From the Guidelines
For severe pollen allergies when antihistamines aren't working, the most effective next step is to use nasal corticosteroids like fluticasone (Flonase) or mometasone (Nasonex) daily during allergy season to reduce inflammation, as recommended by the 2017 Joint Task Force on Practice Parameters 1. When considering alternative treatments, several options can be explored:
- Leukotriene modifiers such as montelukast (Singulair) can be taken orally once daily, especially in patients with concurrent mild persistent asthma, as they may provide additional benefits for seasonal allergic rhinitis 1.
- Allergen immunotherapy (allergy shots) can gradually desensitize the immune system through regular injections over 3-5 years, offering a long-term solution for severe cases.
- Sublingual immunotherapy tablets like Grastek or Ragwitek provide a similar approach without needles, offering an alternative for patients who prefer not to receive injections.
- Combination therapy using multiple medication types often works better than single treatments, as evidenced by studies comparing the efficacy of combination therapy with an intranasal antihistamine and an intranasal corticosteroid compared to monotherapy with either agent 1.
- Nasal saline irrigation with devices like neti pots can physically flush allergens from nasal passages, providing relief from symptoms.
- Environmental controls, such as keeping windows closed during high pollen days, showering after outdoor activities, using HEPA air purifiers, and tracking pollen counts to plan activities accordingly, are also crucial in managing severe pollen allergies.
These treatments work by either blocking inflammatory pathways, reducing immune system reactivity to allergens, or physically removing allergens from the environment, ultimately improving morbidity, mortality, and quality of life for individuals with severe pollen allergies.
From the FDA Drug Label
Fluticasone Propionate Nasal Spray, USP works right in your nose to help block your allergic reaction at the source to relieve the symptoms that make you uncomfortable. Fluticasone Propionate Nasal Spray, USP acts on multiple inflammatory substances, including histamine, prostaglandins, cytokines, tryptases, chemokines and leukotrienes Most common OTC allergy pills act on histamine alone.
If antihistamines are not effective for severe pollen allergy, Fluticasone Propionate Nasal Spray, USP can be considered as an alternative treatment. It works by blocking the allergic reaction at the source and relieving symptoms such as sneezing, itchy nose, runny nose, and itchy, watery eyes. Additionally, it can also relieve nasal congestion.
- Key benefits:
- Relieves a broad range of symptoms from many allergens
- Acts on multiple inflammatory substances, not just histamine
- Can be used for allergies caused by pollen, mold, dust, or pet dander
- Important considerations:
- Should not be used by people who have had an allergic reaction to Fluticasone Propionate Nasal Spray, USP or any of its ingredients
- Should be used with caution in people taking certain medications, such as those for HIV infection or fungal infections
- Children aged 4-11 should use a lower dose and for a shorter period of time than adults 2 2
From the Research
Alternative Treatments for Severe Pollen Allergy
When antihistamines are ineffective, there are several alternative treatments that can be considered for severe pollen allergy. These include:
- Allergen Immunotherapy: This is a long-term treatment that involves regular injections or sublingual tablets to desensitize the body to specific allergens, such as pollen 3, 4, 5, 6.
- Subcutaneous Immunotherapy: This involves injecting small amounts of the allergen into the skin to build up tolerance 3, 4, 5, 6.
- Sublingual Immunotherapy: This involves placing a tablet or liquid under the tongue to build up tolerance 3, 4, 5, 6.
- Oral Immunotherapy: This involves ingesting small amounts of the allergen to build up tolerance, often used for food allergies but also being researched for other types of allergies 5.
Efficacy of Alternative Treatments
Studies have shown that these alternative treatments can be effective in reducing symptoms of severe pollen allergy. For example:
- A study found that subcutaneous and sublingual immunotherapy were effective in reducing symptoms of allergic rhinitis and asthma 3.
- Another study found that sublingual immunotherapy was safe and effective for treating seasonal allergic rhinitis 7.
- A comparative study found that all administration routes (subcutaneous, sublingual, and oral) were effective, but each had its own advantages and disadvantages 5.
Considerations for Alternative Treatments
When considering alternative treatments, it's essential to: