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2017 HCHB_digital

Hay Fever Hay fever

Hay Fever Hay fever (also called intermittent or seasonal allergic rhinitis) is an allergic reaction that occurs seasonally, most commonly in spring and summer. Hay fever can have a huge impact on a person's quality of life, with 20% of sufferers experiencing symptoms for more than nine months of the year. Customers with symptoms that happen continuously throughout the year are more likely to have another form of rhinitis, called persistent allergic rhinitis (see Sinus and Nasal Problems). Hay fever is mostly associated with grass or tree pollens which are only present for part of the year. People whose symptoms tend to come on in late winter or early spring are more likely to have an allergy to tree pollen. People whose symptoms present in late spring or early summer are typically allergic to grass or weed pollen. Pollen season at the top of the North Island usually starts in October and ends in February, approximately one month earlier than that at the bottom of the South Island. Causes Wind-pollinated plants produce masses of light, buoyant pollen grains which are easily distributed through the air. These plants are more likely to cause hay fever than brightly coloured plants that attract bees and other insects for their pollination. The most common causes of hay fever in New Zealand are perennial rye grass, English plantain and the silver birch tree. Perennial rye grass First introduced to New Zealand in the 19th century, perennial rye grass is the most widely sown turf and pasture grass in this country. It is the biggest pollen producer of all and the most common cause of springtime hay fever. The pollen is small and can remain windborne for many miles. How badly a person is affected depends on their proximity to grasslands and the prevailing wind. A huge amount of pine pollen comes from our widespread forestry plantations of pinus radiata. Thankfully it is not very allergenic and only a small proportion of people with hay fever will be sensitised to it. Some fruit and vegetables have a similar molecular structure to pollen, so cross-reactivity can occur. This most frequently affects people with a silver birch allergy. Oral allergy symptoms (ie, itching or swelling of lips, tongue, throat, or roof of the mouth) develop on exposure to raw apples, stone fruit, wheat, carrots and some other vegetables. Cooking or canning destroys the allergens causing these reactions. How does hay fever develop Hay fever develops in a similar way to other allergies. When the body comes into contact with an allergen it produces immunoglobulin antibodies to it, as it perceives it as being harmful. This antibody combines with the allergen and causes mast cells to release histamine. Histamine irritates the tissues of the throat and nose which results in the symptoms of hay fever. Grass pollen allergies usually develop around the ages of three or four whereas tree pollen allergies typically develop about age seven. It is not unusual for adults to develop hay fever as it can take two to three seasons to become sensitised to pollen. People moving from relatively pollen-free coastal areas to inland farming areas are most at risk. It is not known why some people are more atopic (genetically predisposed towards allergies) than others. Symptoms Symptoms of hay fever may be similar to those of a cold and can include an itchy nose, roof of the mouth, throat or eyes; sneezing and a blocked or runny nose; red English plantain English plantain is an abundant weed in New Zealand growing in parks, lawns and roadside verges. Although it produces only small amounts of pollen, the pollen is highly allergenic and is a common cause of hay fever. Silver birch The silver birch is an popular introduced species that produces copious amounts of pollen. It is the main cause of tree pollen allergies. Other causes Privet is commonly seen throughout our countryside and produces a highly scented flower. However, it is not a strong allergen and many people who think they are allergic to privet are actually allergic to ryegrass which is not as visible as privet. Cupressus macrocarpa is commonly cultivated as shelter belts on farms or individually in gardens. Although the tree produces a lot of pollen it is not as allergenic as silver birch but may be responsible for a lot of early spring hay fever. OUTPERFORMS ANTIHISTAMINE TABLETS 1-3 TARGETS 6 ALLERGIC SUBSTANCES, NOT JUST 1 1,4,5 GSK Healthcare HAndbook Adverts.indd 4 Page 84 HEALTHCARE HANDBOOK 2017-2018 Common Disorders

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. 15/03/17 10:08 am Page 85

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