Home' Australian Pharmacist : Australian Pharmacist August 2014 Contents Australian Pharmacist August 2014 I ©Pharmaceutical Society of Australia Ltd.
CONTINUING PROFESSIONAL DEVELOPMENT
COUNSELLING IN PRACTICE
Zoe, 27, often comes into your pharmacy for prescription medicines and
quite enjoys browsing through your cosmetics and skin care section.
Today, she's come in to ask for a waterproof mascara as she finds that
her eyes have been quite itchy. Her usual mascara runs down her face
when her eyes get watery from sneezing. She says she doesn't think the
mascara is irritating her eyes because she starts sneezing from the time
she wakes up. She also gets an itchy and runny nose. Does Zoe need more
than a waterproof mascara?
What is hay fever?
Hay fever is a common term for allergic
rhinitis (AR) and may affect about 15% of
Australians.1 The condition does not
entail developing a fever but the name
came about as symptoms would typically
occur during the hay harvesting season.
Although people may be allergic to the
hay, it is more likely that allergies are due
to grass, tree pollen or other allergens.
Rhinitis can be classified as allergic
(hay fever) or non-allergic.2 Non-
allergic rhinitis can be due to sinusitis,
ear infections or certain medicines.
In the World Health Organization
guidelines, Allergic Rhinitis and its
Impact on Asthma (ARIA), allergic
rhinitis is re-classified from the original
terms, seasonal and perennial rhinitis.3
The new terms, intermittent rhinitis
(IAR) and persistent rhinitis (PER), were
introduced. The severity of AR can be
classified as mild or moderate-to-severe.
A key number to remember in
understanding the new classification is
'4' -- patients with IAR have symptoms
for less than 4 days/week and less than
4 weeks/year, whereas patients with PER
have symptoms for more than 4 days/
week for more than 4 weeks/year.4
What are the causes and
symptoms of AR?
There are several types of allergic
reactions and AR is considered a
Type 1 reaction. Type 1 reactions
are an immediate hypersensitivity
reaction involving immunoglobulin
E (IgE)-mediated release of histamine
and other mediators from mast cells
and basophils. Patients who experience
these reactions are usually atopic,
which is a genetic predisposition to
making IgE antibodies in response to
allergens.5 The triggers or allergens for
AR are usually the same as those for
asthma such as house dust, pet hair or
plant pollen. Environmental pollutants,
chemical fumes and temperature
changes can also trigger symptoms of AR.
Symptoms of allergic and non-allergic
are similar and may include:
• runny and itchy nose
• nasal congestion
• itchy, watery, red eyes
• itchy nose, ears, throat.
Other symptoms that can occur from
the constant nasal congestion include
headaches, impaired sense of smell or
coughing from the post-nasal drip.
Maureen Narayan-Ram is a Professional Practice
Pharmacist based at the PSA Queensland Branch office
After reading this article pharmacists should be
• Explain the classification and recognise the
symptoms of hay fever
• Counsel on treatment options for hay fever
• Provide patient education on management of
trigger factors and adherence to medicines.
Competency standards (2010) addressed: 1.3, 2.1,
Accreditation number: CAP140808A
on hay fever
BY MAUREEN NARAYAN RAM MPS
This article has been independently researched and peer reviewed.
AR symptoms can impact a person's
quality of life and affect their
performance at work. It can result in poor
quality of sleep, tiredness and daytime
sleepiness. Children with AR can find it
harder to concentrate at school and it
can also cause daytime sleepiness and
interfere with their learning.6
Does AR run in families?
Allergic conditions such as AR are
strongly associated with other
conditions such as asthma, allergic
conjunctivitis and eczema.7--9 Evidence
is accumulating that AR often precedes
the onset of asthma symptoms.8
There is a strong link between asthma
and allergy and they frequently co-exist10:
• 30--40% of Australians have allergies.
• Allergic sensitisation is seen in up to
80% of people with asthma.
• Early childhood asthma is associated
with sensitisation to allergens in the
• Sensitisations do not cause asthma but
people with asthma have an increased
risk of developing sensitisations.
Studies are suggesting that early
treatment with immunotherapy of
individuals who have allergies, may aid
in asthma prevention.8
How can AR be treated?
Treatment is often begun without
the need for any testing and first-line
therapy should be based on nature and
severity of symptoms.11 Table 1 shows
the Australian guidelines for treating AR.
The mainstays of therapy are
antihistamines (oral/nasal) and intranasal
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