Symptoms typically include redness, intense itching, watery discharge, and swelling around the eyes, often affecting both eyes. Over-the-counter antihistamine eye drops can provide effective relief for many people. Pharmacists can also assess allergic conjunctivitis and recommend or prescribe additional treatment when needed. Management may include antihistamine and mast cell stabilizing eye drops such as olopatadine, cold compresses, and reducing exposure to allergy triggers. Symptoms often improve within a few days of starting treatment but may persist as long as exposure to the allergen continues.
Reducing exposure to allergens is an important part of managing seasonal allergies. Monitor local pollen forecasts and consider limiting outdoor activities when pollen counts are high. Keeping windows closed in your home and vehicle, changing clothing after spending time outdoors, and showering before bed can help reduce exposure. Regular use of saline nasal rinses may also help wash away pollen and other allergens before they trigger symptoms.
Assessments for allergic rhinitis and allergic conjunctivitis are publicly funded for patients with a valid New Brunswick Medicare card. For allergic rhinitis, coverage is available for an initial assessment plus two follow-up assessments. For allergic conjunctivitis, coverage is available for two assessments within a 12-month period.