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2017 HCHB_digital

Allergies An allergy

Allergies An allergy occurs when the body’s immune system overreacts to a normally harmless substance (called an allergen). Symptoms vary and range from very mild to potentially life-threatening. Allergies are a contributing factor to conditions such as hay fever, eczema and asthma. Allergens may be in the air or on things that are touched or eaten, and encompass many different things. Environmental allergens can be grouped into those that are seasonal (for example, pollens and moulds) and those that last year round (such as house dust mites and pets). Other common allergens in New Zealand include: • foods such as cow’s milk, eggs, fish, peanuts and other nuts, soy, and wheat (account for over 90% of all food allergies) • insect stings or bites (see also Bites and Stings) • latex • medicines (for example, aspirin, penicillin). While allergies are not directly inherited, people do inherit the tendency to be allergic. A person prone to allergies is called atopic, and these individuals have a tendency to develop new allergies, often to things that they have not been allergic to in the past. When a person who is allergic to a particular allergen is exposed to that allergen, their body responds by overproducing immunoglobulin E (IgE) antibodies. The antibodies attach themselves to immune system cells, called mast cells, and trigger the release of histamine and other chemicals. Mast cells are most commonly found in the skin, mucosa of the lungs and digestive tract, as well as in the mouth, conjunctiva of the eye, and nose, and the release of histamine causes allergic symptoms such as itching, redness, sneezing, swelling, and tightness. Initial assessment A person’s symptoms depend on how the allergen entered the body, for example, mosquito bites on the skin cause a characteristic wheal and flare reaction, whereas allergic rhinitis caused by inhalation of pollens into the nose results in sneezing, a blocked and runny nose, tickly throat and itchy eyes (see also Hay Fever). Other symptoms include a swelling of the lips, face and eyes, hives or welts on the skin (see also Urticaria), a tingling mouth, and with food allergy, abdominal pain and vomiting. Symptoms may rapidly progress in some people to anaphylaxis. Symptoms caused by conditions such as hay fever or insect bites are usually obvious; however, some allergic reactions are not so obvious, so ensure you ask your customer for a full description of their symptoms and if they have any idea of the likely cause. Refer customers with severe or recurring allergies to the pharmacist. Emergency treatment should be sought for any customer who presents with facial swelling or with breathing difficulties. Many people just buy treatments in case of future exposure, so make sure that the product sold will be effective against their typical symptoms. Always take a person’s history of allergy seriously, and ensure they know what to do if they ever have a serious allergic reaction. Diagnosing allergies Although some people are aware of what is causing their allergy, many people are not, and actually pinpointing the allergen can be a complicated process. A medical and family history may be required, in addition to a physical exam, skin prick testing, and/or blood tests. Food diaries are often used to narrow down likely allergens in people with suspected food allergies or intolerances. A food diary is a written record of a person’s diet and any resultant symptoms over a set period of time. Over a period of a week or two, a pattern may emerge. It is important to note, if reactions to TREATMENT OPTIONS Category Examples Comments Adrenaline Oral antihistamines [PHARMACIST ONLY] eg, adrenaline auto-injector device (EpiPen Adult, EpiPen Junior) [PHARMACY ONLY MEDICINE] Non-sedating, eg, cetirizine (Razene, Zetop), desloratadine (Aerius), fexofenadine (Fexofast, Telfast, Xergic), levocetirizine (Levrix), loratadine (Claratyne, Loraclear) Sedating, eg, promethazine (Phenergan*) Customers with allergies should be trained on how to use an auto-injector device. EpiPen training pens are available free on joining EpiClub (www.epiclub.co.nz). Inject into the upper thigh not the buttock. Always call an ambulance following administration for further follow-up. ACC may reimburse cost of EpiPen used as treatment for an anaphylactic reaction. Note: At the time of going to print, EpiPen was the only auto-device available to purchase in New Zealand Oral antihistamines help control total body itch and inflammation. Generally, non-sedating medicines do not cause drowsiness; however, some people may be more sensitive than others. Customers need to be warned about the risks of driving or operating machinery if they do get drowsy (see also Hay Fever). Oral and topical (nasal and ocular) antihistamines, nasal corticosteroids and decongestants See Hay Fever for a list of products in this category Emollients and topical corticosteroids See Dermatitis/Eczema for a list of products in this category Products with an asterisk have a detailed listing in the Allergies section of OTC Products, on page 220. Dual Action Relief Non-drowsy Antihistamine for hayfever + Decongestant for blocked or runny nose Maxiclear Hayfever & Sinus Relief combines a non-sedating antihistamine (Loratadine) with a nasal decongestant (Phenylephrine) to simultaneously treat hayfever and a blocked or runny nose. Page 14 HEALTHCARE HANDBOOK 2017-2018 Common Disorders

CONTINUING OTC EDUCATION a particular food are obvious, advise the customer to avoid the food in question until they have consulted their doctor. Treatment of allergies The best management for allergies is to avoid the allergen; however, this is not always possible. Treatment of an allergic reaction depends on the reaction, but may include antihistamines, decongestants, skin creams, corticosteroids and adrenaline, some of which may need to be prescribed by a doctor (see treatment options below). Some allergies can be treated with immunotherapy (also called desensitisation or hyposensitisation). This involves a series of injections over a long period (up to five years in some cases) that gradually increase the exposure to an allergen and stimulate the immune system to develop a resistance to the allergen. Immunotherapy is particularly useful for allergies to insect venom, such as bee or wasp stings. People who have life-threatening allergic reactions should always carry adrenaline and know how to use it correctly. Adrenaline is available in an automatic device (such as the EpiPen); however, automatic devices are expensive as they are not currently subsidised and have a limited shelf life. Encourage people with allergies to wear a medical bracelet or necklace (eg, Mediband, Medic Alert) that states details of their allergy(ies). People with allergies should always tell a doctor, pharmacist, or other health professional of their allergies before starting any new treatment, including complementary medicines. For children with serious allergies attending school or daycare, caregivers should consider providing a poster complete with their child’s photograph that clearly outlines their child’s condition and treatment. Training for staff on how to use auto-injector devices may also be needed. See www.allergy.org.nz for more information on keeping children with allergies safe at school and preschool. Anaphylaxis Anaphylaxis is the most severe form of allergic reaction and is potentially lifethreatening. It must be treated as a medical emergency, requiring immediate treatment and urgent medical attention. Anaphylaxis can occur in anybody, even people who have never reacted to an allergen before. Signs and symptoms Signs and symptoms of anaphylaxis may occur almost immediately after exposure or within the first 20 minutes of exposure and may include: • difficulty and/or noisy breathing • swelling of the tongue, or swelling or tightness in the throat • difficulty talking or a hoarse voice, wheeze or persistent cough • loss of consciousness and/or collapse. Abdominal pain and vomiting is also a sign of anaphylaxis with insect allergy. Reactions in young children may be more subtle. They may turn pale, become unresponsive and go floppy. Symptoms can rapidly become life-threatening. Useful websites www.allergy.org.nz Charitable organisation that provides information, education and support (includes anaphylaxis e-training and guidelines for schools, parents and others). www.allergy.org.au The Australasian Society of Clinical Immunology and Allergy (ASCIA) provides education, information and action plans. Treatment of anaphylaxis Administration of adrenaline is the first line of treatment for anaphylaxis. Once medical attention is available, other medications may also be administered. Antihistamines are not a treatment for anaphylaxis. People who are prescribed reliever-type asthma inhalers (such as salbutamol) should use their inhaler for breathing problems after using the adrenaline autoinjector, not before. Co-existing asthma is associated with a higher risk of death from anaphylaxis so it is important asthma is kept well controlled. Prevention of anaphylaxis Accidental exposure to allergens happens and customers and their caregivers should be educated on recognising the signs and symptoms of anaphylaxis and in the administration of adrenaline if they are at high risk of anaphylactic shock. ALLERGY TRIGGER Animal dander Dust mites Food allergies Insect bites and stings Pollen Skin allergies ADVICE Keep pets out of your bedroom and off carpet and furniture. Use allergen-proof bed covers and wash bedding weekly. Keep humidity low and ensure good house ventilation. Buy washable stuffed toys and keep stuffed toys off beds. Remove dust regularly with a damp rag. Vacuum regularly with a double-layered microfilter bag or HEPA filter. Remove carpeting and replace with wood or vinyl flooring. Remove any clutter that is likely to collect dust. Consider the introduction of allergenic-type foods in babies aged four to six months once less-allergenic foods have been tolerated. Wear footwear outdoors and cover body with clothes. Be alert for the presence of wasps around camp-sites or bins. Wear gloves and insect repellent when gardening. Keep the garden free of highly allergenic plants. Stay indoors when pollen count is high (eg, hot or windy days), shut windows and turn on air conditioner. Get someone else to mow your lawn, or wear a good mask and wraparound sunglasses. Shower and wash hair at night to wash away any pollen. Avoid strong soaps, perfumes and products that may irritate. Hayfever Itchy eyes Sneezing Runny nose Nasal congestion Maxiclear® Hayfever & Sinus Relief (Phenylephrine HCl 10mg and Loratadine 2.5mg, 30s) is a Pharmacy Medicine for the temporary relief of nasal and sinus congestion, hayfever, runny nose, watery and itchy eyes and sneezing. AFT Pharmaceuticals Ltd, Auckland. TAPS 1733HA. NZ Patent No. 588134. Page 15

  • Page 1 and 2: HEALTHCARE HANDBOOK incorporating t
  • Page 3 and 4: 2017-2018 HEALTHCARE HANDBOOK PUBLI
  • Page 5 and 6: Index Common Disorders Acne--------
  • Page 7 and 8: Asthma and COPD CONTINUING OTC EDUC
  • Page 9 and 10: Head and scalp • Condition of hai
  • Page 11 and 12: HELP KIDS BE THEMSELVES AGAIN NEW L
  • Page 14 and 15: NUROFEN ZAVANCE* IS ABSORBED UP TO
  • Page 16 and 17: Acne Acne is a common skin problem
  • Page 20 and 21: Asthma and COPD Asthma New Zealand
  • Page 22 and 23: Baby Feeding Breastfeeding is best
  • Page 24 and 25: Bites and Stings Bites and stings c
  • Page 26 and 27: Bruises, Scars, Spider Veins Bruise
  • Page 28 and 29: Childhood Diseases and Immunisation
  • Page 30 and 31: Childhood Diseases and Immunisation
  • Page 32 and 33: Childhood Diseases and Immunisation
  • Page 34 and 35: Childhood Diseases and Immunisation
  • Page 36 and 37: Childhood Pain and Baby Teething Pa
  • Page 38 and 39: Colds A cold is a contagious viral
  • Page 40 and 41: Cold Sores Cold sores are fluid-fil
  • Page 42 and 43: Constipation Constipation is the te
  • Page 44 and 45: Contraception & Sexual Wellbeing Co
  • Page 46 and 47: Contraception: Emergency Emergency
  • Page 48 and 49: Coughs: Dry Coughs are called dry o
  • Page 50 and 51: Coughs: Productive Coughs are consi
  • Page 52 and 53: Cuts, Abrasions and Blisters This t
  • Page 54 and 55: Cystitis [Bladder Infection] Cystit
  • Page 56 and 57: Dandruff Dandruff is a common condi
  • Page 58 and 59: Dermatitis/Eczema Dermatitis is a g
  • Page 60 and 61: Diabetes Diabetes is a condition in
  • Page 62 and 63: Diarrhoea and Vomiting Diarrhoea an
  • Page 64 and 65: Dry Skin Dry skin is skin that lack
  • Page 66 and 67: Ear Conditions Our ears allow us to
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    Eye Conditions Almost two-thirds of

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    Eye Conditions (continued) Type Sym

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    Eyes: Contact Lenses Contact lenses

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    Fever What is fever Fever is define

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    Foot Care Common foot problems incl

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    Fungal Infections: Superficial Supe

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    Fungal Nail Infections (Onychomycos

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    Gout Historically known as the “d

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    Haemorrhoids Haemorrhoids (also cal

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    Hair Loss Alopecia is the medical t

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    Hay Fever Hay fever (also called in

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    Hay Fever (continued) TREATMENT OPT

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    Headache Headaches are common and c

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    Head Lice Head lice (pediculosis ca

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    Heart Health Cardiovascular (CV) di

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    Indigestion, Heartburn and Gastriti

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    Influenza Influenza (flu) is a comm

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    Influenza (continued) TREATMENT OPT

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    Iron Deficiency Iron is an essentia

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    Irritable Bowel Syndrome Irritable

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    Menopause Menopause - the “change

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    Migraine Migraines are a type of se

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    Muscular Aches, Pains and Tightness

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    Nappy Rash Nappy rash is a red rash

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    Oral Health Oral health disorders i

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    Osteoarthritis Osteoarthritis is th

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    Osteoporosis Osteoporosis (meaning

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    Period Pain and Endometriosis Perio

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    Poisonings Any substance that has t

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    Pregnancy Tests and Supplements Hom

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    Preventive Health There are certain

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    Probiotics and Prebiotics Probiotic

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    Psoriasis Psoriasis is a long-term

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    Scabies Scabies is a very contagiou

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    Shingles Shingles (herpes zoster) i

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    Sinus and Nasal Problems Sinuses ar

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    Sleep Problems and Snoring Sleep is

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    Smoking Cessation Almost 5000 New Z

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    Sore Throat Sore throats are very c

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    Strains and Sprains Sprains and str

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    Sun Care Sunburn Sunburn occurs fro

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    Sun Care: Eye Protection Protecting

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    Sweating: Excessive (Hyperhidrosis)

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    Toothache Toothache is the term use

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    Travel Health (including Vaccinatio

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    Travel Sickness Travel, or motion,

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    Urinary Incontinence Urinary incont

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    Urticaria (Hives) Urticaria refers

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    Vaginal Health The vagina is a clos

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    Varicose Veins and Support Stocking

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    Vitamins and Dietary Supplements Vi

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    Warts Warts are benign (non-cancero

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    Weight Loss Obesity has reached epi

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    Worms Pinworms (Enterobius vermicul

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    Wound Care Our skin acts as a barri

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    Wound Care (continued) Wound type M

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    Glossary WHAT DOES THAT WORD MEAN?

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    Chapter References (continued) Diar

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    Chapter References (continued) Gord

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    Significant learning opportunity: W

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    PharmacyToday A part of your everyd

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    OTC Medicines: Interactions When se

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    OTC Medicines: Interactions OTC Med

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    OTC Medicines: Interactions OTC Med

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    OTC Medicines: Interactions OTC Med

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    OTC Medicines: Precautions OTC Medi

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    OTC Medicines: Precautions OTC Medi

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    OTC Medicines: Adverse Effects OTC

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    Herbal Supplements: Interactions He

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    Herbal Supplements: Interactions He

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    Herbal Supplements: Interactions He

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    Herbal Supplements: Interactions He

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    Drugs in Sport Treating Athletes Me

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    Drugs in Aviation AVIATION - PRECAU

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    Drugs in Pregnancy Drug use in preg

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    NZ Support Groups ADHD Association

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    NZ Support Groups New Zealand AIDS

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    HEAT or INFLAMMATION Unlike heat ru

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    OTC Products Over-the-counter produ

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    OTC Products Index Foot Care - Fung

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    »» Acne CRYSTADERM CREAM AFT PHAR

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    »» Childhood Pain and Baby Teethi

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    »» Colds BONNINGTON’S IRISH MOS

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    CODRAL RELIEF MAX STRENGTH COLD & F

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    OTRIVIN JUNIOR GLAXOSMITHKLINE CONS

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    DULCOLAX SANOFI CONSUMER HEALTHCARE

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    BENADRYL MUCUS RELIEF DOUBLE ACTION

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    »» Dandruff COCO-SCALP AFT PHARMA

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    EAR CLEAR WILSON CONSUMER PRODUCTS

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    »» Foot Care - Fungal Infections

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    TELFAST ORAL LIQUID SANOFI CONSUMER

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    NUROFEN ZAVANCE RECKITT BENCKISER (

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    MOOV HEAD LICE SOLUTION DOUGLAS PHA

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    GAVISCON DUAL ACTION LIQUID RECKITT

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    CODRAL COLD & FLU + COUGH JOHNSON &

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    »» Irritable Bowel Syndrome GASTR

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    VOLTAREN EMULGEL GLAXOSMITHKLINE CO

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    TURMERIC EXTRA STRENGTH GOOD HEALTH

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    PREGNOSIS EARLY PREGNANCY TEST DIP

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    »» Sexual Wellbeing - Contracepti

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    SUDAFED PE SINUS DAY + NIGHT RELIEF

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    NICORETTE INHALATOR JOHNSON & JOHNS

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    STREPSILS PLUS LOZENGES RECKITT BEN

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    TRAVACALM TRAVEL BAND WILSON CONSUM

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    CRYSTADERM CREAM AFT PHARMACEUTICAL

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    An ENHANCED ELearning Experience As

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    Product Index ANIME LUBRICANT 50ML-

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    Manufacturer’s Index AFT Pharmace

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    Topiramate Actavis Topiramate 25mg,

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