Understanding seasonal allergies

It’s no secret that allergy symptoms can make sufferers miserable.

Whether it’s itchy noses, throats, eyes and skin, or sneezing, congestion and difficulty breathing, the symptoms aren’t much fun. Often a retail pharmacy is the first stop for sufferers aiming to find relief.

Leading into allergy season, this month we cover asthma and allergic rhinitis (AR), and the role of pharmacists in this space.

“AR may be classified as seasonal or perennial,” said Debbie Rigby, advanced practice pharmacist and Clinical Executive Lead at the National Asthma Council Australia. “Seasonal AR is often caused by outdoor allergens such as pollens and moulds, whereas perennial is frequently caused by indoor allergens such as house dust mites, moulds, cockroaches and animal dander.

“The duration of symptoms can be described as intermittent or persistent. Intermittent refers to symptoms occurring less than four days a week or for less than four consecutive weeks.

“Asthma is a chronic condition, characterised by inflammation and narrowing of the airways. Asthma flare-ups can happen quite quickly or emerge gradually over hours or days. The common cold or viral infection is a common trigger for asthma flare-ups. While allergies can be an asthma trigger for some people, asthma flare-ups can also be triggered by other factors, such as exercise, respiratory infections, irritants, cold air, stress and even laughter.

“Allergies and asthma can have overlapping symptoms, but it’s important to distinguish between the two, as the treatment options differ. However, for people who also have asthma, better control of AR symptoms often results in better control of their asthma.

“AR and asthma frequently coexist. At least 75 per cent of patients with asthma complain of AR symptoms, and 20-30 per cent of those with AR also have asthma.”

One of the first steps in managing allergies and asthma is recognising the triggers. Ms Rigby says some of the triggers for AR and asthma include environmental allergens such as pollens, dust mites and animal dander and cigarette smoke.

“Asthma can also be triggered by airborne or environmental irritants, including cold or dry air, fuel combustion, household aerosols, traffic pollution, bushfires, indoor wood fires and gas cooking, and even thunderstorms,” she said, adding that while AR isn’t caused by food allergies when it comes to asthma “some people may have dietary triggers or allergies”.

According to Jacqui Coote, managing pharmacist and owner of WholeLife Pharmacy and Healthfoods at Strathpine in Queensland’s Moreton Bay region, knowing the triggers is an important part of knowing whether an allergic attack is about to occur.

“Each person is different in the signs they may receive that they’re having a reaction,” she said. “Typically for asthma, you’d notice a cough, wheeze or chest tightness. For allergies, you’d more commonly notice sneezing, runny nose or itchy eyes, but allergies can also trigger skin reactions – so welts or itchy skin.”

A pharmacist can help sufferers manage allergy and asthma symptoms through various strategies, including advice on common pharmacy products.

“Both prescription and OTC products are effective in relieving the symptoms of AR and associated conditions such as asthma,” Ms Rigby said. “It’s important to manage comorbidity of AR and asthma. Patients with AR severe enough to affect everyday activities or worsen asthma control will need long-term preventer nasal medication – just like asthma preventers.

“Pharmacists can support people living with asthma and allergies through awareness, case finding, education and counselling when dispensing OTC and prescription medicines, assessing control, and referring patients to the GP when appropriate.

“Inhaler and nasal spray techniques should be assessed and corrected at every opportunity. In people who have AR and asthma, effective treatment for AR is important to help keep asthma under control – treat AR to manage asthma.”

Ms Coote added: “Asthma can be managed by increasing education in the pharmacy, particularly around correct inhaler technique and the use of spacer devices for all patients. Pharmacies also have access to air filtration devices and Wheezo asthma management devices, which can be offered to improve asthma management.

“Education around the use of a steroid nasal spray when asthma symptoms are worse can be highly beneficial, as the tissue in the nasal passages ‘speaks’ with the lung tissue and can help reduce overall reactivity of the airways. 

“Allergies are typically managed by the use of over-the-counter antihistamines, steroid nasal sprays, nasal rinses, and short-term use of decongestants in severe cases. For skin allergies, there are many options for hypoallergenic skin care: steroid creams and education around environmental factors such as having warm, not hot, showers to preserve skin barrier function.

“Pharmacists are well equipped to provide one-on-one education to people with chronic asthma and allergies. In addition to over-the-counter products and advice, pharmacists can perform a medication review and provide suggestions to the treating GP for any medication management issues.”

This feature was originally published in the August issue of Retail Pharmacy magazine. 

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