Allergies

Video of woman arranging flowers

Hay fever

Hay fever affects 10-15% of children and 26% of adults in the UK.1

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Hayfever is usually worse between late March and September as this is when the pollen count is highest.2

Symptoms include:3

  • Sneezing
  • Itchy nose/palate/throat
  • Blocked/stuffy nose/nasal congestion
  • Runny nose/nasal discharge
  • Red/itchy/watery eyes (can become sore with frequent rubbing)
  • Post nasal drip
  • Cough
  • If you have asthma you may also notice wheezing or a tight feeling in your chest as well as a cough
  • Sinus inflammation/pain
  • Feeling of itch in ear/ear blockage

Also known as seasonal allergic rhinitis, hay fever is caused by airborne allergens from grasses, trees, weeds, plants and moulds which are wind pollenated.3

Grass pollen is the most common trigger of hayfever. It is possible to be affected by more than one type of pollen, extending the sufferer’s season.3

Self-care advice for management of hay fever3

  • Monitor pollen forecasts and stay indoord when the count is high
  • Limit time spent in rural areas
  • On high pollen days, shower and wash hair after arriving home and change clothing
  • Keep windows closed when indoors – especially early morning and evening
  • Avoid mowing lawns or raking leaves if possible – a filtration face mask may help if this is not possible
  • Wear wraparound sunglasses and a hat when outside
  • Keep car windows closed and have the air intake on recirculate

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Food allergies

Incidence of food allergy tends to be greater in young children/toddlers (5-8%) than adults (1-2%).4

Symptoms of food allergy include:5

  • Skin reactions – itching and swelling (rash or nettle rash)
  • Respiratory reactions – runny nose, sneezing, cough

Common food allergens include:5

  • Celery
  • Cereals containing gluten
  • Crustaceans
  • Eggs
  • Fish
  • Lupin
  • Milk
  • Molluscs
  • Mustard
  • Tree nuts
  • Peanuts
  • Sesame seeds
  • Soya
  • Sulphur dioxide

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Pet allergies

Pet allergies are caused by protein in a pet’s saliva, urine or dander (shed skin particles). This is spread when pets groom themselves.6

Patients who have allergic asthma or hay fever are more likely to have a pet allergy.6

Symptoms of pet allergy include:

  • Sneezing
  • Coughing
  • Breathing difficulties
  • Wheeze
  • Watery, red, itchy eyes
  • Skin rash/hives
  • Eczema flares

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Itchy skin rash associated with chicken pox

The itchy rash of chicken pox can make children feel miserable. It is important that children try not to scratch the spots as this can lead to scarring.

Chicken pox is most common in children under 10 and the key season for catching it is winter and spring, particularly between March and May.7

The rash starts as small itchy red spots which develop a blister on top and become intensely itchy after about 12-14 hours.7

The use of an antihistamine may help to relieve the itchy rash of chicken pox when symptoms are troublesome at night and so aid restful sleep.

  • What is an allergy?

    Women sneezing

    Allergic disorders, including anaphylaxis, allergic rhinitis/hayfever, eczema, and asthma, affect approximately 25% of people in the developed world8

    An allergy is an excessive or abnormal adaptive immune response directed against non‐infectious, often inert environmental substances (allergens), including non‐infectious components of certain infectious organisms8. For people with allergies, persistent or repetitive exposure to allergens, which are typically innocuous substances, results in chronic allergic inflammation8.

    In turn, this can produce long‐term changes in the structure of the affected organs and substantial abnormalities in their function8.

    Allergens and allergic inflammation:

    Allergen

    1. There are two main types of allergen:Any non‐infectious environmental substance that can induce immunoglobulin E (IgE) production (thereby ‘sensitising’ the subject) so that later re‐exposure induces an allergic reaction8Common allergen sources include8:
      1. Grass and tree pollens
      2. Animal dander (from skin and fur)
      3. House dust mite faecal particles
      4. Certain foods (eg, peanuts, tree nuts, fish, shellfish, milk, and eggs)
      5. Latex
      6. Various medicines
      7. Insect venoms
    2. A non‐infectious environmental substance that can induce an adaptive immune response linked to local inflammation—but one thought to occur independently of IgE (eg, allergic contact dermatitis to poison ivy or nickel)8.

    Allergic inflammation

    This is the inflammation produced in sensitised subjects after exposure to a specific allergen(s). With persistent or repetitive exposure to allergens, chronic allergic inflammation develops, with associated tissue alterations8.

    What is allergic rhinitis?

    Allergic rhinitis (AR) is defined as an IgE antibody‐mediated, inflammatory disease characterised by one or more of the following symptoms9:

    1. Nasal congestion
    2. Rhinorrhea—runny nose (anterior and posterior)
    3. Sneezing and itching

    There are several AR classification characteristics that can be helpful to determine appropriate patient treatment strategies, including9:

    1. Temporal pattern and context of exposure to a triggering allergen:
      • Seasonal (e.g., pollens) or perennial (year‐round exposures such as house dust mites), or
      • Episodic environmental (from allergen exposures not normally encountered in the patient’s home or occupational environment, e.g. visiting a home with pets not present in an individual’s home)
    2. Frequency and duration of symptoms
    3. Severity of symptoms

    AR has traditionally been categorised as seasonal AR (SAR) or perennial AR (PAR), both of which are conditions recognised as having similar pathophysiologic and end‐organ manifestations. In general, the differences between the two conditions are primarily based on the causes and duration of disease9.

    Management of allergic rhinitis in pharmacy

    Based on the guidance developed by the British Society for Allergy and Clinical Immunology (BSACI)8

    First line recommendations

    Mild symptoms

    Oral/H1 antihistamines

    • Effective on symptoms of itch, sneeze and rhinorrhea. Some H1 antihistamines have modest effects on nasal blockage
    • Improve allergic symptoms at sites other than the nose
    • Regular therapy is more effective than ‘as needed’ use in persistent rhinitis

    Moderate/troublesome symptoms

    Topical intranasal corticosteroids

    • Act by suppression of inflammation at multiple points in the inflammatory cascade

    Find out more about managing allergic rhinitis by completing the module on your personalised learning page.

  • Causes and mechanisms of allergies

    Mechanism of allergies

    What happens when an allergen infiltrates the body?

    The body’s immune response to allergens includes a series of early‐ and late‐phase reactions – the allergic cascade. There are several allergic mediators involved in this cascade, not just histamines10.

    Typically, the allergic cascade follows this pattern10,11:

    • Sensitisation to an allergen
    • Early‐phase response upon re‐exposure to an allergen
    • Late‐phase response

    When the body is exposed to an allergen:

    • Sensitisation involves being exposed to an allergen for the first time10
    • The body produces immunoglobulin E (IgE) designed specifically for that particular allergen, but an allergic reaction does not yet occur10
    • Re‐exposure to an allergen triggers an early‐phase response that occurs within minutes to an hour10
    • The IgE of mast cells binds to the allergen, crosslinking the IgE10
    • When enough crosslinking occurs, the mast cells explode with histamine and other inflammatory substances, called mediators, such as cytokines, leukotrienes, prostaglandins, eosinophils, and thromboxanes10,11
    • The end result is the allergic response consisting of a range of symptoms such as rhinorrhea (runny nose), sneezing, congestion, and pruritus (itching)10
    • The late‐phase response occurs from 3 to 10 hours after allergen re‐exposure10
    • Immune cells, such as eosinophils, secrete substances that increase inflammation and bring other immune cells into the reaction, perpetuating the inflammatory response10
    • Symptoms can be more severe than those in the early phase10

    MOA of antihistamines

    Antihistamines work by binding to the H1 receptor, therefore inhibiting histamine (a mediator of the inflammatory response) from binding to the H1 receptor. This hinders the body’s response when exposed to an allergen, thus preventing symptoms such as wheezing, sneezing, coughing, itchy nose and eyes, runny nose, and shortness of breath12.

    MOA of decongestants

    Decongestants work by stimulating receptors on blood vessels, causing vasoconstriction and shrinking of the nasal turbinates. Constriction alleviates nasal mucosa inflammation and allows the sinuses to drain, thereby reducing nasal congestion13.

    MOA of anti‐leukotrienes

    Anti‐leukotrienes block the action of leukotrienes, which cause tightening of airway muscles and production of excess mucus and fluid, reducing nasal secretions14.

    MOA of intranasal corticosteroids (INSs)

    INSs, often used as first‐line treatment for patients with mild persistent or moderate‐to‐severe symptoms, work locally in the nasal mucosa to block multiple mediators involved in the allergic cascade, including histamine, cytokines, leukotrienes, chemokines, prostaglandins, and tryptase11,15-17.

    INS11,15-17:

    • Act on both early and late phases of the inflammation process, therefore relieving the symptoms they cause
    • Provide relief of nasal congestion and itching, runny nose and sneezing, and itchy, watery eyes.
  • Prevalence of allergic rhinitis

    Allergic rhinitis is a global health problem, affecting up to 20% of people globally18.

    44% of British adults suffer from at least one allergy, a statistic that is on the rise19 and AR affects up to 40% of British children19.

    The symptoms of AR can have a deep impact on an individual’s emotional and psychological well‐being. Patients may be looking for a solution that restores their ability to live their lives uninterrupted by AR symptoms.

    AR may limit the ability of your patients to participate in social and outdoor activities, work productively, and sleep20.

    AR prevalence

    Recent studies indicate that the prevalence of AR is increasing21. Across the United States and Europe, in many populations, the frequency of sensitisation to inhalant allergens is increasing and is now more than 40%22.

  • Quality of life impact

    Quality of life impact

    Many patients will “suffer in silence” without talking about their symptoms. They may be purposefully diminishing their allergy symptoms and the impact they have on their quality of life for a variety of reasons23

    1. They believe allergies aren’t that serious or are not a “real disease,” but more of a nuisance24
    2. They may not know that while allergies may seem benign, they can still significantly impact their quality of life23
    3. They may be unaware that untreated allergies can increase the risk for more serious diseases, such as anaphylaxis, asthma, sinusitis, altered mood, and cognitive impairment23,25

    Patients may not recognise some symptoms as being related to allergies. In addition to the more obvious symptoms, these surprising symptoms may be due to allergies23,25,26

    • Chronic fatigue
    • Asthma
    • Upper respiratory infection
    • Bronchitis
    • Sinus infection
    • Depression
    • Sleeping problems
    • Difficulty concentrating
    • Lack of exercise endurance
  • Product Information - Pirinase Allergy

    Pirinase Allergy 0.05% Nasal Spray (fluticasone propionate 50 micrograms per spray). Uses: Prevention and treatment of allergic rhinitis. Dosage and method of use: Adults: Two sprays into each nostril once or twice a day if required. Maintenance: one spray per nostril once a day if possible. Use lowest possible maintenance dose. Max 4 sprays a day in each nostril. Children under 18 years: Not to be used. Contraindications: Hypersensitivity to ingredients. Precautions: Seek medical advice if inadequate relief after 7 days, or require more than 3 months continuous use. Seek medical advice before use with: concomitant corticosteroid use, fever, nasal/sinus infection, recent nasal injury/surgery, nasal ulceration, pregnancy, breast feeding. Caution due to interactions with cytochrome P450 3A4 inhibitors like ketoconazole, and protease inhibitors such as ritonavir and cobicistat which may increase systemic exposure to fluticasone. Caution commencing in those withdrawing from systemic steroids, particularly if impairment of adrenal function suspected. Systemic effects of nasal corticosteroids may occur, particularly at high doses prescribed for prolonged periods. May cause visual disturbance. Contains benzalkonium chloride which may cause bronchospasm. Side effects: Dryness and irritation of the nose and throat, nasal ulcers, unpleasant taste and smell, headache and epistaxis. Hypersensitivity reactions including skin rash and oedema of the face or tongue. Eye disorders such as glaucoma and blurred vision. Rarely anaphylaxis/ anaphylactic reactions and bronchospasm. See SPC for full details. Legal category: P. PL number: PL 44673/0099. Product licence holder: GlaxoSmithKline Consumer Healthcare (UK) Trading Limited, Brentford, TW8 9GS, U.K. Package quantity and MRSP (excl. VAT): 60 sprays £7.24; 120 sprays £11.66. Date of last revision: April 2020.

  • Product information – Piriton Syrup and Piriton Allergy Tablets

    Piriton Syrup and Piriton Allergy

    Tablets (chlorphenamine maleate) Syrup: 4 mg /10 ml. Tablets: 4 mg. Uses: Symptomatic relief of allergic conditions including hayfever. Symptomatic relief of itch associated with chickenpox. Dosage and method of use: Adults: 4 mg 4-6 hourly. Max 24 mg/24h. Elderly: Lower dose may be required. Children 6-12 years: 2 mg 4-6 hourly. Max 12 mg/24h. Children 2-6 years: 2.5 ml 4-6 hourly. Max 6 mg/24h. Children 1-2 years: 2.5 ml, twice daily. Max 2 mg/24h. Piriton Allergy Tablets not recommended for children under 6 years. Do not use either product continuously for more than two weeks without consulting a doctor. Contraindications: Hypersensitivity. Treatment with MAOIs within last 14 days. Precautions: Avoid concurrent use with other antihistamines. May seriously affect ability to drive and use machinery. May increase effects of alcohol. Caution in enlarged prostate, severe hypertension, cardiovascular disease or respiratory conditions, hepatic or renal impairment, epilepsy, raised intraocular pressure, intolerance to some sugars. Avoid use in elderly patients with confusion. Avoid concurrent use with drugs which cause sedation. Syrup: Contains sucrose. Contains hydroxybenzoates (E218, E214, E216) which may cause allergic reactions. Contains ethanol. Side effects: Sedation, somnolence, fatigue, disturbance in attention, abnormal coordination, dizziness, headache, blurred vision, nausea, dry mouth, allergic disorders including anaphylaxis. Children and the elderly are more prone to the neurological anticholinergic effects and rarely may become confused or excitable. See SPC for full details. Legal category: P. PL numbers: Syrup: PL 44673/0094. Tablets: PL 44673/0093. Product licence holder: GlaxoSmithKline Consumer Healthcare (UK) Trading Limited, Brentford, TW8 9GS, U.K. Package quantity and RSP (excl. VAT): Syrup: 150 ml £4.99. Tablets: 30s £3.99, 60s £6.99. Date of last revision: January 2021.

  • Product Information – Piriteze

    Piriteze Allergy Tablets and Piriteze Allergy Syrup

    (cetirizine hydrochloride). Tablets: 10 mg; Syrup 1 mg/ml. Uses: Symptomatic treatment of perennial rhinitis, seasonal allergic rhinitis and chronic idiopathic urticaria. Dosage and method of use: Adults and adolescents over 12 years: 10 mg daily. Children 6-12 years: 5 mg twice daily. Elderly: As adults if renal function normal. Children under 6 years: Not recommended. Adjust dose in moderate to severe renal impairment. See SPC for details. Contraindications: Hypersensitivity to ingredients, hydroxyzine, piperazine derivatives or severe renal impairment (creatinine clearance <10 ml/min). Precautions: Concomitant alcohol. Predisposition to urinary retention (e.g. spinal cord lesion, prostatic hyperplasia). Epilepsy/risk of convulsions. Caution when driving or operating machinery. Tablets: Not suitable for those with galactose intolerance, Lapp lactase deficiency or glucose-galactose malabsorption. Syrup: Not to be taken by those with fructose intolerance. Contains methyl and propyl parahydroxybenzoate which may cause allergic reactions. Side effects: Dizziness, headache, fatigue, somnolence, dry mouth, sore throat, abdominal pain, nausea, diarrhoea, rhinitis, allergic disorders including anaphylaxis and hypersensitivity, suicidal ideation, depression, nightmares, inflammation of the liver, skin eruptions, joint pain. See SPC for full details. Legal category: GSL (7, 12, 30 tablets & syrup). PL numbers: PL 44673/0097 & 0095. Product licence holder: GlaxoSmithKline Consumer Healthcare (UK) Trading Limited, 980 Great West Road, Brentford, TW8 9GS, U.K. Package quantity and RSP (excl. VAT): Tablets: 7s £3.73, 12s £5.77, 30s £8.33. Syrup: 70 ml £5.08. Date of last revision: April 2020.

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