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Australian Journal of Pharmacy : September 2005
May I have a box of ... please? Is it for you? Is it effective? How does hay fever affect you? May need to prompt What is the best medicine(s) for this patient? Does it affect your sleep or daily activities? Do you think there is anything that causes it? Do you have any other medical conditions? Are you on any other medications? Suggest the patient should see their GP promptly if results are not obtained with your suggestions Can trigger factors be avoided? Can the patient be desensitised? Hay fever can make asthma worse or be a risk factor for the development of asthma Have you needed more reliever? Has asthma interfered with your sleep or daily activities? Have you had any wheezy breathing? Have you noticed any shortness of breath? Have you been coughing? Or had a tight chest? Refer to GP provoke the patient’s AR, hence may assist in trigger avoidance strategies. The symptoms reported by the patient may result from conditions other than AR, such as vasomotor rhinitis or nasal septum deviation. The absence of the above-men- tioned symptoms does not exclude AR. Management AR management aims to achieve optimal symptom control via allergen avoidance, pharmacotherapy or immunotherapy. The option chosen is determined by what triggers the condition, what the symptoms are and their severity. Allergen avoidance Avoidance of factors known to trigger the condition is recommended for the man- agement of AR despite the fact that sev- eral reviews of data in this area have been inconclusive and suggest that further research is required.18 ance of known triggers is harmless, logi- cal and often helpful. Immunotherapy Immunotherapy has beneficial effects on the symptoms of AR. It should only be administered by clinicians with training and experience in this form of treatment, in a setting with adequate resuscitation facilities. It is indicated when: • a particular allergen can be identified by history and then by allergy tests (for example, skin prick); • future exposure to the allergen is unavoidable or only partially reducible; • an effective allergen extract is available; • there has been a poor response to pre- vious medication. However, avoid- Pharmacotherapy There are a variety of options available for the treatment of AR which include over-the-counter (OTC) preparations. These allow the person with AR to be involved in self-management. Self-man- agement OTCs include antihistamines (intranasal and oral), decongestants and intranasal corticosteroids (INCS). Intranasal corticosteroids Of the pharmacotherapy available, INCS have been shown to be most effective and are first-line treatment for patients with How do you know it is an allergic eye condition?* • If it itches and waters, it is allergy. • If it burns, it is probably dry eye. • If the eyelids are stuck together in the morning, it is bacterial infection. * Global Resources in Allergy (GLORIA). Allergic conjunctivitis revised guidelines. June 2003. Available from URL: http//www.worldallergy.org/educational persistent AR and the patient with inter- mittent moderate-severe AR.11 They work in both the early-phase response (itching, sneezing, mucus production) and the late phase response (which includes blockage). INCS are well tolerated and can be used long term without harming the nasal mucosa (covering). Most side effects are due to local irritation (stinging, itching). The doses of corticosteroid are too small for any likelihood of absorption into the body at recommended doses. They are safe to use in pregnancy and lactation. They are all similarly effective with their onset of action being within 3–7 hours, but maximum effect may take several days THE AUSTRALIAN JOURNAL OF PHARMACY VOL.86 SEPTEMBER 2005 ? 709 Nose? Running, sneezing, itching congestion, loss of smell Eyes? itchy, watery, red Other? headache, easily tired, fatigure, problems concentrating, itchy throat, pressure over the cheeks and forehead, ear problems Treatment algorithm: Suggested pharmacy protocol for allergic rhinitis I need something for my hay fever