HAYFEVER


work, home life and has a negative impact on their social life. Further to that, many children have reported the negative impact so hayfever on their schoolwork and specifi cally affecting their sleeping patterns. In previous years skin prick tests would have been routinely carried out, however these now tend to be reserved for more extreme or diffi cult to manage cases.


HOW TO TREAT OR REDUCE THE EFFECTS OF HAYFEVER? The basic principle of symptom reduction is to avoid the causative allergen, however for many people this would involve not venturing outside. Obviously this is not a realistic situation and as such, the majority of patients can fi nd relief with the use of topical or systemic medicines available over the counter. Education of patients regarding simple steps that can be taken to help reduce exposure to pollen, such as closing


ALMUS® OTC ALLERGY RELIEF RANGE


The Almus® OTC allergy relief range offers patients a quality- assured selection of products to help relieve the symptoms of seasonal allergies and allergic reactions.


Incorporating a wide range of P and GSL lines commonly found in the local pharmacy, Almus® OTC allergy relief products provide value for money for patients and improved profi t margins for pharmacists.


The range incorporates strong and distinctive colour packaging, including full-colour illustrations and markings, to enable both pharmacy teams and patients to easily differentiate and distinguish product lines.


The Almus OTC range of allergy relief medicines currently includes: Cetirizine tablets 10mg; Loratadine tablets 10mg; Chlorphenamine tablets; Chlorphenamine Maleate solution and Beclometasone nasal spray.


Ritu Bhardwaj, Senior Product Manager, Alvita® & Almus® OTC comments: “Around 1 in 4 people in the UK are affected by allergies. They can be triggered in a number of ways and cause many different reactions that can be uncomfortable, debilitating and frustrating to deal with.


“The Almus® OTC range of allergy relief medication helps patients to manage their condition, with products that offer a high quality alternative to leading brands, combined with great value for money for both pharmacists and consumers.”


Customers can order from the Almus® OTC allergy relief range via their PMR system, or by contacting their local Alliance Healthcare Customer Services team.


For more information on the full range of Almus® OTC medicines and to discuss your OTC requirements, please contact your local Alliance Healthcare Account Manager.


Medical information: Tel: 0800 917 7983 Email: medinfo@almus.co.uk 16 - 16 - SCOTTISH PHARMACIST


doors and windows in the home, especially during the summer months will help to reduce the effects felt by the patient.


MEDICAL TREATMENTS INCLUDE:


• Topical nasal antihistamines – these are fast acting (generally within 15 minutes of application) and demonstrate superior effects over oral antihistamines. The main drawback here is that they do not help to reduce symptoms at other areas, such as the eyes and mouth.


• Oral Antihistamines – These medicines are more effectiveness when taken on a regular basis, to allow a build up within the systemic circulation. Their primary mode of action is to control/regulate the release of histamine, however neural action has been shown to be


the predominant mechanism with regards to itchiness, sneezing and rhinorrheoa.8


• Intranasal topical steroids – the vast majority of patients will gain good control over nasal symptoms with regular and continued use of topical steroid sprays. Long-term use of such medicines has been shown to be effective and safe when used within the recommended dose. As with all medicines the mantra of lowest dose for the shortest period of time should be adopted here, especially when such medicines are used in children, perhaps alongside inhaled steroids for the treatment of asthma. These medicines can be associated with dryness of the nasal mucosa with occasional bleeding and this may warrant a reprieve from treatment.9


• Sodium Cromoglicate – this medicine is a second line option, as generally is less effective than antihistamines and intranasal corticosteroids. Frequent application, up to fi ve times each day, can have a negative impact on patient adherence with this particular medicine.


In particularly young children or patients who prefer not to use long- term medicines, the use of nasal saline washes has shown benefi t and can reduce nasal steroid requirements.


Topical decongestants are generally not recommended for the treatment of hayfever, as although initial usage will help to relive symptoms, continued use will result in the rhinitis medicamentosa phenomenon. This is where rebound congestion can be experienced as a direct result of prolonged use of topical decongestants. Oral steroid treatments are generally held for cases where all other options have failed to attain adequate control, and the patient feels signifi cant detrimental impact on everyday life. Prolonged use of oral steroids is associated with numerous drawbacks.


Immunotherapy options are available, however in light of safety concerns these are only indicated for those who have not responded to all other anti-allergy medicines. These medicines are recommended for prescribing under medical staff that are trained and specialise in this area. These immunotherapeutic vaccines contain extracts of grass or tree pollen in order to suppress the


body’s immune response to such antagonists. 10


Grazax® is a sublingual


tablet containing pollen extract. The treatment is initiated at least four moths prior to the start of the next pollen season and can be continued for up to three years.11


With the increasing prevalence across Northern regions it seems hayfever will continue to be a community pharmacy favourite. By equipping patients with the information that is available, many negative aspects of hayfever can be contained, or at least reduced. Pharmacists in the community can continue to be a sympathetic ear to the general public, offering advice and practical support; tissues to immune- modulating drugs, Pharmacy has it all. •


REFERENCES


1. The Herald News Article. Accessed on Friday 6th March 2015. Available at: http://www.heraldscotland.com/news/ health/grim-news-for-victims-of-hay- fever.25785859


2. Daily Express News Article. Accessed on Friday 6th March 2015. Available at: http://www.express.co.uk/news/ nature/482021/HAY-FEVER-HELL- Pollen-count-will-stay-at-record-highs- for-FIVE-MONTHS-warn-forecasters


3. Daily Mail News Article. Accessed on Saturday 7th March 2015. Available at: http://www.dailymail.co.uk/health/ article-2312742/Pollen-counts-set- soar-summer-experts-warn-hay-fever- worst-50-years.html


4. Allergy UK, Leading the Fight against Allergy. Accessed on Thursday 5th March 2015. Available at: http://www. allergyuk.org/hayfever-and-allergic- rhinitis/hay-fever-and-allergic-rhinitis


5. NICE guidelines on Allergic Rhinitis. Accessed on Friday 6th March 2015. Available at: allergic rhinitis http:// cks.nice.org.uk/allergic-rhinitis NICE Sept 2012.


6. Guidelines for the management of allergic and non-allergic rhinitis. British Society for Allergy and Clinical Immunology (January 2008).


7. Risk factors in allergy/asthma. Allergy Asthma Proc. 2004 Jan- Feb;25(1):7-10.


8. Oral antihistamines for the symptom of nasal obstruction in persistent allergic rhinitis--a systematic review of randomized controlled trials. Clin Exp Allergy. 2005 Feb; 35(2):207-12.


9. Nasser M, Fedorowicz Z, Aljufairi H, et al; Antihistamines used in addition to topical nasal steroids for intermittent and Cochrane Database Syst Rev. 2010 Jul 7;(7):CD006989.


10. Di Bona D, Plaia A, Scafi di V, et al; Effi cacy of sublingual immunotherapy with grass allergens for seasonal allergic J Allergy Clin Immunol. 2010 Sep;126(3):558-66. Epub 2010 Aug 1.


11. Summary of Product Characteristics (SPC) Grazax®; Summary of Product Characteristics (SPC) Grazax®, ALK-Abello Ltd, electronic Medicines Compendium. Dated November 2010


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