An allergy is a reaction produced by the body’s immune system when it is exposed to a specific substance that it has become hypersensitive to. The body overreacts to a substance that typically causes no problems in most people.

Download The hayfever consultation poster for your pharmacy here.

What are the common allergens?

The following are examples of common allergens:¹

How does hayfever occur?

In hayfever, the allergen (pollen) enters the nose and sensitises the mast cells. In the early phase of the allergic response the mast cells release histamine and cause symptoms e.g. an itchy, runny nose and sneezing. White blood cells enter the affected area and cause irritation and inflammation that leads to congestion. This inflammation leads to the release of more histamine and worsening of symptoms – this is known as the late phase response.²

What symptoms should you watch out for?

Hayfever can have a range of symptoms,³ for example:

• Itchy nose, throat or eyes
• Sneezing
• Runny nose
• Nasal congestion
• Blocked sinuses
• Post-nasal drip
• Watery eyes
• Headaches
• Shortness of breath
• Tiredness

How to manage hayfever

Self-care

An important part of allergy management is avoiding allergens. For example, you can recommend patients:⁴

• Try to stay indoors
• Keep windows closed in homes and cars as much as possible
• Avoid walking in grassy, open spaces when the pollen count is high
• Wear wraparound sunglasses to help prevent pollen getting into the eyes
• Change out of outdoor clothing and shower or wash their hair following high pollen exposure
• Vacuum regularly, preferably with a high-efficiency particle arresting (HEPA) filter in place
• Avoid drying clothes outdoors when the pollen count is high or when cutting grass.

Treatment

The following are examples of available treatment options:^4,5

What questions should you ask?

To make sure the patient is suffering from hayfever you should rule out other conditions,^6,7 such as a cold. The following questions can help you determine the cause:

Benacort™ 64mcg Nasal Spray (budesonide)

Benacort is indicated for both prevention and treatment of seasonal allergic rhinitis (hayfever).

It relieves:

• Nasal congestion
• Runny nose
• Itchy nose
• Sneezing

Benacort:

• Is non-drowsy
• Is scent and alcohol free
• Offers convenient once daily dosing of 256mcg
• Can stop hayfever symptoms for 24 hours with one dose

Product information

Presentation: Nasal spray, suspension. Each actuation contains 64mcg budesonide Uses: Prevention and treatment of seasonal allergic rhinitis (hayfever). Dosage (adults): Once daily dosing:128mcg into each nostril in the morning or 64mcg into each nostril if good effect is achieved. Twice daily dosing: 64mcg into each nostril morning and evening. Full effect not achieved until after a few days treatment. Treatment of seasonal rhinitis should start, if possible, before exposure to the allergens. If symptoms are not controlled, or persist for longer than 2 weeks of treatment, medical advice must be sought. Benacort should not be used continuously for longer than 3 months. Paediatric population: Not be used in children and adolescents under 18 years of age. Contraindications: Hypersensitivity to active ingredient or to any of the excipients. Warnings and precautions: If symptoms are not controlled or persist for longer than 2 weeks of treatment, medical advice must be sought. Patients should consult a physician before use if: they are using a corticosteroid for other conditions, they currently have or have been exposed to tuberculosis, chicken pox or measles, they have severe or frequent nose bleed or have/had nose ulcers, nose surgery or injury, they have ever been diagnosed with glaucoma or cataracts, they have an eye infection or diabetes. Special care needed: when treating patients transferred from oral steroids, where disturbances of hypothalamic-pituitary-adrenal (HPA) axis could be expected; in patients with fungal and viral infections of the airways. Reduced liver function affects the elimination of corticosteroids, may lead to higher systemic exposure and possible systemic side effects. Systemic effects of nasal corticosteroids may occur, particularly at high doses prescribed for prolonged periods. CYP3A inhibitors may increase systemic exposure to budesonide. Raised plasma concentrations and enhanced effects of corticosteroids have been observed in women treated with oestrogens and contraceptive steroids. No effect observed during concomitant intake of low dose oral contraceptives. As adrenal function may be suppressed this may lead to false results in ACTH stimulation test for diagnosing pituitary insufficiency. Pregnancy and lactation: Avoid during pregnancy unless benefit outweighs risk. No effects on breast fed child are expected at therapeutic doses. Side effects: Consult SmPC for full list of side effects. Common: Haemorrhagic secretion and epistaxis. Nasal Irritation (sneezing, stinging and dryness). Uncommon: Immediate and delayed hypersensitivity reactions including erythema, urticaria, rash, dermatitis, angioedema and pruritus. Muscle spasms. Rare: Anaphylactic reaction, signs and symptoms of systemic corticosteroid effects, including adrenal suppression and growth retardation, nasal septum perforation, nasal ulcer and dysphonia. Blurred vision. Contusion. Very rare: Ulceration of mucous membrane. Not known: Raised intraocular pressure or glaucoma and cataract. In rare cases, signs or symptoms of glucocorticosteroid-side effects such as Cushing’s syndrome, Cushingoid features, psychomotor hyperactivity, sleep disorders, anxiety, depression or aggression (particularly in children) may occur. Acute overdose even in excessive doses, is not expected to be a clinical problem. RRP (excl. VAT): 120 actuations: £8.33 Legal category: P PL holder: McNeil Products Ltd, Roxborough Way, Maidenhead, Berkshire, SL6 3UG PL number: 15513/0404 Date of preparation: 18th July 2018.

References

1. NHS Allergies: Overview. Available at: https://www.nhs.uk/conditions/allergies/ (accessed 21 March 2019).
2. Pawankar, R. (2011) Overview on the pathomechanisms of allergic rhinitis Asia Pacific allergy. October 2011. 1(3): 157-167. Available at:  https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3206239/ (accessed 21 March 2019).
3. Allergy UK. Hayfever (allergic rhinitis). Available at: https://www.allergyuk.org/information-and-advice/conditions-and-symptoms/11-hay-fever-allergic-rhinitis (accessed 21 March 2019).
4. NHS Inform – Hayfever. Available at: https://www.nhsinform.scot/illnesses-and-conditions/immune-system/hay-fever (accessed 28 March 2019)
5. NHS - Hay fever. Available at: https://www.nhs.uk/conditions/hay-fever/ (accessed 9 April 2019)
6. Is it a common cold or allergies? Available at: https://www.webmd.com/cold-and-flu/cold-guide/common-cold-or-allergy-symptoms (accessed 28 March 2019)
7. NHS Inform – Common Cold. Available at: https://www.nhsinform.scot/illnesses-and-conditions/infections-and-poisoning/common-cold#symptoms-of-a-common-cold (accessed 28 March 2019).