2017 HCHB_digital

CONTINUING OTC EDUCATION
or watery eyes. Frequent rubbing of itchy eyes may also lead to the development
of conjunctivitis (see Eye Conditions).
Some people may also complain of a headache or sinusitis. Symptoms can be
troublesome enough to interfere with sleep, work performance, learning ability
and participation in social activity. Symptoms are often worse in the morning or
evening, or in hot, humid or windy weather, and particularly after thunderstorms
when pollen levels are high. Symptoms often get worse as the season goes on.
Research has found that allergic rhinitis is a very common trigger for
asthma and responsible for thousands of asthma-related hospitalisations
and hundreds of asthma-related deaths each year. It is estimated that up to
80% of people with asthma also have hay fever, and up to 40% of people
with hay fever, will go on to develop asthma. Guidelines recommend that
all asthma patients be evaluated for allergic rhinitis and vice versa, and in
planning treatment, both conditions should be considered together.
Initial assessment
Clarify that your customer's symptoms are the result of hay fever, and not from a
cold. Itchiness of the eyes, ears, mouth or throat is typical of pollen allergies, and
hay fever is a seasonal condition, that generally occurs around the same time
each year. Offer lifestyle advice and refer any customers with "yes" answers to
the Refer to Pharmacist questions. For other customers, base product selection
on most troublesome symptom, for example, itchy eyes – an antihistamine eye
drop; blocked nose – an oral decongestant; runny nose – an oral antihistamine;
multiple eye and ear symptoms – a nasal corticosteroid.
Encourage everybody presenting with hay fever to talk with their doctor at
their next appointment about its link with asthma. Further investigations may
be warranted.
Treatment
Treatment consists of treating or preventing the allergic reaction with
antihistamines, corticosteroid nasal sprays or mast cell stabilisers and relieving
symptoms using decongestants, pain relievers or antihistamines. See Treatment
Options next page.
Non-sedating antihistamines prevent histamine release and are available as
liquids, tablets and nasal sprays. All relieve sneezing, itching, and help dry up a
runny nose but only levocetirizine has shown to be effective at relieving nasal
congestion. Experts recommend antihistamines as a first-line treatment for mild
hay fever symptoms. Antihistamine eye drops are also available to help soothe
and relieve the redness and itch of allergic conjunctivitis commonly associated
with hay fever (see also Eye Conditions).
Corticosteroid nasal sprays reduce inflammation in the lining of the nose and
work better when used as a preventative, ie, taken before symptoms develop.
They can be used continuously for weeks or months throughout the hay fever
season and are the best treatment for moderate-to-severe hay fever symptoms.
Decongestant nasal sprays and tablets unblock the nose and relieve nasal
congestion. Only use occasionally and not for more than three days at a time as
Refer to
PHARMACIST
The following questions aim to identify customers who would
benefit from further input from a pharmacist. Your initial assessment
may have already provided some answers. Decide if any further
questions still need to be asked and refer any “yes” answers to a
pharmacist.
• Does the person have any other health conditions (eg, heart or
lung problems, diabetes, is pregnant or breastfeeding)?
• Does the person take any other medication or herbal remedy,
either prescribed by a doctor or bought from a shop?
• Does the person also have shortness of breath, a cough or wheeze?
• Are there any other symptoms (eg, swollen glands, fever and/or a
persistent headache)?
• Is there any coloured or yellow discharge from the nose or eyes?
• Is only one side of the nose or eye affected?
• Are the ears or sinuses painful?
• Have symptoms persisted despite treatment or do symptoms
occur all year round?
• Is the person a child?
• Does the person have any allergies to medicines?
prolonged use can result in a worsening of nasal congestion.
Desensitisation or immunotherapy may be considered for people with
particulary severe hay fever if none of the above treatment options work (see
also Allergies).
Advice for customers
• Start preventive treatment for hay fever early in the season and take it
regularly, especially if triggers that set off hay fever are unavoidable.
• Eye symptoms generally reduce once nasal symptoms are controlled.
• Corticosteroid nasal sprays must be used regularly since maximum relief may
not be obtained for several days.
• Wear sunglasses and possibly a mask or scarf outside and wash hands and
face on returning. Avoid parks and pollen-abundant areas (especially if just
mowed). Stay indoors if pollen counts are high (see www.metservice.com).
• Wipe pets down with a damp cloth to remove pollen collected on their fur.
1. Australian Medicines Handbook 2016, AMH Pty Ltd; Adelaide.
2. Bousquet J et al. Allergy 2008; 63(Suppl 86):8–160.
3. Wallace DV et al. J Allergy Clin Immunol 2008;122:S1–84.
4. Bachert C & Geveart P. Allergy 1999;54(Suppl 57):116–23.
5. Wiseman LR & Benfield P. Drugs 1997;53:885–907.
Always read the label. Use only as directed. For the treatment and prevention
of allergic rhinitis. If symptoms persist, see your healthcare professional.
Pharmacy Medicine. Flixonase Allergy and Hay fever contains fluticasone
propionate 50mcg per spray. For the prevention and treatment of seasonal and
allergic rhinitis including hayfever. Precautions: Nose bleeds, nasal infection,
pregnancy and lactation. For adults 18 years and over two sprays in each
nostril once daily. FLIXONASE is a registered trade mark of the GSK group of
companies or its licensor. Auckland, New Zealand. TAPS PP9392.
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