caseSTUDIES

Author: Lauren S. Schlesselman, PharmD

CASEONE:

MK, a 30-year-old housewife, comes to the pharmacy to purchase an OTC treatment for her allergies. She requests assistance from the pharmacist to choose the best product. The pharmacist asks her about her symptoms and how long she has had them.

MK informs the pharmacist that every spring, when she starts to get her flower garden ready for planting and around the time that the trees start budding, she develops nasal congestion, runny nose, and sneezing. During their conversation, the pharmacist observes that MK is breathing through her mouth and constantly wiping her nose with a tissue.

The pharmacist asks MK whether she has any difficulty continuing her normal activities or sleeping due to her symptoms. She admits that the symptoms are annoying but not so severe that she cannot sleep or that she has to stop her normal activities, including gardening. The pharmacist also asks her how long she has had these symptoms, and she replies that she has had them for 2 weeks. She says that the symptoms typically last only 3 to 4 weeks.

The pharmacist walks into the aisle to make a recommendation for MK. Based on her symptoms and their duration, how is her allergic rhinitis classified? What treatment option is recommended for this classification

CASE TWO:

AH, a 35-year-old man, comes to the pharmacy to purchase an OTC medication for his allergies. He asks the pharmacist where he can find the antihistamines.

AH explains that his doctor recommended that he try an oral antihistamine to control his pollen-allergy symptoms, because his symptoms are intermittent and mild. AH is concerned that the antihistamines will cause drowsiness and interfere with his daytime activities. The pharmacist recommends that he try loratadine or another second-generation antihistamine because they are associated with less sedation than diphenhydramine and other firstgeneration antihistamines.

As the pharmacist is ringing up his purchase, AH inquires about ways to avoid pollen and thereby reduce his allergic rhinitis. He has already hired a teenager in the neighborhood to mow his lawn. What recommendations can the pharmacist make to help him avoid pollen exposure?

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A N S W E R S

CASE ONE:

If MK's symptoms do not interfere with activities of daily living, they would be considered mild. Symptoms lasting less than 4 weeks or occurring less than 4 days per week would be considered intermittent. Therefore, she has mild intermittent allergic rhinitis. The Allergic Rhinitis and Its Impact on Asthma guidelines recommend oral antihistamines for the treatment of mild intermittent allergic rhinitis. The guidelines also recommend avoidance of allergens whenever possible.

CASE TWO:

Along with not cutting the grass himself, AH should keep windows closed when the grass has been mowed and at peak pollen times, particularly in the evening. He should consider wearing glasses or sunglasses to prevent pollen from entering his eyes. During peak times, he can consider wearing a mask over his nose and mouth to prevent inhalation. Using an air conditioner with pollen filters, even in the car, also will reduce pollen exposure.