Ask The CVS Pharmacist About Allergies

Do you know what you need to know about allergies? 

CVS Pharmacist Jeff McClusky answers your questions:

Q: I live in Winnipeg, Manitoba and it gets very cold in the winter, and I suffer from an allergy to the cold. The rest of the year, I suffer from hay fever. I have also had severe asthma since I was 2. The asthma is under control, but my allergies make it difficult to live a normal life. I can’t go outside in the winter because my asthma flares up and I get really bad headaches and red, itchy blotches on my skin. The rest of the year, I’m congested and I avoid going out when it’s windy. My question is: Can you give me any suggestions to make my life in Winnipeg a little easier? – From Lorraine in Manitoba

JM: Allergies can be difficult to manage at times, especially in an area like Winnipeg where the weather varies sharply from season to season. Without knowing what you are currently taking for the various allergies you have, it is hard to recommend an alternative. However, it is possible to find relief from year-round allergy symptoms by using certain over-the-counter (OTC) or prescription medications. Medications for hay fever, also known as seasonal allergic rhinitis, include antihistamines, decongestants, nasal corticosteroids and leukotriene modifiers. Most medications can be started a few weeks before allergy season and continued throughout to provide the greatest relief. The following is a review of OTC and prescription treatment options available in the U.S. Talk to your local pharmacist to verify the availability of these or similar products in Canada.

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Antihistamines are a class of medications that block the release of histamine in the body and can significantly reduce allergy symptoms. Antihistamines are useful in patients with mild-to-moderate allergy symptoms, especially itchy, watery eyes, itchy throat, sneezing and a runny nose. Some common OTC antihistamines include diphenhydramine (e.g. Benadryl®), chlorpheniramine (e.g. Chlor-Trimeton®), clemastine (e.g. Tavist®), loratadine (e.g. Claritin®, Alavert®) and cetirizine (e.g. Zyrtec). During the winter, when your allergies seem to be more bothersome and persistent, these medications can be taken daily to avoid experiencing these symptoms.

Another class of allergy medications is decongestants, which help to decrease nasal congestion and stuffiness. The most common oral decongestants in the U.S. include pseudoephedrine and phenylephrine (e.g. Sudafed®, Sudafed PE®), and are available in combination with many OTC and prescription antihistamine products. These medications can be useful to help relieve your allergy symptoms and congestion, especially in the spring and fall. There are also nasal decongestant sprays available, that contain phenylephrine (e.g. Neo-Synephrine) and oxymetazoline (e.g. Afrin®), but these medications cannot be used long-term. An alternative to a nasal decongestant spray is nasal saline spray or drops, also effective for clearing out a stuffy nose.

Remember to first discuss taking any OTC medication with your doctor or pharmacist. If your symptoms do not resolve using any of the above options, he or she may prescribe prescription-strength antihistamines and decongestants. In addition to these, nasal corticosteroids are prescription nasal sprays that reduce swelling in your nasal passages and prevent symptoms such as sneezing, itching and a runny nose. These medications work very well, but can take up to a week before their full effects can be seen. Also, leukotriene modifiers are effective at reducing the symptoms of seasonal allergies; available in the U.S. such as montelukast (Singulair®) and zafirlukast (Accolate®).

The best way to prevent seasonal allergy symptoms is to avoid the allergens that trigger them. Ask your doctor to perform a skin scratch test to determine which specific allergens cause your allergy symptoms. Also, whenever possible avoid the outdoors and close the windows on days where pollen and other allergen counts are high, as well as on windy, dry days when the allergens may be strong. Pollen levels peak in the morning, so limit outdoor activities during this time. Also, it is helpful to remove and wash your clothes after being outside to remove any pollen or allergens that may linger. A high-efficiency particulate air (HEPA) filtration system in your home may be useful for cleaning the air indoors. Although it may not be necessary to avoid spending time outdoors altogether, it is possible to reduce the likelihood of suffering from allergy symptoms by following these simple ideas.

Q: I am on Lexapro® and I am concerned that I might have bleeding because I am on Naproxen 500 x 2 a day. – From Cindy in Texas

JM: Using Lexapro® (escitalopram), a serotonin-reuptake inhibitor (SSRI) usually used for depression, together with Naproxen, a nonsteroidal anti-inflammatory drug (NSAID) usually used for pain and inflammation, may increase your chances of bleeding. All NSAIDs can thin your blood to a certain degree, and SSRIs increase that effect when they are taken together. You should report any unusual bleeding to your physician immediately. For instance, you may notice that you bruise more easily than normal, or that it may take longer for your blood to clot if you cut yourself. In extreme cases you may notice the appearance of black, tarry stools that resemble coffee grinds when you go to the bathroom, a sign of internal bleeding. Your physician may want to switch you to another pain-relieving medication that will not interact with Lexapro®, or place you on a medicine that will protect your gastrointestinal (GI) tract from bleeding. For example, proton pump inhibitors (PPIs) are often prescribed to treat gastrointestinal reflux disease (GERD) and ulcers, and can be used to protect the stomach from issues with bleeding while taking NSAIDS. I recommend speaking with your physician about your concerns as soon as possible.

Q: I am 22 and have recently been diagnosed with celiac disease after not being able to keep food down and having a lot of abdominal pain. I had the blood tests and they came back positive. Why did it take until I was 22 for me to react to wheat and gluten? And, is there anything I can do so I can still eat my favorite foods? – From Elizabeth in Ohio

JM: Celiac disease is a disorder resulting from an intolerance to gluten (a protein) in your diet. It causes damage to your small intestine and affects your ability to absorb nutrients from the foods you eat. Unfortunately, celiac disease is a lifelong condition, but if properly managed, patients can live normal and happy lives. Celiac disease is an autoimmune disease, which means your immune system is attacking the cells in your body. There is a genetic link to celiac disease, which means that you have a predisposition to developing celiac disease but it may not develop until later in life. In adults, it is typical that symptoms begin to develop between ages 20 to 50.

Symptoms typically subside after beginning a gluten-free diet, though the damage that has already been done needs time to heal, which may take several months. Symptoms will return again when foods with gluten are reintroduced to the body. Unfortunately, you may never be able to enjoy some of your favorite foods again. Manufacturers and restaurants are becoming more aware of this disease and creating products to accommodate people. You will be able to find a variety of products now that are labeled gluten-free, and you should always make your server in restaurants aware of your needs. There may be a separate menu or specific foods that do not contain gluten.

"It is important to know that anything you ingest may have gluten. It is not just breads and pastas."

It is important to know that anything you ingest may have gluten. It is not just breads and pastas. For example, certain over-the-counter and prescription medicines contain gluten in the form of starch. You should always make your pharmacist aware of this condition, and ask about the gluten content of products you are taking. Other hidden sources of gluten include postage stamps and envelope adhesives, lipsticks, crumbs in a toaster or on a cutting board, cross-contamination, ground spices, toothpastes and mouthwashes.

You will need to learn to read food labels very carefully and ask questions about prepared foods. Typical ingredients containing gluten are: wheat (farina, graham flour, semolina and durum), rye, barley, bulgur, kamut, kasha, matzo meal, spelt, triticale and oats. Foods that are generally safe to eat include fresh meats, fish, poultry (as long as it's not breaded or marinated), most dairy products, fruits, vegetables, rice, potatoes and gluten-free flours.

There are many reputable resources on the Internet for you to learn more about your condition, such as the American Celiac Disease Alliance ( ), the National Institute of Health’s Celiac Disease Awareness Campaign ( ) and the Celiac Disease Foundation ( ).

It may be helpful to use these resources and speak with other people who have celiac disease to exchange information and recipes. It would also be beneficial to speak with a registered dietician for more information.

Q: My 11-year-old daughter has severe allergies to where, at times, just being outside for short periods of the day, she will suddenly have running, watery eyes, and that have that cold-like stuff in her eyes, and they are also red. The other day, her throat was hurting also. Her symptoms of allergies seem different from year-to-year; she doesn’t get a break at all. We always will miss school or be late for school. She had an allergy skin test several years ago, and it said she is allergic to everything, in a sense of a way. I have tried just about everything I can think of and what the doctors tell me. – From Marie in Georgia

JM: Allergies can change from year-to-year, which is perfectly normal. Some allergies are more serious than others. For instance, seasonal allergies are very common and rarely life-threatening. However, food and insect bite allergies can be more serious, potentially leading to a sharp drop in blood pressure, severe skin symptoms like swollen lips, difficulty breathing and severe stomach upset (cramping, vomiting, and diarrhea – a reaction also known as anaphylaxis). If your daughter has a known severe allergy such as this, you should have an Epi-Pen® (epinephrine) kit to treat dangerous allergic reactions at all times. Also, it is important for her safety to have someone at home, work and/or school that can administer this injection in the event that you are either unable to or not available at the time of her reaction.

The good news is, in a lot of cases, seasonal and respiratory allergies subside or even disappear by the time a child reaches the teenage years. Food allergies are also usually outgrown if the offending food is removed from the diet for a few years.

The safest over-the-counter product to use would be nasal saline sprays to relieve nasal irritation and dryness. This could decrease stuffiness, runny nose, and sneezing. There are also many things you can do around the house to reduce allergies as much as possible without medications. Recommendations are as follows:

• Keep windows and doors closed during pollen season
Avoid fans that draw in outside air
Use air conditioning with a high-efficiency particulate air (HEPA) filter
If possible, eliminate outside activities during times of high pollen counts
Shower, shampoo and change clothes following outdoor activity
Use a vented dryer rather than an outside clothesline

Use similar controls as above
Avoid walking through uncut fields, working with compost or dry soil and raking leaves
Clean indoor moldy surfaces
Fix all water leaks in the home
Reduce indoor humidity to less than 50 percent if possible

House Dust Mites
Encase mattresses, pillows and box springs in an allergen-impermeable cover
Wash bedding in hot water weekly
Remove stuffed toys from bedroom
Minimize carpet use and upholstered furniture
Reduce indoor humidity to less than 50 percent if possible

Animal Allergens (if removal of pet is not acceptable)
Keep pet out of bedroom
Isolate pet from carpet and upholstered furniture
Wash pet weekly

Keep food and garbage in tightly closed containers
Take out garbage regularly
Clean up dirty dishes promptly
Use roach traps

Additional Recommendations
Do not allow smoking around the person affected, in the house or in the family car
Minimize the use of wood-burning stoves and fireplaces
Use washable area rugs and avoid wall-to-wall carpeting

Q: Is 6 months old too young to have allergies? I think my son has them. He has been congested, and has had an on-and-off cough, sneezing and running nose for about two months now, but whenever I take him to the doctor, there isn't anything wrong. His symptoms come and go throughout the day, and one day he will be fine and the next day he will be congested! That is why I am wondering about allergies; his dad has allergies really bad. – From Tonya in Michigan

JM: Six months of age is not too young to develop allergies, but it is too young to take any medications for allergies. It is important to give your doctor specific information about the symptoms that your son is having at home. You should keep a record of when his allergies occur to help determine what is causing them.

Keep track of the following information regarding your son’s symptoms and bring it with you to review with your pediatrician:
The symptom your son experienced (for instance, runny nose, sneezing, chest congestion, cough)
The date and time during which the symptom occurred
Weather conditions that day
Any changes to his normal routine
How long the symptoms lasted

There are hundreds of different allergy triggers with pollen, mold, dust mites and animal dander being the most common. Timing is a good detector of what allergy triggers are responsible. For instance, if your son develops symptoms only in the spring, he may have hay fever, caused by an allergy to pollen. If his symptoms seem to persist, he might be allergic to mold, mites or animal dander. The good news is, in a lot of cases, seasonal and respiratory allergies improve or even disappear by the time a child reaches the teenage years.

Some infants who are exposed to high levels of dust mites are at increased risk for developing asthma. Environmental control of these allergens may be helpful in stopping further allergy symptoms and prevent later asthma. See the previous response for a list of things you can do around the house to reduce allergies as much as possible without medications. 

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