Home' Australian Pharmacist : June 2011 Contents Vol. 30 -- June #06
Continuing Professional Development
The articles in this series are independently researched and compiled by PSA commissioned authors and peer reviewed.
By Lynn Greig
counselling in practice
immunoglobulin E-mediated immune
response to an inhaled allergen.
The allergic inflammatory cascade
has three phases:4,5
• Sensitisation -- initial contact
with an allergen may lead to the
production of immunoglobulin E
(IgE) antibodies against the allergen.
These IgE antibodies bind to high-
affinity receptors on mast cells.
• Early-phase response -- on further
exposure to the allergen, sensitised
mast cells are activated when two
molecules of bound IgE are cross-
linked by antigen. The activated mast
cells release chemical mediators
such as histamine, cytokines (e.g.
tumour necrosis factor-alpha),
interleukins and prostaglandins
into the nasal mucosa, resulting in
immediate onset of symptoms such
as rhinorrhoea and sneezing.
• Late-phase response -- over the
next few hours the nasal mucosa
is infiltrated by other inflammatory
cells (e.g. eosinophils, neutrophils
and basophils), which release
further inflammatory mediators,
producing continued inflammation.
The predominant late-phase
symptom is nasal congestion.
Allergic rhinitis has a strong genetic
component. If a child has one parent
with atopy (allergies) they have a 30%
risk of developing allergic rhinitis.
This risk increases to 50--70% if both
parents are atopic. Having other
allergic conditions also predisposes a
person to allergic rhinitis, and a person
with a history of infantile eczema has
a 70% chance of developing allergic
rhinitis, asthma, or both. Allergic
rhinitis and asthma often co-exist.
Approximately 20--30% of people with
allergic rhinitis also have asthma, and
allergic rhinitis is recognised as a risk
factor for developing asthma.6,7
How common is
Australia has one of the highest rates
of allergic disorders in the developed
Lynn Greig is a Professional Programs
Pharmacist with PSA National Office.
After reading this article you should
be able to:
• Provide customers with
information on allergic rhinitis.
• Counsel on the treatment options
for allergic rhinitis.
• Identify symptoms which warrant
referral to a doctor.
Competency standards (2010)
6.1.1, 6.1.2, 6.2.1, 6.2.2, 7.1.4
world, with allergic rhinitis being
the most prevalent allergic disorder
in all age groups except children (in
whom asthma is the most common
allergic disorder). The prevalence of
allergic rhinitis in Australia has almost
doubled over the past 10 to 15 years
and in 2005 it was estimated to affect
over three million Australians. Its
prevalence peaks in the mid-teens and
it affects over 20% of young adults.
It becomes gradually less prevalent
with increasing age, but remains
the most common allergic condition
What are the typical
symptoms of allergic rhinitis?
The classic symptoms of allergic
rhinitis include rhinorrhoea (runny
nose), nasal congestion (which
increases during the late phase),
sneezing, itching of the palate,
nose and throat, and watery, itchy
eyes. Other symptoms may include
headaches, postnasal drip, snoring,
tiredness, daytime sleepiness, sore
throat, constant clearing of the throat,
cough, and dark circles under the
eyes (known as 'allergic shiner').3,6
Allergic rhinitis is classified according
to the severity, timing and duration of
symptoms. See Table 1 for details.
What are other causes
Rhinitis may also have non-allergic
causes. Common non-allergic causes
include upper respiratory infections
(usually viral), vasomotor rhinitis and
sinusitis. Other non-allergic types
of rhinitis include hormonal rhinitis
(e.g. due to pregnancy, menstruation,
hypothyroidism, acromegaly or use
of oral contraceptives), anatomic
rhinitis (e.g. deviated septum, adenoid
hypertrophy), nasal polyps, nasal
tumour, rhinitis medicamentosa
(due to overuse of decongestant
nasal sprays), non-allergic rhinitis with
eosinophilia syndrome (NARES) and
a nasal foreign body.3,7,9,10
A young woman presents to the
pharmacy complaining of a runny
nose, sneezing, and itchy eyes and
throat. She says she has been using
a decongestant nasal spray for the
past two days but it hasn't made
What is causing my
It is likely that the lady is suffering
from allergic rhinitis. Rhinitis is
defined as 'inflammation of the
mucous membranes of the nose,
usually accompanied by swelling of
the mucosa and a nasal discharge'.1
Allergic rhinitis is the most common
form of rhinitis not associated with
infection (e.g. viral -- common cold).2
It may be seasonal (hay fever),
occurring mainly in spring and early
summer and triggered by pollens;
or persistent, occurring throughout
the year and triggered by a variety
of allergens, including house dust
mites, animal dander, moulds and
The symptoms of allergic
rhinitis develop as a result of an
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