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Ask the Pharmacist: Seasonal allergies and how to manage the Irish pollen season
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In this instalment of Ask the Pharmacist, featuring Boots director of pharmacy Caoimhe McAuley, we dive into seasonal allergies.
While many cheer the arrival of warmer weather, for others it is marred by the onset of itchy eyes, sneezing and congestion as they battle seasonal allergies. In this column, we explore how best to treat your allergies with Boots director of pharmacy Caoimhe McAuley. Whether you are trying to stay sharp with modern, non-drowsy antihistamines or looking for simple, evidence-based lifestyle tweaks to trap pollen before it hits your airways, this interview will help you navigate and manage the lengthy Irish pollen season.
Most people wait until they are sneezing to take action. When is the optimum time to start allergy medication for the Irish pollen season?
Start before you sneeze – don’t wait until you’re suffering to begin treatment. Medications like antihistamines and nasal steroid sprays work best as preventatives, not rescue remedies. In Ireland, we have a really long pollen season, with tree pollens like birch and ash starting to flower as soon as March, while grass pollen – the biggest culprit for most sufferers – peaks in June and July and can linger right into September and October. Because nasal steroids generally take a few days to kick in, I recommend taking your seasonal allergy medications around two weeks before you would typically expect your symptoms to begin.
With spring colds still circulating, what are the tell-tale clinical signs that it’s actually an allergy?
This is genuinely one of the most common questions I used to get at the pharmacy counter in spring. The clinical tell-tale signs of an allergy versus a cold are actually quite distinct once you know what to look for.
With a cold, you’ll often feel a sore throat first, develop thick (and potentially coloured) mucus, body aches, and possibly a low-grade fever, and crucially you’ll likely feel better within seven to ten days. With an allergy, think itch. Itchy, watery eyes, an itchy nose, throat, or ears, persistent clear watery nasal discharge, and sneezing that carries on for weeks are classic signs. Another giveaway is that allergy symptoms fluctuate with your environment. If you feel worse outdoors or on a windy day, and better indoors with windows closed, that’s a significant clue it’s allergic rhinitis rather than a virus.
Many women avoid antihistamines because they fear they’ll impact their focus (we hear the word ‘foggy’ being used). What are the modern, non-drowsy options available over the counter now?
I hear this concern constantly, and it’s largely rooted in the older generation of antihistamines such as Piriton (chlorphenamine), which actually does cause sedation. Thankfully, we now have an excellent range of second and third-generation non-drowsy antihistamines available over the counter. Your key options are:
- Cetirizine: Fast-acting and effective for most symptoms, though a small number of people may find it somewhat sedating.
- Loratadine: This would be the least sedating of the second-generation antihistamines.
- Fexofenadine: This third-generation antihistamine only recently came off prescription-only status in Ireland. It is probably the least sedating of them all.
All three are once-daily options and are appropriate for women who need to stay focused and productive. I’d always say: if one isn’t working well for you, it’s worth trying another. Your individual response may vary, and it is always worth chatting to your pharmacist.
When should someone choose a nasal spray over a tablet? Is there a correct technique for using sprays that people often get wrong?
This is where I put my clinical hat on and say that it really all boils down to what you’re trying to treat and what your symptoms are. When your dominant symptom is nasal congestion, a nasal spray is better because it works locally with minimal systemic absorption. Whereas if you’re experiencing a mix of sneezing, itchy eyes, and an itchy throat, you’d be better off using a tablet. Some people use a combination, which is completely fine for moderate to severe symptoms.
As for technique, this is where most people go wrong. The most common mistake is pointing the spray straight back and sniffing hard, which just sends the medication straight down your throat.
The correct method is:
- Blow your nose gently to clear your passages.
- Tilt your head slightly forward.
- Insert the nozzle into one nostril and — this is essential — use your opposite hand (left hand for the right nostril) to angle the spray towards your outer ear, not the centre of your nose.
- Press and breathe gently. There is no need for a forceful sniff.
Many people wouldn’t know that you have to aim it away from your nasal septum (the wall between your nostrils), but this technique prevents unnecessary irritation.
Speaking of nasal interventions, what about nasal rinses? Are they recommended?
Oh yes, absolutely. I love a nasal rinse and am a genuine advocate for nasal irrigation. They can oftentimes significantly reduce your allergy symptoms, including congestion, runny nose and sneezing.
Using a squeeze bottle bought in a pharmacy with a sterile saline solution is great practice. I would actually recommend doing it before administering your nasal steroid spray, as it clears your passages first.
For those who wear contact lenses or make-up, what are the best pharmacist-recommended solutions for pollen-induced eye irritation?
This is a question close to many of our customers’ hearts. Honestly, during high-pollen days, contact lenses can make things so much worse. Some helpful solutions include:
- Switching to your glasses on high-pollen days.
- Using preservative-free, contact-lens-compatible antihistamine or lubricating eye drops (always check that they are safe to use with your specific lenses).
- Applying eye make-up with caution, avoiding the inner waterline, and opting for hypoallergenic products during the allergy season.
- Wearing wrap-around sunglasses, which are genuinely brilliant at physically blocking pollen from reaching your eyes.
Can you explain the link between high pollen counts and sudden respiratory issues for those who don’t usually consider themselves asthmatic?
This is really important and under-discussed. High pollen counts can trigger sudden respiratory symptoms – coughing, chest tightness and wheezing – even in those who haven’t been diagnosed with asthma. This happens because the same inflammatory response that causes your nose and eyes to react can extend down into the lower airways.
Some research has shown that certain measures of lung function can decrease when people are exposed to high pollen counts. If you find yourself unusually breathless or wheezy during the pollen season and you’ve never considered yourself asthmatic, please mention it to your pharmacist or GP.
Beyond medicine, what small lifestyle changes (eg: showering at night, petroleum jelly barriers) actually have a clinical impact?
Beyond medication, there are several non-pharmacological measures with genuine evidence behind them, which is good news!
- Shower at night: Washing pollen off your hair and skin before bed is one of the single most impactful things you can do, as it prevents pollen transfer to your pillow and bedding.
- Apply a thin layer of petroleum jelly (Vaseline): Placing this inside the edges of your nostrils physically traps pollen before it reaches your airways.
- Keep windows closed: Do this on high-pollen days, particularly in the morning when counts peak.
- Change clothes: Swap your clothes immediately after spending time outdoors on high-pollen days.
- Monitor the pollen count: Met Éireann publishes daily pollen forecasts; on red-alert days, plan indoor activities.
- Dry laundry indoors: Avoid using the clothesline during peak season, as wet clothes act as excellent pollen collectors.
At what point does an allergy move from “manageable at the pharmacy counter” to requiring a prescription or a specialist?
As a pharmacist, I’m proud that we can manage the vast majority of allergy cases. With the introduction of allergic rhinitis being treatable under the common conditions service, that access has only expanded. However, a core part of the service and a vital function of a community pharmacist is knowing when to refer a patient onwards. Signs that warrant a GP visit include symptoms significantly impacting your sleep or daily functioning, the development of a wheeze or chest symptoms, recurrent sinus infections, facial pain (suggesting sinusitis), or swollen nasal polyps.
To learn more about how your local pharmacist can help you with summer ailments and beyond, visit your local Boots pharmacy or explore the new Common Conditions Service here.
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