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HAYFEVER


AS THE ANNUAL POLLEN SEASON STRIKES THE UK ONCE AGAIN, TIMOTHY MCCLURE LOOKS AT THE REASONS WHY THE INCIDENCE OF ALLERGIC RHINITIS CONTINUES TO GROW.


ALLERGIC RHINITIS: ANNUAL IRRITATION


by Timothy McClure T


he UK has one of the highest prevalence’s of allergic rhinitis in the world, with the overall rate for the population standing at around 26 per cent, rising to 38 per cent in teenagers.1


Furthermore; a recent


report has predicted that the incidence of allergic rhinitis in the UK will double by 2030. With over-the-counter (OTC) allergic rhinitis remedy sales valued at £105 million in 2016, and with this year’s ‘pollen season’ upon us, community pharmacists are ideally placed to educate patients on the management and treatment of this increasingly common condition.2


Allergic rhinitis is essentially a mucosal reaction in response to allergen exposure. It is commonly defi ned as an Immunoglobulin E (IgE) mediated


48 - SCOTTISH PHARMACIST


infl ammatory disorder of the nose occurring when the nasal mucosa becomes sensitised to allergens. This subsequent allergic reaction triggers the release of potent infl ammatory mediators, primarily histamine, which exert their action via neural and vascular mechanisms. Ultimately, this causes the sufferer to experience the classic symptoms of allergic rhinitis. These include sneezing, itching, rhinorrhoea, nasal obstruction and a post-nasal drip. Patients might also suffer from ocular irritation giving rise to allergic conjunctivitis. The condition can develop at any time over the age of two years but will typically begin during adolescence or early adulthood.3,4


Interestingly, late onset


cases are becoming increasingly more prevalent. Moreover, fi gures suggest that fewer people are ‘growing


out’ of the condition as they reach adulthood.1


The exact reasons why some people develop allergic rhinitis are unclear. There appear to be both genetic and environmental factors contributing to its development. Some recognised risk factors include:


• Personal history of atopy • Familial history of rhinitis or atopy • Air pollution • Reduced exposure to infection • Exposure to cigarette smoke3,5


Allergic rhinitis is generally classifi ed as seasonal, perennial or occupational:


Seasonal – symptoms occur at the same time each year. If caused by grass or tree pollen allergens, it is also


commonly called hay fever. Other allergens include mould spores and weed pollen.


Perennial – symptoms occur throughout the year. Typically caused by house allergens like dust mites and domestic pets.


Occupational – symptoms occur due to exposure to allergens at work. Examples include fl our, wood dust and latex gloves.1,5


More recently, allergic rhinitis has been classifi ed by severity and persistence of symptoms. Categories include mild intermittent, moderate severe intermittent, mild persistent and moderate severe persistent.3


Symptoms can be divided into acute- phase and late-phase responses. Within minutes of allergen exposure,


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