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Australian Journal of Pharmacy : March 2005
allergy the patient. Chronic urticaria can go on for a long time and may have no appar- ent underlying symptoms. People can get pretty fed up with having to constantly take medicines like antihistamines, and never finding out what the cause is. ‘Many of them think that since the doc- tor or specialist can’t help them, they’ll seek help elsewhere.’ Unorthodox treatment The rise of heavily promoted (but unproven) unorthodox allergy tests and treatments recently prompted ASCIA to issue a position paper, Unorthodox Tech- niques for the Diagnosis and Treatment of Allergy and Asthma, to help distinguish between unorthodox treatments and those known to be reliable and safe. Associate Professor Ray Mullins, ASCIA’s education representative, authored the paper. He told the AJP that the most popular unorthodox treatments were, in order, acupuncture, chiropractic therapy and diet manipulation. ‘Acupuncture is quite well accepted in the community as a form of treatment— even Medicare helps pay for it,’ he said. ‘It’s useful in treating pain syndromes and helping with analgesia, but when you come to conditions like asthma and hayfever, the evidence just isn’t there. ‘I have patients who swear by it, but it’s not clinically proven—any evidence is anecdotal, and we need to be aware of this.’ From there the unorthodox treatments for allergies become increasingly ‘bizarre’, he said, with testing including Vega (electrodermal) testing, radionics (psionic medicine, dowsing) and pulse testing; and treatments including autoge- nous urine therapy and Vega matrix regeneration therapy. Complementary medicines Most people, however, sought help from the field of alternative medicine in the form of supplements like echinacea and other herbal medicines. However, they often told neither their GP nor pharmacist that they had done so. ‘When people are prescribed a drug, Incidence of allergies T HE incidence of allergic disease (including rhinitis, asthma and eczema) has risen sharply. According to Australian Institute of Health and Welfare (AIHW) statistics, allergic rhinitis affects around 18.7 per cent of people, with the highest prevalence (24.4 per cent) affecting those aged 25 to 44. And the lifetime prevalence of self- reported asthma and hayfever in Tasmanian adults doubled from 19.2 per cent in 1968 to 41.3 per cent in 1991–92, according to another study. Felton Grimwade Bickford, the supplier of Bosisto’s products including anti-dust mite washes, told the AJPthat the allergy market is currently growing at around 20 per cent on last year. they’ll often ask the GP or the pharmacist about it—how to take it, whether it will interact with anything else,’ Associate Professor Mullins said. ‘They don’t do that with herbal medicine. ‘It’s important to at least ask them whether they’re taking substances which could interact with any other medication they’re on. ‘There’s no point in condemning peo- ple for using any of these alternatives; instead there’s an opportunity to educate them about the fact that anything they put in their mouth, prescription or not, is going to have an effect. And some very few people are, in fact, allergic to herbal medicines.’ So why do people turn to alternative treatments? ‘Simply because some of these practi- tioners claim to be able to cure the allergy,’ Associate Professor Mullins said. ‘Doctors and pharmacists are a bit more realistic about it—they say they can treat the disease and manage the symp- toms. So they can make the patient feel better, but they can’t fix it. ‘Allergy can be a rotten thing to live with, but just like diabetes, high blood pressure and a whole lot of other health problems, there’s just no fix, only man- agement—and of course some people won’t accept that.’ 188 ? THE AUSTRALIAN JOURNAL OF PHARMACY VOL.86 MARCH 2005 Associate Professor Walls said that another reason some patients preferred alternative practitioners was the fact that they had more time to discuss the issue, again highlighting the need for pharmacists to spend time educating allergy sufferers. But is it an allergy? Food allergies, in particular, can be a dif- ficult area for health professionals to negotiate, according to Associate Profes- sor Mullins. He told the AJP that there was a signif- icant group in the community who believed themselves to be allergic to cer- tain food groups, often on the advice of consultants who practised non-evidence- based techniques. ‘Somebody who comes into the phar- macy with a snotty nose, who asks for hayfever treatment, may find it doesn’t work,’ he said. ‘There’s two reasons for this. ‘One, he has a severe allergy; or two, he doesn’t have an allergy at all. He may have a cold, he may have a sinus infec- tion—sinus infections can sometimes per- sist for months. It can be difficult even for professionals like pharmacists to sort out what’s wrong with him. ‘The problem is that the word “allergy”, when used by pharmacists or clinicians like myself, often has a different meaning to that applied to it by people in the community, including naturopaths and other suppliers of some of these non- proven treatments—and it’s particularly the case with food allergies. ‘What I’m talking about is the sort of person who goes to a naturopath or to the store in the local shopping centre com- plaining of feeling tired and run-down. Almost invariably the person’s told they’re allergic and taken off wheat and milk. ‘To be fair, some naturopaths do try and address the fact that the person might need to make some lifestyle changes. Peo- ple are tired and run-down because they’re overweight, they’re working 60- hour weeks, they’re drinking too much alcohol; so taking them off wheat and milk is meaningless.’ s