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Ask a Pharmacist: Attacking Your Allergies

, by Jennifer Cocohoba, PharmD, AAHIVE

Man sneezing into a tissueBirds chirping, new leaves growing, and wildflowers blooming announce the arrival of spring. But for some people, the sniffles, a persistently runny nose, and itchy, watery eyes also announce that spring is here.

These seasonal allergies—sometimes called “hay fever”—result from pollens, dust, and other substances that cause short-term inflammation of the respiratory passages. Common symptoms include congestion, itchiness, sneezing, rhinorrhea (a runny, watery discharge from the nose), irritated eyes, fatigue, and headaches. (Seeing green nasal discharge or coughing up phlegm? These symptoms go beyond seasonal allergies and warrant a call to your doctor.)

When a foreign substance—the allergen—enters your nose or eyes and interacts with your immune system, your body begins activating biochemical signals. Histamine and other chemicals are released, causing the allergy symptoms. “Seasonal” allergies may begin as early as February but may last through the fall when ragweed—a common plant allergen—is in bloom. In some states, people may experience perennial, or year-round, allergies because allergy-causing plants grow all year long.

If you suffer from seasonal allergies, you certainly are not alone. In the 2005–2006 National Health and Nutrition Examination Survey, a study designed to measure the health and nutrition status of Americans, 6.6% of participants reported having hay fever. The American Academy of Allergy, Asthma, & Immunology states that 7.8% of the U.S. population has hay fever, and 10% to 30% of the population experiences allergic rhinitis, in which allergy symptoms primarily affect the nose.

Seasonal Allergies and HIV: Questions Remain

It is unclear whether seasonal allergies are more common in persons living with HIV/AIDS (PLWHA) than in those without HIV disease. In one cross-sectional survey of 136 PLWHA in a New York clinic, 15% of participants self-reported having hay fever. This proportion is higher than reports of hay fever in the general U.S. population; however, the statistics are difficult to compare because they were measured in different samples in different years.

For PLWHA, it is also unknown whether severity of allergy symptoms changes with your health status. A cross-sectional survey conducted with 203 PLWHA at a Texas outpatient HIV clinic found no statistically significant difference in the severity of allergy symptoms for those with HIV versus those whose HIV disease had progressed to AIDS. Severity of nasal or sinus symptoms did not appear to be significantly associated with CD4 cell count either.

Scientists continue to conduct research to better understand the chemical signaling pathways through which seasonal allergies manifest, and how these might differ in PLWHA compared with the general population.

Seeking Relief: Strategies and Over-the-Counter Remedies for Seasonal Allergies

Fortunately, there are plenty of over-the-counter medicines to help you if you are suffering from symptoms of seasonal allergies, and most of these non-prescription products do not have clinically significant interactions with HIV meds (in rare instances, some may increase sedation, or sleepiness). In fact, there are so many choices that the “cold and allergy” aisle can be a very confusing place. Test your own knowledge in a few of the allergy-adventure scenes below.

Scene 1: Hide or Seek

It’s a bright, windy day. You’re thinking about the long list of spring chores you want to accomplish such as sweeping out the garage, planting seeds in the garden, and mowing the lawn. Your partner looks at you and jokingly says, “I know you’re going to be miserable with a runny nose and itchy eyes from your allergies. Maybe you should just stay in bed.” You wonder if you should…

  1. Stay in bed. Your partner is right—the best way to stop allergy symptoms is to avoid the things you are allergic to.
  2. Go off and do your chores. There’s nothing you can do to help keep your allergies at bay.

If you chose A: There is some merit behind this choice, although it may not need to be as extreme as staying in bed all day. (If you are allergic to dust mites, which lurk in pillows and other bedding, staying in bed might not help either!) There are several strategies you can use to help minimize your exposure to allergens. Listen to the news or read the newspaper for pollen counts; if pollen counts are high, you may want to save outdoor work for another day. You can let someone else do the garden chores or the sweeping, or you can wear a dust mask. Consider showering or changing clothes after doing those chores or after an extended period outside, because allergens may stick to your hair and clothing. You may need to keep the windows closed in your house to prevent allergens from blowing in. Air conditioning and other special air filters sometimes help reduce allergy symptoms.

If you chose B: It is true, you don’t have to let allergies stop you from performing activities. Go back and read choice A to find out some strategies you can use to minimize or avoid your allergic triggers.

Scene 2: Pick Your Poison

It is another miserably pollen-filled day. Your nose is itchy and raw from constantly using tissues, and it feels like it’s been running non-stop for several days. You head to the cold and allergy section of your pharmacy and pick up a bottle of…

  1. Diphenhydramine (e.g., Benadryl) or chlorpheniramine (e.g., Chlor-Trimeton). Oldies but goodies, and cheaper to boot.
  2. Loratidine (e.g., Claratin), fexofenadine (e.g., Allegra), or cetirizine (e.g., Zyrtec). Aren’t the newer ones supposed to be better?
  3. Pseudoephedrine (e.g., Sudafed). If it’s behind the counter with the pharmacist, it must work.

If you chose A: Diphenhydramine and chlorpheniramine are two examples of older “first-generation” antihistamines. They block histamine receptors so your body cannot create the itchy, watery, inflammatory reaction. While these medicines will certainly work to treat your nasal allergy symptoms (especially runny nose), they also come with a host of side effects that not everyone can tolerate. First-generation antihistamines are very lipophilic, or “fat loving,” and they tend to cross the blood-brain barrier and block histamine-1 receptors in the brain, causing sedation. They can also interact with cholinergic receptors and can cause blurry vision and dry mouth.

If you chose B: Medicines like loratadine, fexofenadine, and cetirizine are considered “second-generation” antihistamines. They work the same way as older antihistamines, but they are less likely to cross the blood-brain barrier. Because they don’t cross, they usually cause less sedation. For example, fexofenadine appears to be truly non-sedating, loratadine is only sedating when taken at higher doses, and cetirizine can be mildly sedating at its usual dose but is less sedating than older antihistamines. Second-generation antihistamines also have lower anticholinergic activity, meaning less blurry vision and dry mouth.

If you chose C: Antihistamines can help with itching and somewhat with runny nose, but they usually do not provide relief of nasal congestion. Medicines such as pseudoephedrine work on alpha-adrenergic receptors to provide relief of congestion. Pseudoephedrine was a popular decongestant, but because it can be used to manufacture methamphetamine, it is now stored behind the pharmacist’s counter. Most decongestants on the shelves contain phenylephrine, a slightly weaker decongestant. Decongestants can sometimes cause people to feel jittery and to have trouble sleeping. Also, if you have high blood pressure, experience heart palpitations, or have underlying heart disease you should speak with your doctor before using a decongestant.

Scene 3: Eye to Eye

You have picked your medicine in the allergy aisle. You rub your itchy, watery eyes and wonder if you should pick up something to help. You…

  1. Pick up a bottle of Visine to “get the red out.”
  2. Do nothing. Your antihistamine should help your eye symptoms.

If you chose A: You could buy a specific eye product, but if you do, it is important to read the labels carefully. Most over-the-counter eye drops contain tetahydrozoline or oxymetazoline, which are decongestants. Decongestants may reduce the symptom of eye wateriness associated with allergies but usually do not relieve itching. Some eye drops contain both a decongestant to slow watery discharge and an antihistamine such as pheniramine to help relieve itching. These products may be helpful for eye allergy symptoms—but then again, if you’re already taking an oral medication for your allergies, read below.

If you chose B: An oral medication, such as a decongestant or an antihistamine, should also give your seasonal allergy–affected eyes some relief. A specific product for your eyes is not really necessary if you’re taking an oral medicine, though some people find that taking both gives them better symptom relief.

As you choose your own allergy-relief adventure, remember that you can always ask your pharmacist to help you choose the best self-care product for your symptoms. If over-the-counter remedies do not seem to be helping, contact your doctor.

Your doctor may refer you to an allergy specialist if your symptoms seem severe, or may request that you have a skin test to determine what substances you are allergic to. Your doctor or allergist may recommend a prescription-only allergy medication, such as a nasal steroid, which requires close monitoring if you’re on protease inhibitors as they can dramatically raise the blood levels of these nasal steroid drugs and cause unwanted side effects.

Seasonal allergies do not have to get the best of you. Your pharmacist and your doctor can be two of your greatest allies in managing your seasonal allergy symptoms.

Jennifer Cocohoba, PharmD, is an associate clinical professor in the School of Pharmacy at the University of California, San Francisco (UCSF). Since 2004, she has worked as the clinical pharmacist for the UCSF Women’s HIV Program, where she provides adherence support and medication information to patients and providers.

Selected Sources

Salo, P. and others. Allergy-related outcomes in relation to serum IgE: results from the National Health and Nutrition Examination Survey 2005–2006. Journal of Allergy and Clinical Immunology 127(5):1226–1235.e7. May 2011.

American Academy of Allergy Asthma & Immunology. Allergy Statistics. http://www.aaaai.org/about-the-aaaai/newsroom/allergy-statistics.aspx.

Lin, R. and T. Lazarus. Asthma and related atopic disorders in outpatients attending an urban HIV clinic. Annals of Allergy, Asthma and Immunology 74(6): 510–515. June 1995.

Porter, J. and others. Prevalence of sinonasal symptoms in patients with HIV infection. American Journal of Rhinology 13(3):203–208. May-June 1999.

Goetz, D. and others. Aeroallergen-specific IgE changes in individuals with rapid human immundeficiency virus disease progression. Annals of Allergy, Asthma and Immunology 78(3):301–306. March 1997.

Corominas, M. and others. Predictors of atopy in HIV-infected patients. Annals of Allergy, Asthma and Immunology 84(6):607–611. June 2000.

Mayo Clinic. Seasonal Allergies: Nip them in the bud. http://www.mayoclinic.com/health/seasonal-allergies/AA00060.

Krouse, J. Allergic rhinitis—current pharmacotherapy. Otolaryngologic Clinics of North America 41(2):347–358. April 2008.

Weber, R. Allergic rhinitis. Primary Care: Clinics in Office Practice 35(1):1–10. March 2008.

Comments

5 Responses to Ask a Pharmacist: Attacking Your Allergies

  1. homey says:

    What about non-toxic, natural, homeopathic solutions for allergies? Why does one have to “Pick your poison?” There are so many great herb, supplements and homeopathic remedies available, which could be especially helpful for those with compromised immune systems who might not want to take another chemical that can add to the burden of the liver and kidneys. surely there are experts that the community can go to for this advice.

    • San Francisco AIDS Foundation says:

      Thank you for your comment! Complementary and alternative therapies are definitely areas we’d like to explore on BETA. If you have suggestions for specific topics or resources, we’d be glad to hear them; you can reach us at beta (at) sfaf.org. Thanks again!