Clinical Tips: Hayfever

Allergies and seasonal rhinitis are not just a minor condition that can be easily dismissed, writes Karalyn Huxhagen

Spring is fast becoming summer and the hot winds and pollen in the air are bringing out the allergic reactions.

Customers are presenting with prescriptions for non-sedating antihistamines and corticosteroid nasal sprays to try and alleviate their symptoms.

Seasonal rhinitis occurs during the time that the allergen is in the air, for example a particular flower is in bloom, while perennial rhinitis occurs all year around and the trigger is often things like dust or animal hair.

Many allergy sufferers will present at the pharmacy and ask for over the counter medication to ease their symptoms. Patients will describe this condition as hayfever, allergies or sometimes just a simple runny nose and itchy watery eyes.

Many will have their favourite tried and true products to reduce the symptoms of allergy and seasonal rhinitis. These conditions can make you feel very unwell with the following symptoms being common:

• watery, itchy eyes;
• sneezing;
• general feeling of malaise;
• headache;
• inability to concentrate;
• runny or stuffy nose;
• sore or scratchy throat; and/or
• dark circles under the eyes.

Some patients may have skin sensitivity as well including hives, itchy skin.

There are many causes of allergic reactions from animal hair and dander to pollen, seeds, grains and dust.

When presented with a patient expressing the above symptoms it is important to discuss whether the problem is short term, long term or continual.

Patients who frequently suffer from seasonal rhinitis sometimes switch antihistamines as they have concerns that they are becoming immune to the one they are taking.

If the patient is not gaining relief and has long term reactions occurring it would be prudent to recommend visiting an allergist to discuss how to identify the trigger substance and reduce the reactions that are occurring.

The patient will need to undertake testing and desensitisation to assist in reducing their reactions.

Prevention is always better than cure and there are many ways to reduce the incidence and severity of seasonal rhinitis:

• Identify your trigger factors and avoid these triggers:
  • stay inside when pollen counts are high;
  • remove carpet and curtains to minimise dust mite and pet dander;
  • removal animals that are triggers;
  • bath the animal twice a week to reduce hair and dander loss;
  • take a shower immediately after coming in from outside;
  • air and vacuum your mattress regularly;
  • keep the windows and doors shut in allergy season;
  • cover the mouth and nose when out in the garden; and
  • avoid chores that trigger your allergy e.g. vacuuming, mowing, raking leaves.
• Take medications before the seasonal allergies occur to reduce the potential for flareup.
• Use medications such as Montelukast for seasonal flareups.
• Use regular saline nasal sprays/washes to reduce the inflammation in the nasal mucosa.
• Regular use of nasal inhaled corticosteroids.

When a patient presents with seasonal rhinitis it is important to remember that this reaction is occurring in:

• all of the sinuses;
• eyes;
• skin; and
• lungs and bronchioles.

Symptom relief should be discussed to cover all of the areas of the body that are involved in the allergic reaction:

• eye drops for allergy;
• topical corticosteroids;
• inhaled steroids for both the lungs and the nasal passages;
• short term decongestants for the nasal passages; and
• antihistamines to reduce the inflammatory response to the histamine.

Seasonal rhinitis may seem a minor condition but it is easy for a secondary bacterial infection to occur. This can cause deterioration in the patients’ health.

While seasonal rhinitis seem a minor condition it does have the possibility to make the suffer feel very unwell, be unable to concentrate and cause a large degree of absenteeism from school or workplace.

Continual issues with seasonal rhinitis should be investigated further by an allergist or appropriate specialist.

As pharmacists our role is to be vigilant to identify the frequent flyers that come into the pharmacy seeking symptom relief and to discuss with them the need for further investigation and preventative measures.

Source: Karalyn Huxhagen, AJP, 21 October 2016, https://ajp.com.au/education/clinical-pharmacy/clinical-tips-hayfever/