Pharmaceutical care in self-medication: ABC/VED analysis of over-the-counter antiallergic medicines

Overview

Introduction: The growing prevalence of allergic diseases and the widespread use of over-the-counter (OTC) medicines necessitate rationalization of symptomatic treatment, balancing clinical relevance with limited healthcare resources.

Aim: To evaluate OTC  medicines used for symptomatic allergy treatment through ABC/VED analysis in order to identify priority medicines and support pharmaceutical and managerial decision-making.

Materials and methods: The study included 25 OTC medicines registered in Ukraine for symptomatic allergy treatment during 2024–2025. Aggregate sales data from pharmacy networks and distributors were analysed. ABC analysis was used to assess expenditure distribution, while VED analysis classified medicines according to clinical importance based on pharmacist protocols, clinical guidelines, pharmacological role, safety profile, and suitability for self-medication. The integrated ABC/VED matrix was applied to determine priority medicines.

Results: A limited number of medicines accounted for the majority of expenditures. Cetirizine, Loratadine, Desloratadine, Xylometazoline and Oxymetazoline formed the A/Vital category, representing the highest priority group combining economic weight with clinical relevance. The results demonstrate a strong concentration of financial resources in first-line antihistamines and essential topical agents used for rapid symptom relief in self-medication.

Conclusion: The integrated ABC/VED approach is an effective tool for identifying priority OTC antiallergic medicines, supporting rational pharmacy assortment management, supporting evidence-based practice and pharmaceutical care in self-medication under limited healthcare resources.

Keywords:

allergy – Pharmaceutical Care – self-medication – OTC medicines – ABC/VED analysis

Introduction 

Modern pharmacotherapy of allergic diseases is increasingly guided by evidence‑based principles that integrate both clinical efficacy and safety considerations, which is particularly relevant under limited healthcare resources (1, 2). The growing prevalence of allergic diseases together with the widespread practice of self‑medication emphasizes the need to rationalize symptomatic therapy, especially within the segment of over-the-counter (OTC) medicines forming an essential part of pharmaceutical care (3). The continuous expansion of the pharmaceutical market, emergence of new‑generation agents, and increasing diversity of OTC medicines require updated approaches to their selection and evaluation in real pharmacy practice.

Allergic diseases represent a heterogeneous group of conditions including allergic rhinitis, conjunctivitis, urticaria and mild dermatological manifestations, many of which are initially managed through self-medication. Within this context, pharmacists play a pivotal role in pharmaceutical care by providing clinical counselling, preventing complications of self-medication, and promoting rational medicine use in accordance with national and international recommendations under the “physician-patient-pharmacist” model (4).

Allergic diseases represent one of the most widespread global health challenges, affecting over one‑third of the population and significantly impairing quality of life, productivity, and social functioning. They are also associated with substantial direct healthcare expenditures and indirect socioeconomic losses linked to temporary disability. Urbanization, environmental pollution, climate change, dietary and household allergens, and unequal access to medical care contribute to a large proportion of undiagnosed or poorly controlled allergy cases, thereby increasing the burden on healthcare systems (5, 6, 7). 

The continuing rise and diagnostic complexity of allergic diseases underscore the importance of rational medicine selection for symptomatic relief. Antihistamines merit particular attention, as they are most frequently used by patients for self‑medication without prior medical consultation. In line with national pharmacist protocols on non‑prescription medicine dispensing, pharmacists are required to identify potentially life‑threatening symptoms warranting physician referral, and in their absence, to recommend appropriate OTC medicines for symptomatic allergy treatment (8). 

Allergic reactions can occur not only as primary allergic manifestations but also as adverse effects of pharmacotherapy in various pathological conditions, including infectious, autoimmune, or oncological diseases. Such reactions may develop during the use of antibiotics, nonsteroidal anti‑inflammatory drugs, glucocorticosteroids, cytostatics, antituberculosis agents, sulfonamides, immunomodulators, or contrast media administered as part of combined pharmacotherapy (9). In these cases, timely symptomatic management with OTC medicines helps mitigate the severity of manifestations and supports adherence to baseline therapy. 

Under constrained healthcare budgets and rising medication costs, structured analytical tools are becoming indispensable for rational medicine selection. Among these, the ABC and VED analyses are widely employed to evaluate expenditure patterns and clinical significance across therapeutic areas, providing valuable evidence for pharmaceutical and managerial decision‑making (10, 11). The integrated ABC/VED approach combines financial assessment with clinical prioritization, forming a methodological basis for optimizing the selection of OTC medicines used in symptomatic allergy treatment, improving pharmacy assortment strategies, and enhancing pharmaceutical care for patients with allergic diseases in resource-limited settings.

The aim of the study 

To evaluate OTC medicines used for symptomatic allergy treatment through ABC/VED analysis in order to substantiate priorities for rational selection and to support managerial and pharmaceutical decision-making in self-medication under limited healthcare resources.

Materials and methods 
The methodological framework of the study was based on the evaluation of OTC medicines used for symptomatic allergy treatment in pharmaceutical practice. The ABC/VED method was ap-plied to assess the structure of the medicine assortment without comparing therapeutic out-comes.
The study included 23 positions of active ingredients (25 dosage forms), defined by the national pharmacist protocol, used in OTC medicines for symptomatic allergy treatment during 2024–2025.
Inclusion criteria comprised compliance with OTC pharmacotherapy conditions and the presence of mild allergic symptoms manageable through pharmaceutical counselling without medical referral. The analyzed group included systemic and topical antihistamines, sympathomimetics, mast cell stabilizers, topical glucocorticosteroids, and enterosorbents.
In order to take into account, the national characteristics of the availability of OTC medicines in Ukraine, a generalized table used for the symptomatic treatment of allergic conditions was formed. Some active substances (Dimethindene, Loratadine) were available in multiple dosage forms and thus appear repeatedly in the classification. Table 1 presents the complete list of included medicines classified by active substance, dosage form, and pharmacological group ac-cording to the mechanism of action.
In Ukraine, pharmacist protocols for dispensing OTC medicines are developed and approved by the Ministry of Health of Ukraine and serve as the regulatory framework for pharmaceutical practice. These protocols have advisory status rather than being legally binding clinical stan-dards. They determine the scope of pharmaceutical counseling, criteria for patient referral to physicians, and the list of recommended OTC medicines for specific conditions, including aller-gic diseases.
Expenditure assessment was performed using aggregate data on sales volumes and mean retail prices of OTC medicines in Ukrainian pharmacy networks for 2024-2025, obtained from commer-cial analytical databases and distributors’ reports. The analysis was conducted from the per-spective of pharmaceutical practice and assortment management. The two-year study horizon did not require discounting due to the short observation period.
The ABC method was applied to evaluate the expenditure structure by ranking medicines in descending order of total sales value and allocating them into categories A (Always important), B (Better control), and C (Control less) according to the Pareto principle (12, 13).
For ABC analysis, medicines were ranked in descending order according to total expenditure (calculated as product of sales volume and average retail price). Cumulative expenditure per-centages were calculated, and medicines were categorized as follows:
•    Category A: top 70-80% of cumulative expenditure
•    Category B: next 15-20%
•    Category C: remaining 5-10%
VED classification was performed using a multi-criteria expert-based approach incorporating:
•    clinical efficacy according to national, international guidelines,
•    safety profile in self-medication context,
•    role in first-line or supportive therapy,
•    necessity for rapid symptom control,
•    suitability for pharmacist-led pharmaceutical care.
Each medicine was assigned to Vital (V), Essential (E), or Desirable (D) category based on con-sensus evaluation of these criteria. The ABC and VED results were integrated into a matrix to identify priority groups (A/Vital, B/Essential, etc.), reflecting combined economic and clinical significance.
The VED method was used to assess the clinical significance of OTC medicines by classifying them into V (Vital), E (Essential), and D (Desirable) groups, based on national and international clinical guidelines, treatment protocols, and reference publications (14, 15).
VED classification was performed using a multi-criteria approach based on national pharmacist protocols for OTC allergy treatment, international clinical guidelines, pharmacological role in symptom control, safety profile in self-medication, and the need for rapid relief of core allergic symptoms.
The combined application of the ABC and VED methods enabled the development of a priority matrix to identify medicines with high therapeutic relevance that accounted for the largest share of expenditures in the OTC segment of symptomatic allergy treatment. The results were interpre-ted as a practical tool for decision making in pharmaceutical care and assortment management, rather than a full pharmacoeconomic analysis such as cost effectiveness or cost utility evaluation (16, 17, 18, 19).
Descriptive data analysis was carried out using Microsoft Excel software to calculate frequency distributions, cumulative percentages, and graphical summaries of the results. 

Results

To assess the expenditure structure of OTC medicines used for symptomatic allergy treatment, an ABC analysis was conducted. This method enables evaluation of the distribution of financial resources within the assortment and identification of medicines that constitute the largest share of total expenditures in pharmaceutical practice. The distribution of the analyzed medicines by ABC categories based on expenditure volumes for 2024-2025 is presented in Table 1. According to ABC analysis results (Tab. 2), the distribution of medicines by expenditure showed that 7 medicines account for 75.2% of total costs.

As shown in Tab. 2, category A included Cetirizine, Loratadine, Desloratadine, Xylometazoline, Oxymetazoline, Fexofenadine, and Chloropyramine, which together form over three-quarters (75.2%) of total expenditure in the OTC allergy treatment segment. Category B comprises OTC medicines with moderate financial contribution 19.8% (Azelastine, Dimetindene, Cromoglicic acid, Naphazoline, Levocetirizine), while category C includes auxiliary agents with minimal expenditure share 5.0% (Activated charcoal, Diosmectite, Methylsilicic acid hydrogel, others).

The graphical representation of ABC analysis illustrates a steep cumulative expenditure curve typical for this type of assessment, where category A shows a pronounced initial rise, while categories B and C demonstrate a gradual upward trend (Fig. 1).

The cumulative expenditure curve by ABC categories reflects the distribution of costs for OTC medicines used in symptomatic allergy treatment. Medicines are arranged along the x-axis in descending order of expenditure share, while cumulative expenditure expressed as a percentage of total costs is plotted on the y-axis. The curve demonstrates a steep initial increase, indicating that category A comprises approximately 28 % of medicines accounting for 75.2 % of total expenditure. Category B represents an additional 40 % of items contributing 19.8 % of costs, whereas category C includes the remaining medicines with a minimal expenditure share of 5.0 %. This pattern highlights the strong concentration of financial resources in category A, underscoring the need for careful demand monitoring, pricing control, and ensured availability in pharmacy practice.

Following the results of the ABC analysis illustrated in Fig. 1, which identified the expenditure structure for OTC medicines for symptomatic allergy treatment, a VED analysis was conducted to evaluate their clinical and pharmaceutical relevance. This approach allowed for classification of OTC medicines according to their therapeutic importance, based on national and international clinical guidelines as well as pharmaceutical care protocols. The resulting distribution of medicines into Vital, Essential, and Desirable categories is summarized in Table 3.

The VED analysis classifies OTC medicines for symptomatic allergy treatment into three priority categories based on clinical and pharmaceutical significance (Tab. 3). The Vital category encompasses 10 first-line OTC medicines essential for rapid symptom relief, including cetirizine, loratadine, desloratadine, xylometazoline, and oxymetazoline, which target core manifestations such as rhinorrhea, pruritus, and nasal congestion during acute episodes. The Essential category includes 9 OTC medicines for maintenance and prophylactic therapy, such as azelastine (nasal antihistamine), dimetindene (topical antihistamine), cromoglicic acid (mast cell stabilizer), and beclomethasone (intranasal corticosteroid), supporting sustained inflammation control consistent with evidence-based pharmacotherapy protocols (Tab. 2). The Desirable category comprises 6 adjunctive OTC medicines like activated charcoal, diosmectite (enterosorbents), and lower-priority sympathomimetics, used selectively for supportive care (Tab. 2). This prioritization aligns with pharmaceutical care principles for optimizing allergy self-medication.

Integration of ABC (Always, Better, Control) and VED (Vital, Essential, Desirable) analysis results enabled construction of a priority matrix, which identifies identifies OTC medicines requiring the highest attention for symptomatic allergy treatment (Tab. 4).

As shown in Table 4, the A-Vital category OTC medicines, including Cetirizine, Loratadine, Desloratadine, Xylometazoline, and Oxymetazoline, represent the highest priority (Priority 1) for symptomatic allergy treatment. B-Essential category OTC medicines (Cromoglicic acid, Beclomethasone) and C-Desirable OTC medicines (Methylsilicic acid hydrogel) hold secondary importance while remaining essential components of pharmaceutical care in self-medication.

Discussion

The present study extends the application of the ABC/VED methodology to the segment of OTC medicines used for symptomatic allergy treatment and provides a structured pharmaceutical care perspective for rational self-medication under limited healthcare resources.

A key methodological component of the study was the classification of OTC medicines into Vital, Essential, and Desirable categories. The VED categorization was based on a multi-criteria approach integrating: national pharmacist protocols for OTC dispensing of antiallergic medicines, international clinical recommendations, pharmacological role in symptom control, safety profile in self-medication, and the need for rapid symptom relief to prevent deterioration of the patient’s condition. Medicines were classified as Vital when they represent first-line therapy recommended for rapid control of core allergic symptoms such as rhinorrhea, sneezing, pruritus, and nasal congestion. Essential medicines were defined as agents important for maintenance therapy, prophylaxis, or targeted local treatment. Desirable medicines included adjunctive agents used selectively as supportive therapy. This structured approach ensured that the VED classification reflected both clinical relevance and suitability for responsible self-medication.

Clinical Perspective on ABC/VED Findings

The A/Vital category identified in the ABC/VED matrix represents OTC medicines with the highest combined economic and clinical priority. From a clinical perspective, the predominance of second-generation systemic antihistamines such as Cetirizine, Loratadine, and Desloratadine is consistent with contemporary evidence-based recommendations. These OTC medicines are widely considered first-line therapy due to their rapid onset of action, favorable safety profile, low sedative potential, and suitability for outpatient and self-managed care. Their dominant share in expenditure reflects real-world treatment patterns and indicates alignment of pharmacy demand with clinical guidelines.

The inclusion of topical nasal sympathomimetics such as Xylometazoline and Oxymetazoline in the A/Vital category also has clear clinical justification. Nasal congestion is often perceived by patients as the most distressing symptom of allergic rhinitis and frequently motivates immediate self-medication. However, this finding also highlights potential risks associated with prolonged or inappropriate use of topical decongestants, including rebound congestion and medication-induced rhinitis, necessitating pharmacist counseling on 5-7 days treatment limits. Therefore, the high economic weight of these medicines underlines the importance of pharmacist counselling regarding appropriate duration of therapy and safe use.

The analysis should also be interpreted in light of the heterogeneity of the term “allergy.” Allergic conditions encompass a broad spectrum of clinical manifestations, including allergic rhinitis, conjunctivitis, urticaria, mild dermatological reactions, and mixed respiratory symptoms. The OTC medicines assortment reflects this diversity by combining systemic antihistamines, topical nasal agents, corticosteroids, mast cell stabilizers, and adjunctive enterosorbents. Consequently, the ABC/VED matrix represents an integrated cross-symptom evaluation rather than a disease-specific analysis. Future research may benefit from conducting separate ABC/VED assessments for specific allergic phenotypes in order to achieve more granular clinical interpretation.

From the perspective of pharmaceutical care, the findings highlight the central role of pharmacists in guiding safe and effective self-medication. The concentration of expenditures in a limited number of first-line agents confirms strong patient demand for rapid symptom control. At the same time, the presence of Essential and Desirable categories demonstrates the need for professional counselling in selecting appropriate therapy based on symptom profile, duration of complaints, comorbidities, and potential contraindications.

Several OTC medicines classified as category C (Desirable), in particular Activated charcoal, Diosmectite, Methylsilicic acid hydrogel, represent enterosorbents traditionally used in Ukrainian pharmacy practice for detoxification and supportive care in allergic conditions. While these agents lack direct indications for allergy treatment in many European countries, their inclusion reflects established national patterns of adjuvant therapy aimed at reducing allergen load and supporting elimination processes. These national differences in OTC medicine availability and indications limit direct international comparisons. The present findings should be interpreted within the context of Ukraine's regulatory framework and pharmacy practice, where enterosorbents complement first-line antihistamine and topical therapies.

Study Limitations

Several limitations should be acknowledged. First, the study was based on aggregated sales data and did not include patient-level clinical outcomes or diagnostic confirmation of allergic conditions. Second, the ABC/VED methodology evaluates economic distribution and clinical priority but does not assess comparative therapeutic effectiveness or cost-effectiveness. Third, the analysis treated OTC allergy medicines as a unified group without stratification by specific allergic diseases or severity levels. Fourth, patient adherence, behavioural factors, and potential inappropriate medicine use were not evaluated. Despite these limitations, the study provides structured evidence to support pharmacy assortment management and rational self-medication strategies.

Overall, the results confirm that the integrated ABC/VED approach can serve as a practical analytical tool for aligning economic prioritization with clinical relevance in the OTC segment of allergy treatment and for strengthening pharmaceutical care in community pharmacy practice.

Implications for Pharmaceutical Practice and future research

The ABC/VED analysis successfully identified priority OTC medicine groups by expenditure share and pharmaceutical relevance for self-medication. Nevertheless, actual patient choices in OTC self-medication are influenced by multiple factors beyond economics, including drug availability, market competition, regulatory frameworks, and patient behavior patterns.

The ABC/VED analysis results align with global trends in pharmaceutical care for self-medication of allergy symptoms using OTC medicines, consistent with evidence-based medicine principles. The majority of financial resources and therapeutic impact concentrate on a limited range of systemic agents and essential topical preparations for effective symptom relief.

Practical application of these findings will improve pharmaceutical care for self-medication, ensure patient access to vital OTC medicines during peak allergy incidence periods.

Benefits for Pharmaceutical Practice

These ABC/VED results enable pharmacists to prioritize stocking of A-Vital category OTC medicines (Cetirizine, Loratadine, etc.), optimizing self-medication support and pharmaceutical care while guaranteeing availability of first-line symptom relief agents.

Patient Advantages

Patients gain improved access to evidence-based self-medication options through pharmaceutical care, enabling rapid symptom control (rhinorrhea, pruritus, nasal congestion) without prescription delays during high-demand periods.

Clinical Implications for Physicians

Physicians benefit from a validated priority framework that supports pharmaceutical care recommendations for self-medication, promoting rational medicines use and aligning OTC availability with treatment protocols for allergic conditions.

Further research is recommended to combine ABC/VED analysis with cost-effectiveness or cost-utility studies using real-world clinical data. This integrated approach will comprehensively evaluate OTC medicines for symptomatic allergy treatment, achieving the study's goals of enhancing pharmaceutical care and rational self-medication while supporting evidence-based pharmacy decisions.

Pharmaceutical care recommendations

The ABC/VED analysis provides practical guidance for pharmacists managing OTC allergy self-medication. The findings emphasize pharmacists' central role in guiding safe self-medication. Pharmaceutical care in allergy self-medication should be individualized based on patient characteristics and symptom profile.

For systemic antihistamines (A-Vital: Cetirizine, Loratadine, Desloratadine), once-daily administration is recommended, with preference for second-generation agents due to lower sedative effects. These medicines are suitable for both adult and pediatric populations (age-specific dosing required).

Topical nasal decongestants (A-Vital: Xylometazoline, Oxymetazoline) should be used for short-term relief only (not exceeding 5–7 days) due to the risk of rebound congestion and medication-induced rhinitis.

Intranasal corticosteroids and mast cell stabilizers are recommended for longer-term control and prevention, particularly in patients with recurrent symptoms.

Special attention should be given to:

pediatric patients (dose adjustment, safety),

elderly patients (polypharmacy, comorbidities),

patients with chronic diseases.

Pharmacists should actively assess warning signs requiring physician referral, including severe symptoms, systemic reactions, or lack of response to OTC therapy. Pharmacists should ensure priority stocking of A-Vital OTC medicines during peak allergy seasons while providing counseling to optimize safe, effective self-medication and appropriate medical referral when indicated.

Conclusions

ABC/VED analysis of OTC medicines for symptomatic allergy treatment identified a limited number of preparations with the highest combined economic and clinical priority, namely Cetirizine, Loratadine, Desloratadine, Xylometazoline, and Oxymetazoline.

The concentration of expenditures in this A/Vital category confirms their central role in self-medication practice and pharmaceutical care.

The findings support the use of the integrated ABC/VED approach as a practical managerial tool for optimizing pharmacy assortment policy and ensuring rational, guideline-aligned access to first-line OTC antiallergic medicines under constrained healthcare resources.

Research background

This research is a part of the state-registered scientific work of Ukraine conducted within the following projects: the Private Scientific Institution „Scientific and Research University of Medical and Pharmaceutical Law” and the Scientific Research Establishment of Innovations for Future LLC (USA) –⁠ „Multimodal research on innovative legal, medical and pharmaceutical, clinical and pharmacological, behavioral‑cognitive, psychological, socio‑economic, medical and technological, forensic and pharmaceutical, and digital strategies for patient‑centered pharmacotherapy of PTSD and associated diseases in war and conflict settings” (state registration No. 0125U003297, 2025-2029); the Private Scientific Institution „Scientific and Research University of Medical and Pharmaceutical Law” –⁠ „Multidisciplinary study of post‑traumatic stress disorders during wartime in patients (predominantly combatants)” (state registration No. 0124U002540, 2024-2029); and the Lviv Medical Institute –⁠ „Improvement of the system of medicinal product circulation during pharmacotherapy based on evidence‑based and forensic pharmacy, organization, technology, biopharmaceutics, and pharmaceutical law” (state registration No. 0120U105348, 2021–2026).

Conflict of Interest: The authors declare no conflict of interest.

Author contributions: Viktoriia Oleksiivna Shapovalova: Conceptualization; Methodology; Investigation; Data curation; Writing –⁠ original draft; Writing –⁠ review & editing; Supervision –⁠ Oleksandr Ananiyovych Nevzhoda: Methodology; Investigation; Data curation; Formal analysis; Writing –⁠ review & editing.

Alina Oleksiivna Osintseva: Formal analysis; Visualization; Writing –⁠ review & editing.

Valentyn Valeriiovych Shapovalov: Project administration; Resources; Writing –⁠ review & editing.

Valerii Volodymyrovych Shapovalov: Investigation; Data curation; Resources; Writing –⁠ review & editing.

All authors have read and approved the final manuscript.

Funding: This research received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors.

Ethics approval : Not applicable
(observational ABC/VED analysis without human/animal subjects).