Common precautions to prevent the spread of COVID-19, such as social distancing and wearing masks, also decreased the rates of common respiratory illnesses in 2020 and early 2021, according to results published in Open Forum Infectious Diseases in March.

Study results by investigators at Boston Medical Center (BMC) in Massachusetts showed an approximately 80% reduction in cases of influenza and other common viral respiratory infections compared with similar time periods in previous years when school closings, social distancing, and wearing of masks were not widely implemented.

Public health measures used to prevent COVID-19 transmission also can be useful in preventing other respiratory viral infections, according to the study authors.

“We know viruses that cause the common cold and pneumonia are spread through close contact, aerosols, and/or droplets, which is why we decided to look into how the measures implemented to prevent the spread of COVID-19 may have impacted the incidence of other common viral respiratory illnesses,” coinvestigator Manish Sagar, MD, an infectious diseases physician and associate professor of medicine at BMC, said in a statement.

The investigators performed a retrospective cohort analysis to analyze all documented respiratory viral infections at BMC between January 1, 2015, and November 25, 2020. These infections were diagnosed using a comprehensive respiratory panel polymerase chain-reaction test, which the study authors said scans for 20 common respiratory pathogens. Negative and positive results for SARS-CoV-2 tests were excluded, given the focus on other common respiratory illnesses prior to the COVID-19 pandemic.

According to the study, 2020 was divided into 2 periods: before the implementation of closing schools, social distancing, and wearing masks (period 1) and after the implementation of these practices (period 2).

The investigators analyzed the number of viral infections during periods 1 and 2 for 2015 through 2019 and compared them with the 2020 results.

In period 2 of 2020, after the implementation of measures to stop COVID-19, newly detected respiratory viruses were approximately 80% lower compared with 2015 through 2019. But in period 1 of 2020, there were more respiratory virus infections compared with 2015 through 2019.

Furthermore, the investigators noted that the phased reopening in Boston, which began around July 20, 2020, was associated with an increase in the detection of rhinovirus infections.

The findings could help experts develop prevention strategies for future cold and flu seasons even after the COVID-19 pandemic, according to the study authors.

“Our study results may be particularly helpful for developing prevention strategies in settings where respiratory infections are very harmful, such as congregate settings and for the elderly and immunosuppressed,” Sagar said.

Pranay S, Reifler K, Rossi M, Sagar M. COVID-19 mitigation strategies were associated with decreases in other respiratory virus infections. Open Forum Infect Dis. Published online March 20, 2021. doi:10.1093/ofid/ofab105

Articles

Common precautions to prevent the spread of COVID-19 also decreased the rates of common respiratory illnesses in 2020 and early 2021.

COVID-19 Precautions Cut Rates of Common Respiratory Illnesses

Antihistamines are commonly used to manage hives, sneezing, and watery eyes during allergy season, but many patients may be taking their medications incorrectly, according to Derek Chu, MD, PhD, an allergy expert and clinical scholar in medicine at McMaster University in Hamilton, Ontario.

"People need to rethink what they stock in their home cabinets as allergy medicines, what hospitals keep on formulary, and what policy makers recommend," he said in a statement.

"The message needs to get out. This publication is on time for the spring allergy season, and as COVID-19 vaccines roll out for which [reaction] rashes are common and antihistamines can be helpful," Chu continued.

Coauthor Gordon Sussman, MD, FRCPC, FACP, a professor of medicine at the University of Toronto, said in the statement that there are new second-generation antihistamines that prescribers should know.

 listed 5 things to know about proper antihistamine use.

Antihistamines are among the most commonly and incorrectly used medications worldwide, according to the statement.

Their best use is for managing hay fever and outbreaks of hives, not for asthma, coughs, eczema, or insomnia, according to the statement.

Notably, first-generation antihistamines are associated with substantial and sometimes fatal adverse effects (AEs). These antihistamines contain chlorpheniramine, diphenhydramine, or hydroxyzine, which can cause drowsiness and affect cognitive functions such as school performance. Overdosing with these antihistamines can cause death and are potentially dangerous for both older and young individuals. 

Second-generation antihistamines are safer and as affordable and effective as first-generation antihistamines, according to the study authors.

Later-generation antihistamines have been shown to be more effective and last longer with fewer severe AEs, such as drowsiness, according to the study authors.

In their fourth point, the authors said that antihistamines should not be used instead of epinephrine to treat anaphylaxis; oral drugs can be used in combination with epinephrine injections to treat anaphylactic reactions, but they are not a proper substitute.

Finally, the authors said that most antihistamines are safe to use during breastfeeding and pregnancy and are safe for children.

"These are new modern second-generation antihistamines that are potent, specific, fast acting, and of proven safety, which everyone should be using to treat allergic rhinitis and hives," Sussman said.

Are you using antihistamines properly? News release. April 6, 2021; McMaster University. Accessed April 8, 2021. https://www.eurekalert.org/pub_releases/2021-04/mu-ayu040121.php 

Prescribers should be aware of new, second-generation antihistamines to manage hay fever and outbreaks of hives, according to a recent study.

Antihistamines Are Not Always Used Correctly During Spring Allergy Season

Starting that fateful week in March 2020 when everyone’s life changed, health care settings closed their doors en masse.

From primary care to ambulatory surgery, physical therapy to massage therapy, nearly every setting of care suspended operations, except for emergency departments connected to hospitals and pharmacies. Yes, pharmacies. More than 60,000 remained open to patients, and most pharmacists continued their role as a source for OTC products and the free-of-charge counseling that often goes with them.

Telemedicine grew at an unprecedented rate starting in April 2020, but it did not entirely fill the health care void. Individuals needing acute medications, dose adjustments, or treatment for chronic diseases lost direct access to practitioners, but pharmacies remaining open meant patients could still receive their lifesaving medications. Of course, foot traffic slowed, and the flu was practically nonexistent in 2020, but hundreds of millions of Americans had access to basic triage, care delivery, medications, and testing supplies.

More than 80% of adults use OTC products as first-line treatment for common ailments. With Americans making approximately 3 billion trips to purchase OTC products annually and 60 million Americans using them who would otherwise not seek treatment, patient access to these products is essential to a well-functioning health care system. It is inconceivable these days to schedule an office visit, procure a prescription, and have it adjudicated by insurance just to get ibuprofen for an ankle sprain. A prescription for loratadine? Laughable. Yet less than 2 decades ago, nonsedating antihistamines were deemed too unsafe to be sold over the counter.

Making products available without a prescription does not have to mean patients go without care. Pharmacists and other health care professionals can counsel patients on all types of accessible and affordable OTC products. Does an Apple Watch’s electrocardiograph or pulse oximetry app keep patients from seeing their cardiologists? Do pregnancy tests keep women from visiting their gynecologists? Do wetting drops prevent patients from going to their ophthalmologists?

Do niacin or omega oils keep patients from getting their cholesterol checked? The answer to all these questions is no. Pharmacists have multiple encounters with patients every day, and most are just as meaningful to a patient’s care as billable encounters.

Expanding Access Through OTCs and Testing

COVID-19 self-administered testing is approved and available. Health plans have picked up on the power of patient convenience. Waning resistance against self-empowerment, which the pandemic necessitated, has enlisted a host of home-based diagnostics providing accessible and affordable screening and rescreening directly to health plan members—without a prescription. Need to improve A1c testing and reporting? Why not look to pharmacies or even send the tests directly to patients’ residences?

Postpandemic Self-Care and OTC Product Use

We are only a summer away from what will likely be the first widely prevalent cough and cold season of asthma flare ups, influenza, middle-ear infections, and rhinovirus in nearly 2 years. As social distancing and masking disappear, we will again share microbes. Disease surveillance and patient care will still have a prime spot in the consciousness of the frontline pharmacist’s mind in all seasons. Education, triage, testing, and counseling have a greater meaning and purpose than ever before, and much of this purpose is enabled by access to OTC products.

is vice president of pharmacy provider partnerships for Community Care of North Carolina, which works collaboratively with more than 2000 medical practices to serve more than 1.6 million Medicaid, Medicare, commercially insured, and uninsured patients. He received his PharmD and MBA degrees from Drake University and a PhD in pharmaceutical outcomes and policy from the University of North Carolina. He also serves on the board of directors of the American Pharmacists Association Foundation and the Pharmacy Quality Alliance.

OTC use statistics. Consumer Healthcare Products Association. Accessed May 24, 2021. https://www.chpa.org/about-consumer-healthcare/research-data/otc-use-statistics

COVID-19 permanently changed how pharmacists recommend and sell nonprescription options.

OTC Products Are Accessible When Traditional Health Care Delivery Is Not

Constipation is one of the most common gastrointestinal complaints, and it generally occurs when individuals have fewer than 3 bowel movements per week.

Symptoms may include dry and hard stools, a feeling of not fully emptying the bowels, and straining during bowel movements.

 Many factors can contribute to constipation, including a lack of exercise or not getting enough fiber; conditions such as diabetes, irritable bowel syndrome, or pregnancy; and drugs such as antidepressants, blood pressure medications, or opioids.

 Increasing fiber, fitness, and fluids are important lifestyle modifications to start with for patients with constipation. If these changes are not enough, health care providers can help patients select an appropriate OTC laxative to manage their constipation.

Before recommending laxatives, keep in mind that individuals with signs of appendicitis, such as lower abdominal pain, nausea, and vomiting, should seek medical attention immediately and not use laxatives. If a patient is using laxatives, they should take them separately from other medications to prevent reducing the efficacy of those drugs.

Fiber supplements such as Benefiber, Citrucel, and Metamucil improve the frequency of bowel movements by retaining water in the stool and increasing stool consistency and weight.

 These are typically powder formulations that can easily be mixed with liquid. Advise patients to drink at least 8 ounces of water with bulk-forming laxatives to prevent bloating, bowel obstruction, and cramping.

 Benefiber is safe to use in children and causes less bloating than other fiber products. Individuals who are immobile, on fluid restriction, or have trouble swallowing should avoid bulk laxatives.

 It generally takes approximately 12 to 72 hours to see results with fiber supplements.

Medications such as bisacodyl (Dulcolax) and senna (Senokot) work by increasing intestinal motility.

 Stimulant laxatives generally take approximately 6 to 10 hours to work before a bowel movement occurs, with the most common adverse effect being cramping.

 Patients should start taking stimulant laxatives when starting opioid medications to prevent constipation.

 Patients with intestinal obstruction should avoid oral stimulant laxatives.

 Clinicians should monitor for signs of laxative abuse that can occur in patients with eating disorders and individuals who continue to use these medications long term.

 Symptoms may include dehydration, electrolyte disturbances, and severe diarrhea.

 Some combination products are available that contain more than 1 laxative. However, these may cause more adverse effects, so it is important to advise patients to read the drug facts label.

Osmotics include lactulose, magnesium hydroxide (Phillips' Milk of Magnesia), polyethylene glycol (PEG) 3350 (Miralax), and sodium phosphate enema (Fleet). They work by drawing water into the bowel surrounding the body tissues.

 They usually take 2 to 3 days to produce a bowel movement, although enemas work within 1 to 5 minutes.

 Patients recovering after a heart attack or after surgery can use osmotics to avoid straining during bowel movements. Osmotics also are another option for managing constipation in patients taking opioids. Patients at risk for electrolyte problems, such as those with heart or kidney failure or who are elderly or taking diuretics, should avoid osmotic saline laxatives that contain magnesium or sodium.

 Enemas can be used by individuals with fecal impaction, but they should not be used frequently to treat constipation. Glycerin (Pedia-Lax) suppositories are a type of osmotic laxative considered safe for use in children and infants to manage constipation and will usually produce a bowel movement in 15 to 60 minutes.

 Advise parents to use only 1 suppository in a 24-hour period.

PEG products also are often recommended to treat constipation in children.

 Neuropsychiatric adverse effects, such as anger, anxiety, depression, and paranoia, have been reported in children taking PEG.

 More studies need to be conducted to determine the long-term effects of PEG in children and whether it may be associated with safety concerns. Clinicians should advise parents about the possible risk of neuropsychiatric adverse effects with long-term use of PEG products in children.

Medications such as docusate sodium (Colace) moisten the stool by drawing water from the intestines to prevent straining during bowel movements and typically take 24 to 48 hours for results.

 Additionally, these products are often added to stimulant laxatives to treat constipation. Stool softeners are considered safe during pregnancy and can help with pregnancy-related constipation.

 Health care professionals also can recommend stool softeners to prevent constipation in pregnant patients taking iron supplements for anemia.

Products such as mineral oil work by coating the bowel and stool with a waterproof film to promote bowel movements and make them easier to pass.

 Mineral oil should not be taken when lying down and should be separated by approximately 2 hours from meals as it may interfere with food digestion and absorption of nutrients and vitamins. Mineral oil should not be given to young children or bedridden elderly individuals because lipoid pneumonia can occur, which is caused by inhaling oil droplets into the lungs.

1. Constipation. Cleveland Clinic. Updated November 7, 2019. Accessed May 8, 2021. https://my.clevelandclinic.org/health/diseases/4059-constipation

2. Laxative (oral route). Mayo Clinic. Updated May 1, 2021. Accessed May 7, 2021. https://www.mayoclinic.org/drugs-supplements/laxative-oral-route/description/drg.20070683

3. Bharucha A, Lacy BE. Mechanisms, evaluation, and management of chronic constipation. 

. 2020;158(5):1232-1249.e3. doi:10.1053/j.gastro.2019.12.034

4. Bashir A, Sizar O. Laxatives. StatPearls. Updated September 23, 2020. Accessed May 7, 2021. https://www.ncbi.nlm.nih.gov/books/NBK537246/

5. Dabaja A, Abbas M. Polyethylene glycol. StatPearls. Updated October 20, 2020. Accessed May 7, 2021. https://www.ncbi.nlm.nih.gov/books/NBK557652/

6. Tobah YB. Is it safe to take stool softeners to treat pregnancy constipation? Mayo Clinic. April 11, 2020. Accessed May 7, 2021.

7. https://www.mayoclinic.org/healthy-lifestyle/pregnancy-week-by-week/expert-answers/pregnancy-constipation/faq-20058550

is a drug information pharmacist and Pharmacy Times

Clinicians can play an important role in counseling patients about the 5 main OTC categories of laxatives to treat this gastrointestinal condition.

Help Patients Select Right Products for Constipation

Although guidance from the American Dental Association states that bleeding gums could be a sign of gingivitis, new research from the University of Washington (UW) suggests that it could also mean that individuals need more vitamin C in their diets.

 in February, analyzed published studies of 15 clinical trials in 6 countries involving 1140 predominantly healthy participants and data from 8210 US residents in the CDC's Health and Nutrition Examination Survey. Bleeding of the gums on gentle probing and retinal hemorrhaging both were associated with low vitamin C levels in the bloodstream, the results showed. Furthermore, the investigators said that increasing daily intake of vitamin C in those with low vitamin C plasma levels helped reverse these bleeding issues.

"When you see your gums bleed, the first thing you should think about is not 'I should brush my teeth more.' You should try to figure out why your gums are bleeding, and vitamin C deficiency is 1 possible reason," lead author Philippe P. Hujoel, DDS, PhD, MSD, MS, a dentist and professor of oral health sciences at the UW School of Dentistry in Seattle, said in a news release.

He noted that both gum bleeding and retinal bleeding could be signs of general trouble in the microvascular system, specifically a microvascular bleeding tendency int he brain, heart, and kidneys.

The study findings do not imply that successful reversing of an increased gingival bleeding tendency with vitamin C will prevent strokes or other serious health outcomes, Hujoel said. 

However, the results do suggest that vitamin C recommendations designed primarily to protect against scurvy are too low and that such a low vitamin C intake can lead to a bleeding tendency, according to the study authors.

Based on these findings, Hujoel said that he recommends that individuals increase their vitamin C intake with nonprocessed foods such as kale, kiwis, or peppers.

If foods rich in vitamin C are not palatable, he said, individuals should consider a supplement of 100 to 200 mg per day. 

Furthermore, individuals on special diets, such as paleo, should examine their vitamin C intake. 

"Vitamin C-rich fruits, such as kiwis or oranges, are rich in sugar and thus typically eliminated from a low-carbohydrate diet," Hujoel said.

The association between gum bleeding and vitamin C levels was recognized more than 30 years ago, according to the news release.

Two studies, published in 1986 and 1991, identified gum bleeding as a biomarker for vitamin C levels, though this connection somehow disappeared in dental conversations around gum bleeding.

"There was a time in the past when gingival bleeding was more generally considered to be a potential marker for a lack of vitamin C," Hujoel said. "But over time, that's been drowned out or marginalized by this overattention to treating the symptom of bleeding with brushing or flossing, rather than treating the cause."

Bleeding gums may be a sign you need more vitamin C in your diet. News release. University of Washington. February 1, 2021. Accessed February 3, 2021. https:/www.eurekalert.org/pub_releases/2021-02/uow-bgm020121.php

Two studies in the 1990s identified gum bleeding as a biomarker for vitamin C levels, although this connection somehow disappeared in dental conversations around gum bleeding. 

Gum Bleeding May Indicate Vitamin C Deficiency

Female adolescents and adolescents with darker skin are disproportionately affected by acne's psychological impacts, which calls for a more aggressive approach to treat the condition from a dermatology perspective and to address the psychological toll, according to investigators from the University of California at Riverside (UCR).

"Acne is pervasive, physically harmless, and painless, so we all-too-often underestimate its impacts as the quintessential nuisance of adolescence and puberty," Misaki Natsuaki, PhD, a coauthor of the study and a UCR associate professor of psychology, said in a statement.

The psychological effects of acne among adolescents are often "toxic," according to the study authors.

The investigators noted that 20% of adolescents have moderate to severe acne and 85% experience recurrent bouts.

Numerous studies have shown the direct links between acne and anxiety, depression, and suicidal thoughts.

Teenagers with acne have more difficulty forming friendships, feeling connected to school, and finding romantic partners, according to the study authors.

When shown a picture of a teenager with facial acne, 65% of adolescents said that skin was the first thing they notice. However, in a picture of a clear-skinned teen, the adolescents said that they noticed skin first just 14% of the time. They associated teens with acne with traits such as "lonely," "nerdy," and "stressed."

Research has shown that females experience negative psychological impacts at a rate higher than males, according to the investigators.

"Aesthetic ideals of clear and unblemished skin are held by both sexes," the investigators wrote in their paper, Adolescent Acne and Disparities in Mental Health, published in 

 "But females experience greater social pressure to attain these ideals than males."

Additionally, adolescents with darker skin color, many of whom come from ethnic-racial minority backgrounds in the United States, are likely to have disproportionate effects of acne due to a heightened incidence of scarring and hyperpigmentation, the study results show.

The authors argue that structural systems of inequality, which fuel health care disparities in the United States, further intensify acne and related psychosocial distress among individuals receiving public health insurance.

Further, the complex infrastructure of health insurance system, reluctance to provide dermatology appointments to children and adolescents with public insurance, and uneven geographical density of health care providers all contribute to these disparities, according to the authors.

"According to dermatology research, the psychological burden of acne is on par with that of other serious illnesses such as diabetes," study coauthor Tuppett M. Yates, PhD, a professor of psychology at UCR, said in a statement. "Acne is a medical condition with clear psychological effects, effects that are nonrandomly distributed as a function of gender, skin color, and socioeconomic status."

1. Warren JD. Study: acne treatment only addresses half of the problem. UC Riverside. February 11, 2021. Accessed February 16, 2021. https://news.ucr.edu/articles/2021/02/11/study-acne-treatment-only-addresses-half-problem

2. Natsuaki MN, Yates TM. Adolescent acne and disparities in mental health child development perspectives. Child Dev Perspect. 2021;15(1):37-43. doi:10.1111/cdep.12397

Research has shown that female adolescents and adolescents with darker skin are disproportionately affected by acne's psychological impacts. 

Acne Can Take Serious Toll on Adolescents' Self-Esteem, Study Results Show

 has been a constant source of up-to-date, practical information for the pharmacy community and has led the way in presenting valuable information on the OTC market—in print and via online venues.

Nine years ago, we expanded our reach with this useful guide to OTC products, a special collaboration with 

, to help consumers make informed decisions based on the expert opinions of our pharmacy readers.

More than ever, patients are turning to OTC products to treat conditions like allergies, arthritis, coughs, colds, migraines, and gastrointestinal issues.

OTC products are cost-effective and offer patients a convenient self-treatment option. As blockbuster prescription drugs become available over the counter, pharmacists are being called on to make recommendations from among the 1000-plus OTC brands available.

 OTC Recommendations Survey, conducted by Healthcare Research & Analytics (HRA®), asked thousands of pharmacists
for their recommendations on brands in 148 OTC categories. In these pages, products are organized by health section and in detailed charts that show the percentage of pharmacists who recommend each product. The charts also show the number of recommendations that retail pharmacy professionals make each month. (Note: Survey percentages in charts total 100%.)

As pharmacists continue to counsel consumers on OTC choices, our 2021 

 OTC Recommendations Survey provides pharmacists guidance by showcasing the brands and products that were most highly recommended by their peers.

 to bring these pharmacists’ top recommendations of OTC products directly to consumers. The leading brands receive a “#1 Pharmacist Recommended” award issued jointly by 

Pharmacy Times has been a constant source of up-to-date, practical information for the pharmacy community and has led the way in presenting valuable information on the OTC market—in print and via online venues.

Leading the Way (OTC Guide 2021)

Since 1997, Pharmacy Times® has been calculating pharmacists’ OTC recommendations and publishing an annual survey.

The purpose of our survey is to collect current data on the OTC brands pharmacists recommend most frequently and to ascertain the number of recommendations pharmacists make each month as they work with patients and counsel them on health conditions.

In their daily practice, pharmacists across the country make more than 140 million recommendations to patients every month. As the most accessible, and among the most trusted, health care providers, pharmacists play a key role in their patients’ health and wellness through counseling and product recommendations. Pharmacists are truly a constant source of health care information for the public.

The Pharmacy Times® OTC survey has grown each year since its launch in 1997 when 85 therapeutic categories were included. This year, we surveyed 15 distinct health sections and covered 148 therapeutic categories. As the OTC market has grown, Pharmacy Times® has responded by adding new health sections and new OTC products to the survey. As new therapeutic categories develop and the OTC market continues to evolve, Pharmacy Times® will expand its survey.

Now, for the ninth year, the Pharmacy Times® OTC survey will be available to consumers through a special collaboration with U.S. News & World Report. The results of the survey will be available on the U.S. News & World Report website, along with useful consumer articles, many of them contributed by Pharmacy Times®. Visit health.usnews.com/health-products.

In addition to the valuable charts that summarize the OTC products most often recommended by pharmacists in 15 distinct health areas, this edition of the OTC Guide® includes a number of articles related to the use and management of OTC products. This issue provides articles that focus on the latest information on cough and cold treatments, topical solutions, and oral care.

Our OTC Guide® features an easy-to-use format that provides pharmacists with OTC product information at their fingertips. The color-coded guide is organized for easy access to the multitude of OTC brands that pharmacists recommend each day. The Table of Contents can be found on page 2, each health section is highlighted, and in-depth product charts are found throughout the guide.

These OTC product recommendations are also housed on Pharmacy Times® daughter website https://www.contemporaryclinic.com/otcguide, where the information is searchable both by category and product name. Designed for use by pharmacists and patients, this site helps users navigate the latest products.

Since 1997, Pharmacy Times has been calculating pharmacists’ OTC recommendations and publishing an annual survey.

2021 OTC Guide