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The time to prepare for seasonal allergies is earlier than you might expect, as taking medications before everything is in bloom can help significantly to control symptoms. This year, you may want to consider ramping up your prevention efforts even earlier than usual: one consequence of climate change and rising temperatures worldwide is a longer growing season and higher levels of pollen in the air.

Why It’s Never Too Early to Prepare for Seasonal Allergies

The commonly used over-the-counter (OTC) medications below can help make allergy season more manageable — and many are available for purchase at the Essentials Store in our app! To browse the selection, tap the "Store" icon along the bottom of the Alto mobile app or the "Store" icon in your account on desktop.

Over-the-counter allergy medications to take preventatively

Nasal corticosteroid sprays prevent inflammation to reduce allergy symptoms such as stuffiness, sneezing, and a runny nose. Common OTC options include:

When taken in advance, these medications can potentially prevent the onset of allergy symptoms altogether. Many health experts suggest taking them about four weeks before the official start of allergy season, the specific timing of which depends on where you live.

For many people who experience seasonal allergies, symptoms typically first appear when trees start to release pollen in late winter and early spring. However, this pattern is changing as winter temperatures rise, and the timing of pollination also varies by region. To make the best plan, check local pollen levels and consult with your provider.

These medications block histamine, a chemical that your immune system releases during an allergic reaction. You may take them up to two weeks before the start of allergy season, as a preventative measure, but they can also be taken on an as-needed basis if you experience symptoms. They offer fast relief, taking anywhere from 15 minutes to two hours to go into effect.

Some antihistamines, including Benadryl® (diphenhydramine), can cause drowsiness and are not recommended to take before driving or other activities that require your attention.

The following antihistamines are less likely to cause drowsiness:

Not all allergy medications can be taken preventatively. While decongestants like Afrin® (oxymetazoline) and Sudafed® (pseudoephedrine) are effective at relieving congestion, they should only be taken on a short-term basis. Longer-term use may worsen allergy symptoms.

When to see a specialist for allergy symptoms

Remember that it may take time and a bit of trial and error to find the best relief for your allergies. If you experience regular symptoms after exploring a few options, work with your provider to find the best solution for your needs.

You may benefit from consulting a specialist such as an allergist or immunologist. These healthcare professionals can help identify more specific allergy triggers. They can also facilitate even more treatment options, including a preventative treatment called immunotherapy, which exposes you to allergens so that you become less sensitive to them. Immunotherapy comes in the form of both allergy shots and sublingual tablets placed beneath the tongue.

Stock up on allergy medications at the Alto Essentials Store

Purchase allergy season essentials like Claritin, Flonase, Zyrtec, Allegra and more right from your Alto account! You can order Essentials products whenever you need them, or add them to your next prescription delivery.

If your allergy symptoms persist even after preventative steps and exploring OTC options, we can support your treatment plan. We’ll coordinate with your doctor and insurance to offer your medications at the best price we can find, and our expert pharmacists are available via in-app messaging to answer any questions you may have about symptoms or side effects.

This content is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or another qualified health provider with any questions you may have regarding a medical condition.

All third party trademarks (including logos and icons) referenced by Alto Pharmacy remain the property of their respective owners. Unless specifically identified as such, Alto’s use of third party trademarks does not indicate any relationship, sponsorship or endorsement between Alto and the owners of these trademarks.

Winter’s shorter, darker days often bring out feelings of sadness, lethargy, and fatigue. In many cases, these feelings are symptoms of seasonal affective disorder (SAD), a form of depression triggered by seasonal shifts. 

While the nature of SAD means that symptoms tend to improve as the season changes, the condition should be taken as seriously as any other mental health disorder; untreated symptoms of SAD can interfere with daily life. And since SAD is often a temporary but recurring health concern, making a plan before the seasons change can help reduce the severity of future episodes.

How to Treat Seasonal Depression

Winter’s shorter, darker days often bring out feelings of sadness, lethargy, and fatigue. In many cases, these feelings are symptoms of seasonal affective disorder (SAD), a form of depression triggered by seasonal shifts. 

While the nature of SAD means that symptoms tend to improve as the season changes, the condition should be taken as seriously as any other mental health disorder; untreated symptoms of SAD can interfere with daily life. And since SAD is often a temporary but recurring health concern, making a plan before the seasons change can help reduce the severity of future episodes.

Here’s what to know about seasonal affective disorder and effective treatment options.

What is seasonal affective disorder (SAD)?

Seasonal affective disorder (SAD), also referred to as seasonal depression, is characterized by season-related mood changes and other depressive symptoms. In the majority of cases, SAD symptoms begin during fall and peak during winter. It is also possible to experience the opposite pattern, with symptoms that present during spring or summer.

Since SAD is considered a type of depression rather than a separate mental health disorder, many symptoms overlap with those of major depressive disorder, the clinical term for what we commonly think of as depression. Those symptoms include:

Loss of interest or pleasure in activities

Feelings of low self-worth, guilt, or hopelessness

Symptoms specifically associated with winter-pattern SAD include:

Withdrawal from social activities or a desire to hibernate

Symptoms specifically associated with summer-pattern SAD include:

If you believe you are experiencing symptoms of seasonal depression, speak with your healthcare provider or a mental health specialist for an evaluation and diagnosis.

Specific causes of seasonal affective disorder haven’t been identified, but reduced sunlight during winter is likely a significant factor, resulting in the following physiological changes.

Shifts in circadian rhythms: As seasons change, a shift in your body’s internal clock, or circadian rhythms, can disrupt your sleep and energy levels. This can also disrupt your body’s production of certain chemicals, like the stress hormone cortisol, which can also contribute to feelings of depression.

Imbalanced melatonin levels: Seasonal changes can also disrupt your levels of melatonin, a hormone that helps regulate your circadian rhythms, sleep patterns, and mood.

Decreased serotonin levels: Reduced sunlight is linked to decreased serotonin, a chemical in your brain that affects mood.

SAD is diagnosed in more women than in men, for reasons not entirely understood. It also affects younger adults more frequently than older adults.

Given the correlation between reduced sunlight and symptoms of SAD, the condition is more common among those who live further from the equator in either direction, where there are fewer daylight hours during winter months.

The following factors may also increase your risk of seasonal depression:

Family history: Many people who experience SAD have a relative with the condition or another type of depression.

Other depressive disorders: SAD may occur when symptoms of major depression or bipolar disorder intensify with seasonal shifts.

Decreased levels of vitamin D: It’s common to have less vitamin D during the winter as the result of less sunlight. This may play a role in the development of SAD, as vitamin D can boost serotonin activity. If you aren’t getting enough vitamin D from food or other sources, ask your doctor if you would benefit from taking a supplement.

Fortunately, there are many ways to treat symptoms of SAD, including light therapy, medication, and psychotherapy. For many people, a combination of treatment approaches leads to better results. While symptoms tend to naturally resolve as the seasons change, treatment can provide earlier relief.

Light therapy, which consists of daily exposure to bright light to compensate for less daylight, is a frontline treatment option for SAD. In this approach, an individual with SAD will sit in front of a very bright light box for 30 to 45 minutes every day. Treatment typically happens first thing in the morning, but a supplemental evening session may also be necessary in some cases.

Light therapy is safe for most people, as the light boxes filter out harmful UV light. However, it may not be a good fit if you have certain eye diseases or take medication that increases your sensitivity to sunlight.

Never begin light therapy without consulting your provider, and make sure to discuss your options for bright light boxes.

Psychotherapy, or talk therapy, is another common treatment option for seasonal depression. Cognitive behavioral therapy (CBT) is considered one of the most effective therapeutic approaches for this condition.

CBT focuses on changing thoughts and behaviors. If you experience SAD, CBT may offer the following benefits:

Finding the right therapist can take time. If you have insurance coverage of therapy sessions, check your insurance company’s provider network as a starting point. You can also look through reputable online databases like Psychology Today or the American Psychological Association (APA)’s psychologist locator. Some therapists offer sliding scale fees to make sessions more affordable.

Some people with SAD benefit from increased exposure to sunlight, whether it means spending more time outside during daylight hours or working from a space with ample sunlight.

Prioritizing your general health and wellness by staying physically active, eating a nutritious, balanced diet, and getting enough sleep can also ease symptoms. 

While antidepressants aren’t typically prescribed for SAD alone, medication used to treat major depression or another mood disorder may also improve season-related symptoms. Selective serotonin reuptake inhibitors (SSRIs), a type of antidepressant that regulates serotonin, are particularly effective at treating SAD.

Always consult your doctor before stopping an SSRI. In most cases, you will gradually taper to lower doses of the medication before you stop taking it completely. This helps to prevent withdrawal symptoms.

In addition to SSRIs, bupropion (Wellbutrin®), another type of antidepressant, may play a role in the treatment of SAD, as well as supplemental vitamin D.

Though it can be frustrating, finding the right antidepressant can take some trial and error. Even if you don't feel like the medication is working, continue to take it as prescribed so that you can achieve a therapeutic level. If you have been prescribed an SSRI, it may take several weeks to a month to experience your medication’s benefits. If you still have concerns several weeks into treatment, speak with your doctor.

For more on the medications used to treat depression, read A Guide to Commonly Prescribed Antidepressants.

If you have experienced SAD previously, a healthcare provider may recommend starting an antidepressant before winter as a preventative measure.

Choose a flexible and reliable pharmacy partner

Maintaining good mental health is easier with a reliable pharmacy on your side. Our pharmacists can answer any questions you may have about your medications, and we offer free, same-day delivery and medication management tools like reminders and auto refills in our app.

To learn more, reach out any time through secure in-app messaging or by phone at 1-800-874-5881.

Unlike ordinary sadness, depression is a serious and often debilitating mental health disorder. While prevalent before the pandemic, the condition has become even more widespread in recent years, affecting as many as 1 in 3 U.S. adults according to some research studies.

If undiagnosed and untreated, depression can greatly interfere with daily life. Fortunately, medication and therapy can help manage symptoms. Here’s more on commonly prescribed antidepressants and what to consider when exploring your options.

A Guide to Commonly Prescribed Antidepressants

Unlike ordinary sadness, depression is a serious and often debilitating mental health disorder. While prevalent before the pandemic, the condition has become even more widespread in recent years, affecting as many as 1 in 3 U.S. adults according to some research studies.

If undiagnosed and untreated, depression can greatly interfere with daily life. Fortunately, medication and therapy can help manage symptoms. Here’s more on commonly prescribed antidepressants and what to consider when exploring your options.

There isn’t one single cause of depression. Several factors can trigger the condition, including the following.

Experiences of trauma early in life can affect how your brain reacts to fear and stress, in some cases resulting in depression.

External circumstances including relationship changes, financial stress, or an unstable living situation can also factor into depression.

Like many mental health disorders, depression often runs in families.

Depression has been linked to other conditions, including sleep disorders, chronic pain, anxiety, and attention-deficit hyperactivity disorder (ADHD). Having a heart attack or stroke can also increase your risk of depression.

For women, changes in estrogen and progesterone levels throughout a menstrual cycle or during postpartum or menopause may contribute to the condition.

A history of substance misuse is considered a risk factor for depression, and alcohol use in particular can worsen symptoms of depression. Treatment for a substance use disorder may be part of a treatment plan for some individuals with depression.

A depressive disorder is diagnosed when a person experiences symptoms of a depressive episode for longer than two weeks. These are some of the most common symptoms:

Commonly prescribed antidepressant medications

Symptoms of depression can be managed with treatment, which may include medication, psychotherapy, and lifestyle adjustments like prioritizing physical activity. 

There are many options for medication to treat depression. Your provider will make recommendations based on your specific symptoms. Below are some of the most commonly prescribed medication classes.

Selective serotonin reuptake inhibitors (SSRIs)

Selective serotonin reuptake inhibitors (SSRIs) are the most commonly prescribed antidepressant. These medications increase a person’s levels of serotonin — a chemical in the brain that affects mood — to alleviate symptoms of depression.

It typically takes several weeks to a month to experience an SSRI’s benefits. Even if you don't feel like the medication is working, continue to take it as prescribed so that you can achieve a therapeutic level. If you still have concerns several weeks into treatment, speak with your doctor.

SSRIs have been linked to the following side effects, though they are mild in the majority of cases. Speak with your doctor about any concerns.

Serotonin and norepinephrine reuptake inhibitors (SNRIs)

Serotonin and norepinephrine reuptake inhibitors (SNRIs) increase levels of serotonin — like SSRIs — but they also increase norepinephrine, another brain chemical that affects mood.

These medications also have the potential for mild side effects, including the following. Speak with your doctor about any concerns.

Tricyclic antidepressants also increase the amount of serotonin and norepinephrine in your brain. An older medication class, they are less prescribed than newer medications as they have a greater potential for side effects.

Another older and less frequently prescribed class of antidepressants, monoamine oxidase inhibitors (MAOIs) increase the amount of dopamine, norepinephrine, and serotonin in your brain. They have a greater potential for medication interactions than other antidepressants.

Potential side effects of these medications include:

Some commonly prescribed antidepressants, like the following, don’t fit into the above categories.

Bupropion (Wellbutrin®) belongs to a class of medications called norepinephrine and dopamine reuptake inhibitors (NDRIs). It increases your levels of norepinephrine and dopamine to reduce symptoms of depression.

Nefazodone (Serzone®) and trazodone (Desyrel®, Oleptro®) are 5-HT2 receptor antagonists, which use a different mechanism than SSRIs to increase serotonin levels.

Mirtazapine (Remeron®) is a noradrenergic antagonist. It increases norepinephrine levels.

What to consider when taking an antidepressant

Finding the right antidepressant for your symptoms of depression may take time and trial and error. There are some steps you can take to improve your chances of success with the medication your doctor prescribes.

Recognizing and Treating Anxiety, The Most Common Mental Health Disorder

Some degree of anxiety is natural. In fact, it can even be beneficial in certain contexts, like pre-interview butterflies. Other times, however, anxiety can become so debilitating that it interferes with daily life. Frequent and intense feelings of nervousness may be indicative of an underlying mental health disorder.

Anxiety disorders are the most common type of mental health disorder in the U.S., affecting more than 40 million adults, or about 19%. It is also estimated that 7% of children and adolescents between the ages of 3-17 struggle with symptoms of anxiety.

Over the past few years, as Covid-19 brings much upheaval and change, the number of Americans suffering from anxiety disorders and depression continues to increase. As a result, the U.S. Preventive Services Task Force is now recommending that all adults under the age of 65 be screened for anxiety. 

For many of those with an anxiety disorder, treatment — in the form of medication, psychotherapy, or both — is necessary to manage symptoms and maintain an active and fulfilling life. Below, we explain more about some of the most common treatment options.

Many factors can contribute to anxiety, including genetics, environment, behaviors, and situations. Common causes and risk factors include:

Having another mental health disorder such as depression

Genetics - having a relative with an anxiety disorder is considered a risk factor

Certain personality traits such as shyness

Individual experiences of anxiety can vary, so your anxiety symptoms may be different from those of a friend or family member with the condition. Anxiety can cause physical sensations like butterflies in your stomach or a racing heart. It can also bring an overall feeling of fear or unwanted thoughts.

Digestive issues, stomach pain, or nausea

Thoughts or flashbacks of a traumatic experience

Anxiety disorders are highly treatable with medication and therapy. (A combination of both is necessary for many people with an anxiety disorder.) While it can be difficult to share your feelings with a healthcare provider, it’s an important first step in managing symptoms.

These are some indications that you may benefit from treatment for anxiety:

Anxiety, fear, or worry has interfered with work and relationships

You find it difficult to control your anxiety, fear, or worry

You are concerned about your use of alcohol or other substances

There are many options for medication to treat anxiety. Some are used on a short-term basis or as needed while others are taken daily in the long term. Your provider will make recommendations based on your specific symptoms.

Though it can be frustrating, finding the right medication for your anxiety symptoms can take some trial and error.

There are several types of medications commonly used to treat anxiety disorders.

Benzodiazepines are sedatives that induce a feeling of calm. They amplify the effects of certain chemicals that act as a messenger between brain cells.

Benzodiazepines commonly prescribed for anxiety include:

These medications are typically used for short-term treatment of acute symptoms and may be prescribed on an as-needed basis. They often cause side effects like drowsiness and difficulty with balance and memory.

While benzodiazepines are effective, they have the potential for dependence and misuse. As a controlled substance under the U.S. Drug Enforcement Administration’s guidelines, there are tight regulations for prescribing and dispensing benzodiazepines.

Benzodiazepines are not safe to abruptly discontinue. If you have been taking a benzodiazepine for longer than two weeks, speak with your doctor about slowly tapering off to avoid withdrawal symptoms and lower the risk of seizure.

Selective serotonin reuptake inhibitors (SSRIs) increase a person’s levels of serotonin, a chemical in the brain that affects mood. Increased serotonin levels can alleviate symptoms of anxiety. These medications are considered a frontline treatment option for anxiety disorders and are also used to treat depression.

SSRIs commonly prescribed for anxiety include:

While SSRIs are very effective for many people with anxiety, it typically takes several weeks to experience their benefits. Even if you don't feel like the medication is working, continue to take it as prescribed so that you can achieve a therapeutic level. If you still have concerns several weeks into treatment, speak with your doctor.

Always consult your doctor before stopping an SSRI. It is not recommended to frequently start and stop SSRIs, and they should not be taken on an as-needed basis.

Serotonin and norepinephrine reuptake inhibitors (SNRIs) increase levels of serotonin — just like SSRIs — but they also increase norepinephrine, which boosts energy and focus. These medications may increase your energy levels in addition to alleviating symptoms of anxiety.

SNRIs commonly prescribed for anxiety include:

Venlafaxine extended-release (Effexor® XR)

There are additional medications used to treat anxiety that do not belong to the medication classes above.

The antihistamine hydroxyzine (Atarax®, Vistaril®) blocks histamine and boosts the effects of serotonin. As the only antihistamine that offers this effect, it is the only antihistamine used to treat anxiety. This is typically an option for those who experience side effects with SSRIs or SNRIs, or who have concerns about the addictive potential of benzodiazepines.

Buspirone (Buspar®) is another alternative to SSRIs and SNRIs. While it isn’t entirely understood how buspirone works, the medication likely activates certain areas of the brain to make serotonin more active.

Each person metabolizes medications differently. Open communication with your provider can help identify the medication that works best for you. Your doctor should know:

Any other medications you are prescribed and their dosages

Your experience of anxiety symptoms after taking the prescribed medication — do you feel like it’s working?

Medication for anxiety disorders is often combined with psychotherapy, which helps you understand and manage your emotional and behavioral responses to sources of anxiety.

Cognitive behavioral therapy (CBT) is considered one of the most effective types of therapy for anxiety disorders. It helps you recognize the underlying thoughts and behaviors that fuel uncomfortable or debilitating emotions. Shifting your thoughts and behaviors then alleviates symptoms of anxiety.

Redux is great for managing client state: it allows data to be synchronized across the whole app, reduces prop drilling, and makes it easier to understand when state changes occur.

Server state is a different story. Sure, it’s nice to have data available everywhere in our app, which is why we tend to fetch data from the server and dump it into our Redux store. But because our client application doesn't own that server data, it’s hard to know when it has become stale. And what if multiple components trigger calls to fetch the same data? How do you dedupe requests? How do you decide when to refetch?

Why We Switched to React Query for Managing Server State

Redux is great for managing client state: it allows data to be synchronized across the whole app, reduces prop drilling, and makes it easier to understand when state changes occur.

Server state is a different story. Sure, it’s nice to have data available everywhere in our app, which is why we tend to fetch data from the server and dump it into our Redux store. But because our client application doesn't own that server data, it’s hard to know when it has become stale. And what if multiple components trigger calls to fetch the same data? How do you dedupe requests? How do you decide when to refetch?

Below, we’ll dive into how we’re using React Query at Alto to solve these problems and achieve separation of client and server state.

The Old Way: Fetch Server Data and Store It in State

Historically, we would fetch data and set the response in our React component state.

fetchUser(params) {
 this.setState({ isLoading: true });
 
 return getUser(params)
   .then(({ data }) => {
     this.setState({
       isLoading: false,
       user: data.user,
     });
   })
   .catch(() => {
     toaster.toast({ title: 'Something went wrong...' });
     this.setState({ isLoading: false });
   });
}

To make that data accessible from other components, we’d set that data in the global Redux store. This works fine, except that you have to manage your own loading state, the logic for when and when not to make the request, updating the store when mutating data on the server, and knowing when data is stale.

The React Query Way: Fetch and Cache Server Data

With React Query, fetching data and using that data is more declarative.

const { data, error, isLoading } = useQuery(
 // This is our Query Key, which is unique per query so that React
 // Query can manage the cache for us.
 ['user', { userId }],
 
 // This is our Query Function that actually does the data fetching.
 // We can use anything we want: built-in fetch, axios, etc.
 fetchUser({ userId }),
 
 // This query will not execute until the userId exists.
 { enabled: !!userId },
);

Here, we define our query for a user with a Query Key and a Query Function. The Query Key is unique per query, so React Query can manage our cache for us, and if any part of the Query Key changes, the query will automatically fetch new data. In this example, if the user ID changes, the query will fetch new data for that specific user and store that data in the cache.

Naming is hard, but caching is harder. React Query gives us caching of server data out of the box with cache invalidation and request deduping. If we use this same query with the same Query Key in another component, it'll check the cache: if the data is already there, React Query will simply return it, avoiding extra network requests!

Additionally, useQuery runs wherever you use it — no more fetching data when a component mounts. You just use the query and display the data when it’s ready. The cherry on top? The query returns status updates by default, so we don’t need to store isLoading in component state all the time.

Three Optimizations We Get With React Query

When we rebuilt Alto Connect, our web app for healthcare providers, we found impactful benefits in using React Query to help us manage server state instead of using Redux. Alto Connect provides instant access to patient and prescription information and enables messaging with the pharmacy. Because healthcare providers need to quickly switch between patients and clinics, caching data is important to provide a delightfully fast experience. Apart from the cache, what other optimizations do we get by using React Query? Below are a few that helped us.

Once we’ve queried for some data, it gets entered into our cache, so we can utilize that cached data when using the same query in a different component or when fetching new data for a stale query in the background.

React Query is configured with aggressive but sane defaults and considers cached data as stale. Stale queries will always query for new data when the following criteria are met:

The query is optionally configured with a refetch interval

The fetching for new data when the browser window or tab is refocused is especially useful because the healthcare providers using Alto Connect often switch between multiple browser tabs. If there’s an update to a task, status, or message while they’re checking a patient’s medical chart, it will be immediately reflected in the UI when they come back to Alto Connect.

We also set a refetch interval for our queries involving messages. In the old app, we used WebSockets to enable real-time messaging. Although it’s possible to integrate WebSockets with React Query, we opted for a polling solution instead. Because our app isn’t a real-time messaging application, and we don’t need messages to show up immediately, we set a refetch interval on our messages query to poll for new messages every 30 seconds.

const { data, error, isLoading } = useQuery(
 ['user', { userId }, 'messages'],
 fetchMessages({ userId }),
 {
   // This query is disabled from automatically running if we don’t have a userId
   enabled: !!userId,
 
   // Refetch every 30 seconds
   refetchInterval: 30000,
 
   // Continue to refetch while the tab/window is in the background
   refetchIntervalInBackground: true,
 },
);

This is where the enabled option, which disables a query when it evaluates to false, is particularly powerful. We can pause polling for messages if we route to another page and we know that we won’t make any unnecessary requests if there isn’t a valid userId. We don’t have to worry about closing any socket connections or manually clearing an interval.

Most web apps have some sort of navigation menu, and if you already measure or understand your user behavior, you can prefetch data before users even navigate to a different page. Custom hooks makes it easy to expose a function to prefetch data:

export const usePrefetchUsers = () => {
 const queryClient = useQueryClient();
 const prefetchUsers = async () => {
   await queryClient.prefetchQuery(
     ['users'],
     fetchUsers,
   );
 };
 
 return { prefetchUsers };
};

We prefetch queries when users mouseover or hover over a navigation item so that when they navigate to the next page, the data is either actively being fetched or is already in the cache waiting.

We’ve been talking a lot about queries, but what about mutating data? Mutations, in contrast to queries, are imperative. While queries run automatically when we use them, we need to fire a mutation method in order to run mutations. And in order for our user experience to feel snappy, we can optimistically update the cache and then invalidate it after successfully executing the mutation. useMutation gives us some nice side-effect handlers to deal with every stage of the mutation lifecycle. Now when the user sends a message, that new message is immediately reflected in the UI and we keep the data in sync by invalidating the cache and refetching the messages.

With Redux, we needed to build out solutions to each challenge of managing server state. React Query, on the other hand, gives us those tools right out of the box. We no longer need to worry about when to invalidate or fetch new data, making the user experience more predictable — and the developer experience more enjoyable.

To automate a manual, error-prone pharmacy workflow, we turned to event streaming. Here’s what we learned from one of the first Kafka use cases at Alto.

How We Used Kafka to Build an Event-Driven Automation Pipeline and Scale Our Pharmacy

Imagine this: You're at the doctor’s office, and your doctor just wrote you a new prescription. Minutes later, before you even check out with the receptionist, you already have a notification from Alto Pharmacy on your phone that your prescription is ready. All you have to do is pick the date and time that works best for your free courier delivery.

This is the future we’re building at Alto: a future where a prescription can be transcribed, billed, and verified by a pharmacist in five minutes, flat. To get there without dramatically increasing Alto’s head count, we need to automate much of the process, starting with the first step: transcribing, or intaking, a prescription.

As a pharmacy, we receive prescriptions in many different forms. Some are sent electronically, in a structured format, but others are handwritten, phoned in, or even faxed. To represent all of these forms in a single table, we previously required every incoming prescription to be transcribed by an Alto team member, who would answer questions like:

Whom is this prescription for? Is this customer already in our system?

Where did this prescription come from? Who wrote it?

What is the relevant prescription information (medication to dispense, quantity, days supply, directions, etc.)?

This manual process is both time-consuming and prone to human error, which, if uncaught, could impact our ability to process the prescription downstream. Furthermore, at our busiest times, it could take up to two hours for a team member to get through the pending intake queue — unacceptable if we hope to have prescriptions ready to schedule before people even leave their doctor’s office. 

Automating intake required close collaboration between three teams:

Data Science, who built the decision-making algorithms 

Data Engineering, who served up the results of those algorithms

Product Engineering, who used those results to automatically intake prescriptions 

To allow the teams to operate in parallel without toe-stepping — and in the language most suitable for each (the Data Science and Data teams prefer Python, while product engineers work mainly in Ruby) — we separated the code into two environments: 

1. Data Prod Interface (DPI), where the code for generating automation results lives

2. Wunderbar (our proprietary pharmacy operations platform), where the code for requesting and using those automation results lives

The key question: to establish robust communication between these two environments, should we use an API-based approach, or an event-driven one? Each has its pros and cons. 

Legacy approach everyone at Alto is familiar with

Existing enforcement of strong types and data

Difficult to scale with increased data & requests

Requires ongoing authorization / authentication

Infrastructure relevant to other business areas

Automatic retries, reprocessing, and queueing

Our existing infrastructure currently utilizes a hefty API-based structure, so there was a natural tendency to go down this path, but we knew that beginning to migrate services towards an event-based architecture with Kafka at its heart would help us in the long term.

Kafka is a framework implementation developed by LinkedIn, now open-source with the Apache Software Foundation. It aims to provide a unified, high-throughput, and low-latency platform for handling real-time data feeds. 

Alto uses Amazon Web Services as our cloud provider, and luckily, they offer an out-of-the-box managed solution for Kafka, MSK. To configure Kafka with our system, our infrastructure team worked with AWS to set up managed instances to comply with our business requirements. Our Infrastructure team will share more details about this work in an upcoming blog post. 

Kafka offers many benefits. The asynchronous nature of the message system allows for retries, reprocessing, and queueing as well as easy recovery from outages. In addition, the infrastructure work done for setting up the managed cluster would be a one-off workstream. When complete, we’d be able to re-use the same setup and configurations across various business needs to streamline other projects that leverage Kafka. 

Setting up for success: defining a strict contract

One element we had to get right from the start was the data contract. As we send messages between DPI and Wunderbar, we need to ensure messages are produced with the correct schema, so that downstream consumers know what to expect.

Blog

Why It’s Never Too Early to Prepare for Seasonal Allergies

How to Treat Seasonal Depression

A Guide to Commonly Prescribed Antidepressants

Recognizing and Treating Anxiety, The Most Common Mental Health Disorder

Why We Switched to React Query for Managing Server State

How We Used Kafka to Build an Event-Driven Automation Pipeline and Scale Our Pharmacy

How Alto Reduced Time to Resolution for Production Incidents

New Diabetes Diagnosis? Here’s What to Know

The Best Ways to Prepare for Seasonal Allergies

How to Debug Slow and Failing Cypress Seeds

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