As the prime pollen season begins, you can expect an influx of enquiries about allergic conditions. Now's the ideal time for pharmacies to prepare with the latest advice on how to recognise, treat and prevent allergies this season
Every year, the number of allergy sufferers in the UK increases by five per cent, according to Allergy UK, with half of those affected being children. Figures from NHS Digital reveal that there has been a rapid rise in hospital admissions for severe allergies, which were up by 36 per cent in 2015/16 compared with 2011/12. Hospital admissions for anaphylactic shock have also risen seven-fold in the last 10 years, says the Anaphylaxis Campaign, and up to seven million people have an allergy severe enough to need specialist allergy care.
What’s more, a 2015 YouGov survey found that a quarter of UK households have at least one allergy or intolerance sufferer, and the National Allergy Strategy Group puts the cost of prescriptions for allergy symptoms at almost £1 billion a year – that’s more than 10 per cent of the total community drugs budget.
The reasons why
“Allergy conditions are on the increase and, proportionally, the number of people reacting severely has increased,” says Sarah Birkett-Wendes, communications manager at the Anaphylaxis Campaign. “There is certainly evidence that some patients are not aware that their allergy is potentially severe. For example, they may not have been made aware of the link between poorly controlled asthma and severe reactions. Also, we know that a proportion of individuals, particularly teens and young adults, do not carry their emergency medication at all times.”
There are clear links between our environment and the way we now live and the rise in allergies in the developed world. The ‘hygiene hypothesis’, first proposed as a cause in 1989, suggests that reduced infections in childhood are linked to a rise in allergies and that clean living is to blame. This hypothesis has been reformulated over the years into the ‘old friends’ mechanism. This disproves the idea that over-hygienic homes are to blame and instead reinforces a theory that exposure to a wide range of mircrobes is crucial for regulating our immune system during infancy and childhood.
Modern homes have a different and less diverse mix of microbes compared with rural homes in the past and this, combined with changes in the way we live, including less breastfeeding, more C-sections, smaller families, urban rather than rural living and increased antibiotic use, all affect our early exposure to the microbes that strengthen our immune system, meaning we’re more susceptible to allergies.
Expert advice is therefore not to abandon good hygiene in our homes, which keeps germs such as E. Coli at bay, but to get outdoors and spend more time in the countryside to expose ourselves to a wider range of microbes.
Holly Shaw, nurse advisor at Allergy UK, says: “Allergy rise is linked with our modern way of life. The way we feed our children is a definite factor. Children spending far more time indoors than ever before is also a link. Many studies have shown that children who grow up on farms or in the countryside have a much lower risk of an allergy than city dwelling children.”
Pollution is an important factor in the increase in allergies in the UK. “Where levels are high, those with respiratory allergies like asthma and hayfever can be affected,” says Holly. “Pollen and pollution combine to make allergens more potent and symptoms can worsen. The air quality in our cities is getting worse.”
She says we’ve also seen a rise in self-diagnosed allergy, especially with foods, and this is often incorrect.
What is an allergy?
An allergy is an immune reaction that causes inflammation after repeated exposure to an allergen. An allergen is a normally harmless substance, such as pollen or house dust mites. In people who have an allergy, these are perceived as ‘threats’ and antibodies are produced. These IgE antibodies attach themselves to mast cells in our skin tissues. When the allergen is next encountered, the mast cells flag it as an intruder and produce histamine and other chemicals, and it’s these that cause the allergy symptoms. An allergic response can range from hayfever and eczema to anaphylaxis.
And what is anaphylaxis?
Anaphylaxis is a life-threatening allergic reaction which affects more than one part of the body, such as the airways, heart, circulation, gut and skin. Symptoms begin within seconds or minutes of exposure to an allergen and worsen rapidly.
The most common triggers are foods including peanuts, tree nuts, milk, eggs, shellfish, fish, sesame seeds and kiwi. Other causes include wasp and bee stings, latex and certain drugs, including penicillin. Signs to watch out for include:
- Swollen tongue
- Hoarse voice
- Difficulty swallowing
- Wheezing, difficulty breathing and/or coughing
- Flushed skin
- Swelling of parts of the body
- Stomach pain, nausea and/or vomiting.
People who have poorly controlled asthma are at increased risk of an anaphylactic reaction, as are those who also suffer from hayfever.
Raising awareness of allergies in pharmacy
“If your customer describes allergy-like symptoms, it’s important that they see their GP, nurse or a pharmacist,” says Holly. “The key thing to emphasise is that they should not self-diagnose or self-treat. Talking through symptoms will help determine whether it is an allergy as symptoms often overlap with other common conditions, such as colds.”
Sarah believes it’s important for staff to improve their knowledge of anaphylaxis, and explains that pharmacists and pharmacy technicians can do this by becoming healthcare professional members of the Anaphylaxis Campaign and accessing free online training. “We have also produced an online pathway to help people who think they or their child has a severe allergy,” she says. “This gives guidance and support in recognising the symptoms and what questions they should ask their healthcare professional.”
Is it an allergy, sensitivity or intolerance?
Allergy: a reaction caused by the immune system when exposed to an allergen, such as pollen.
Sensitivity: an exaggerated response to the normal effects of a substance. For example, a cup of coffee causing palpitations.
Intolerance: a food produces a reaction in the body – typically bloating, wind, migraine, or irritable bowel syndrome (IBS). This type of reaction is not caused by the immune system and is not life threatening.
Common allergic conditions
Asthma affects 5.4 million people in the UK. It usually starts in childhood and affects one in 10 children and one in 20 adults. It’s an atopic condition that often runs in families.
The condition causes the airways to constrict, and a cough (particularly at night), wheezing, shortness of breath and a tight feeling in the chest are common symptoms. Severity of symptoms will vary between individuals and at different times of the year.
Inflammation of the airways can be triggered by allergens such as pollen, dust mites, pet fur or moulds, infections (especially colds and coughs), exercise, pollution and cigarette fumes.
Inhalers are used to control and prevent asthma attacks:
- A reliever inhaler containing drugs such as salbutamol or terbutaline eases symptoms and relaxes the muscles in the airways
- A preventer inhaler stops symptoms developing and uses a steroid drug to reduce inflammation in the airways
- A long-acting bronchodilator can be used as well as a preventer inhaler. These work for up to 12 hours after each dose.
Steroid tablets can be prescribed to ease severe attacks.
Pharmacy staff can advise customers to:
- Take medication regularly and correctly
- Give up smoking
- Exercise regularly
- Know their triggers and avoid them where possible.
Atopic is the most common form of eczema, especially among children, in whom it usually develops before the age of one. It accounts for 30 per cent of all dermatology consultations in general practice and affects around 15-20 per cent of children and up to 10 per cent of adults.
Skin becomes itchy, dry, cracked, sore and red. It most commonly affects the hands, insides of the elbows, backs of the knees, the face and the scalp.
Atopic eczema occurs in people who are sensitive to allergens and often runs in families. If both parents are affected, children have an 80 per cent risk of developing it, and a 60 per cent chance if one parent is affected. Common triggers include pollen, house dust mites, food, detergents, stress and cold weather.
Emollients are the main treatment for eczema:
- Ointments are the heaviest, containing the most oil, and are good for overnight use
- Creams contain oils and water, but won’t leave skin greasy
- Lotions are lighter than creams and contain more water. They are good for milder eczema.
Topical steroids may be needed for inflamed eczema. They are used for short periods to control flare-ups. Antibiotic creams or tablets can be prescribed to treat infected skin.
Pharmacy staff can advise customers with atopic eczema to:
- Reduce scratching where possible to cut the risk of infection
- Avoid triggers where possible
- Make dietary changes if foods are linked with eczema flare-ups. This should be done under medical supervision
- Use emollients daily, even between flare-ups.
Hayfever is a common allergic reaction to pollen that affects up to one in five people in the UK at some point. It is most common from May to July when grass pollen is released. It affects more than 20 per cent of people in the UK, with 80 per cent being diagnosed before 20 years of age.
When pollen comes into contact with the cells that line the mouth, nose, eyes and throat, it irritates them and triggers an allergic reaction. Increased air pollution is also thought to be a contributor to the rising number of hayfever cases.
Sneezing, a blocked or runny nose, an itchy nose and throat, and red, watery, itchy eyes are all common symptoms.
Antihistamines are the mainstay treatment for hayfever. These block the action of histamine, which is responsible for the symptoms. They are available as tablets and nasal sprays and are most effective when used regularly. Corticosteroid nasal drops and sprays help to reduce inflammation and relieve sneezing, and mast cell stabiliser eye drops work by stabilising the cells that produce histamine.
Pharmacy staff can advise customers with hayfever to:
- Try an allergen-trapping nasal balm around nostrils or a spray to prevent pollen entering the nose
- Use a nasal rinse to wash away pollen from the nostrils
- Check the pollen count daily and stay indoors when it is high
- Avoid hanging washing out at high pollen count times of the day (morning and early evening)
- Keep windows closed during high pollen count times
- Shower and wash their hair after being outside
- Wear wraparound sunglasses to keep pollen out of the eyes.
Food allergy is thought to affect five in 100 children and three to four in 100 adults in western countries. In the UK, two in 100 babies develop a cows’ milk protein allergy.
With a food allergy, the body’s immune system reacts abnormally, causing reactions such as eczema, vomiting, diarrhoea, stomach pain, wheezing and shortness of breath, and anaphylaxis in severe cases. The foods that most commonly cause allergies are milk, eggs, nuts, sesame, shellfish, fish, wheat, soya and fruits including citrus and kiwi.
Avoidance is the only real treatment. Antihistamine tablets are useful if foods cause an itchy rash, but adrenaline will be prescribed if there is a history of anaphylaxis.
Pharmacy staff can advise customers with a food allergy to:
- Keep a diary to work out which food is causing the problem
- Check labels on food for ingredients and traces of ingredients they need to avoid.
Allergy Awareness Week
Running from 24-30 April 2017, Allergy Awareness Week is a great opportunity to increase awareness of allergies in your pharmacy.
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