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Australian Journal of Pharmacy : March 2005
allergy Pharmacy’s allergic response Down-scheduling of allergy treatments has encouraged greater self-management of the condition and, therefore, confers more responsibility on pharmacy to effectively educate the allergic customer.MEGAN PEARD reports O RTHODOX treatments for aller- gic disease are now mainly avail- able over-the-counter from pharmacy, increasing the pharmacist’s responsibil- ity for helping manage the conditions. ‘Pharmacists have a very big responsi- bility to their allergy patients now, because prescription of a lot of products, like the intra-nasal steroid sprays, have been effec- tively taken out of the hands of doctors and specialists,’ said Associate Professor Ron Walls, past president of the Australasian Society of Clinical Immunology and Allergy (ASCIA) and allergy clinician at Sydney’s Concord Hospital. ‘A lot of these products are now avail- able over-the-counter, or from speaking with a pharmacist about the allergy. So the first port of call in many cases is the pharmacist—or often just the [pharmacy assistant]. I would imagine that for mild- to-moderate severity of symptoms, this would be appropriate. ‘Certainly the algorithm exists, how- ever, whereby if there’s no improvement using these simple measures, then the patient should go to their GP. And from there, depending on whether there are other factors, these people should be referred to the specialist. Educating the consumer Associate Professor Walls said that along with pharmacists’ larger role in providing treatment for allergic symptoms came a responsibility to educate these patients. ‘In particular, pharmacists need to give out information about the correct usage of medicines. There are a lot of misun- derstandings out there regarding intra- nasal corticosteroid sprays, for example. ‘Most of them are intended for use as a preventative, taken daily. However, many patients use them only when they have allergic symptoms. ‘The majority of patients who come to see me use these preventers when their nose is stuffy, and can’t understand why they’re not immediately alleviating the symptoms.’ He said that although evidence indi- cated that intra-nasal steroid sprays were the most effective over-the-counter prod- uct in combating the symptoms of allergic rhinitis, their sales in Australia had dropped over the last year or so. Sales of over-the-counter tablets had risen, he told the AJP. ‘It may be because people don’t like squirting things up their noses. It may be that pills are simply easier to use. But it may also be because inadequate advice is 186 ? THE AUSTRALIAN JOURNAL OF PHARMACY VOL.86 MARCH 2005 given to the patient when they purchase nasal sprays.’ Associate Professor Walls said that some anecdotal evidence indicated to him that in many cases, no advice is given when pharmacy-only medication is sold. Customers also needed to be made aware that allergic conditions can have complications, and predispose people towards developing more serious illnesses. ‘Having allergic rhinitis predisposes one to asthma. If the rhinitis is not treated properly, that patient has three times the risk of developing asthma later in life, compared to a non-sufferer. ‘There is also the risk of chronic sinusi- tis if allergic rhinitis isn’t adequately treated. By not managing the condition you’re exposing yourself to greater risks of these other conditions, and I think that pharmacists have a responsibility to know about these risks and tell the patient.’ A team approach to allergy management Associate Professor Walls told the AJP that becoming involved with other health professionals could improve patient man- agement. A recent round-table project, the results of which were published in the 3 January 2005 issue of the Medical Jour- nal of Australia, proved to be an extremely valuable exercise, he said. ‘We got some very useful leads as to how to refer on, making the assumption that the pharmacist is the first port of call,’ he told the AJP. The project found a continued need for a team approach to the treatment of aller- gic symptoms. One issue highlighted by the project was that among non-sufferers, allergic rhinitis is still considered to be a fairly triv- ial condition. ‘Formal studies have shown that the quality of life of patients with allergic rhinitis is at least as compromised as that of patients with asthma and, in some aspects, more compromised,’ Associate Professor Walls said. ‘It has a significant impact on the ability to perform at school, in sport, at work. ‘Another debilitating condition is urticaria, which can be very frustrating for