What are the discharge instructions for managing seasonal allergies?

From the Guidelines

To manage seasonal allergies, routinely prescribe monotherapy with an intranasal corticosteroid rather than an intranasal corticosteroid in combination with an oral antihistamine. This approach is supported by the 2017 Joint Task Force on Practice Parameters guideline, which recommends monotherapy with an intranasal corticosteroid as the initial treatment for seasonal allergic rhinitis in persons aged 12 years or older 1.

Some key points to consider when managing seasonal allergies include:

• Using intranasal corticosteroids such as fluticasone (Flonase) or triamcinolone (Nasacort) nasal sprays, with 1-2 sprays in each nostril once daily 1
• Avoiding known triggers by keeping windows closed during high pollen days, showering after outdoor activities, and using air purifiers with HEPA filters 1
• Staying hydrated and monitoring local pollen counts to plan activities accordingly 1
• Using over-the-counter antihistamine eye drops like ketotifen (Zaditor) for itchy, watery eyes 1
• Consulting a healthcare provider if symptoms do not improve within 2-3 weeks, or if difficulty breathing, severe sinus pain, or fever occur 1

It's essential to note that the guideline development and review process involved a workgroup of volunteers from the American Academy of Allergy, Asthma and Immunology (AAAAI) and the American College of Allergy, Asthma and Immunology (ACAAI), who reviewed the quality of published trials and considered safety, cost, and patient preference when making recommendations 1.

From the FDA Drug Label

Some patients (12 years of age and older) with seasonal allergic rhinitis may find as-needed use of Fluticasone Propionate Nasal Spray, USP (not to exceed 200 mcg daily) effective for symptom control

• Discharge instructions for managing seasonal allergies may include using Fluticasone Propionate Nasal Spray, USP as needed, not to exceed 200 mcg daily, for patients 12 years of age and older.
• Scheduled regular use may achieve greater symptom control.
• Patients should be instructed to use the medication only on days when they think they need it for symptom control, not to exceed 2 sprays per nostril on any day, and not more than once daily 2

From the Research

Discharge Instructions for Managing Seasonal Allergies

• Patients with seasonal allergic rhinitis should avoid inciting allergens 3
• First-line treatment for mild intermittent or mild persistent allergic rhinitis may include:
  • Second-generation H1 antihistamines (e.g., cetirizine, fexofenadine, desloratadine, loratadine) 3, 4
  • Intranasal antihistamines (e.g., azelastine, olopatadine) 3
• For patients with persistent moderate to severe allergic rhinitis, treatment should be initiated with an intranasal corticosteroid (e.g., fluticasone, triamcinolone, budesonide, mometasone) either alone or in combination with an intranasal antihistamine 3, 5, 6
• Combination therapy of an intranasal corticosteroid and an oral antihistamine may be effective for some patients 5, 6
• Patients should be instructed to keep a symptom diary to track their symptoms and adjust their treatment accordingly 5
• Education on the proper use of medications, including dosage and administration, is essential for effective management of seasonal allergies 6

Medication Options

• Second-generation oral antihistamines: levocetirizine, loratadine, bilastine, fexofenadine 4
• Intranasal corticosteroids: fluticasone, triamcinolone, budesonide, mometasone 3, 5, 6
• Intranasal antihistamines: azelastine, olopatadine 3

Lifestyle Modifications

• Avoiding inciting allergens is crucial for managing seasonal allergies 3
• Patients should be aware of the pollen count in their area and take necessary precautions to minimize exposure 4