Hayfever
(Seasonal Allergic Rhinitis)
INTRODUCTION
Hay fever is the common name for an allergic reaction of the lining of the nose and sinuses. Allergens responsible for seasonal allergic rhinitis include grass pollens, tree pollens and fungal mould spores. Perennial allergic rhinitis occurs when symptoms are present all year round and is commonly caused by house dust mites, animal dander and feathers. Hayfever is characterised by one or more of the following symptoms: nasal congestion, rhinorrhoea (runny nose), sneezing, itchy nose, puffy, itchy bleary and red eyes and a tickling, burning throat.
SYMPTOMS
Rhinorrhoea (runny nose) – the discharge is often thin, clear and watery, but can change to a thick coloured, purulent one
Nasal Congestion – inflammation of the lining of the nose produces vasodilation of the nasal blood vessels and therefore result in nasal congestion. Associated symptoms may include headache and earache.
Sneezing – initial symptom, which progresses to rhinorrhoea then nasal congestion
Nasal Itching – with associated itching of the roof of the mouth may occur
Eye symptoms – puffy, itchy, bleary and red eyes may result from tear duct congestion or be due to direct allergens (pollen grains) being caught in the eye, setting off a local inflammatory response. Some people may even suffer hypersensitivity to bright light (photophobia) and find that wearing dark glasses is helpful
MANAGEMENT PRINCIPLES
NON-PHARMACOLOGICAL MEASURES
- avoidance of aeroallergens and other forms of environmental irritants and pollutants (eg cigarette smoke, dust mites, moulds, pets and pollen)
- wear sunglasses on bright days
- dietary restrictions
- exercise
- keep a good supply of tissues
- appropriate sleep time (as being tired may make symptoms worse)
PHARMACOLOGICAL MEASURES
1. ANTIHISTAMINES
Symptoms of hayfever occur after inflammatory responses involving the release of histamine, which is initiated by allergens. Antihistamines counteract this response, therefore improving hayfever symptoms.
NON (LOW) SEDATING
Eg. Loratadine (ClaratyneÒ) 10mg
Fexofenadine (TelfastÒ) 60mg, 120mg, 180mg
Cetirizine (ZyrtecÒ) 10mg
Important Points
· Avoid in pregnancy and breastfeeding
· Less likely to cause sedation than the older style of antihistamine. Patients should avoid driving / operating machinery until their response to these antihistamines has been determined
· Non (low) sedating antihistamines have less drying action on the nose than older antihistamines
· Combination products with pseudoephedrine are also available eg ClarinaseÒ (loratadine/pseudoephedrine), TelfastÒ (fexofenadine/pseudoephedrine). Special care must be exercised when recommending the multi-ingredient preparations as they may interact with a patient’s concurrent medical condition or other medications.
SEDATING ANTIHISTAMINES
Dexchlorpheniramine (PolaramineÒ)
Promethazine (PhenerganÒ)
Important Notes
· Sedating antihistamines cannot be recommended for people who are driving, operating machinery or needing to be alert
· Safe in pregnancy
2. CORTICOSTEROID NASAL SPRAYS
The cortcosteroid nasal sprays act to reduce inflammation, which has occurred as a result of the allergen’s action
Eg. Beclomethasone (BeconaseÒ) – Dose: >12 yrs 2 puffs twice daily
Budesonide (RhinocortÒ) Ò - Dose: > 12 yrs 1 puff daily (max 8/day)
Important Notes
· Generally takes 1 week for full benefits of the medication to be felt. Regular dosing of these preparations is essential to gain full benefit
· Dryness and irritation of the nose and throat and nose bleeds have occasionally been reported; other side effects are rare
· Should not be used prior to any nose surgery or trauma
3. ANTICHOLINERGIC NASAL SPRAYS
Have a drying action which significantly reduces nasal secretions
Eg. Ipratropium (AtroventÒ 0.03%w/v Spray) – Dose: >12 yrs sprays
2-3 times daily
(Atrovent ForteÒ 0.06%w/v Spray) – Dose: >12 yrs 1-2 sprays 2-3 times daily
Important Notes
· Side effects are mainly limited to the nose (dryness, burning, bleeding, stuffiness)
· Caution in children and in patients with glaucoma and prostatic hypertrophy
4. DECONGESTANTS
TOPICAL DECONGESTANTS (Nasal Sprays)
These are helpful when used short term in combination with a topical steroid spray when commencing the later (waiting for full response)
Eg Oxylometazoline (OtrivinÒ Spray or Drops) – available as either adult (>12 yrs) or junior (<12 yrs) formulations
Important Points
· Do not use nasal decongestants sprays for more than 5 days as this may lead to rebound congestion (nose feels even more blocked)
· Can be used with caution in patients with hypertension, cardiovascular disease and hyperthyroidism
ORAL DECONGESTANTS
Systemically decongestants give good relief from nasal congestion but have no significant effect on sneezing, secretions or pruritis (itching).
Eg. Pseudoephedrine (SudafedÒ)
Important Notes
· Pseudoephedrine can cause stimulation of the heart and increase blood pressure. Therefore it should be avoided in patients with heart disease, high blood pressure or hyperthyroidism
· Also avoid in patients with diabetes, glaucoma and prostate disease
· Possible side effects include dry mouth, tremor, palpitations, restlessness and insomnia
· Available in combination products together with paracetamol and antihistamines
5. EYE PREPARATIONS
Eye symptoms involve a local inflammatory response. Eye preparations containing antihistamines reduce the itchiness and watery discharge of the eye. The decongestant in the eye drops reduces associated redness of the eye.
Eg. Antihistamine/Decongestant (AlbalonÒ) -Antazoline with Naphazoline
Antihistamine (LivostinÒ) – Levocabastine
Important Notes
· Discard eye preparations 28 days after opening the bottle
HERBAL AND HOMEOPATHIC PRODUCTS
HERBAL PRODUCTS
Note that herbal medicines can be mixed or made up at Pharmacy 777 Whitfords specific to symptoms
· Nature’s Own Triple Strength Horseradish, Garlic and Vitamin CÒ
- acts as a demulcent, immune stimulating and a drying agent
- Dose (acute and chronic): 1 tab 2 times daily
· Braurer Hay fever Relief TabletsÒ
- Dose: 1 tablet on rising and retiring and 2-4 tablets during the day
HOMEOPATHIC PRODUCTS
· Bioresearch HFVÒ
- very effective, helps to desensitise person to certain pollens
- Dose: Chronic = 5 drops, 4 times daily
Acute = 4 puffs every half an hour until relief is felt
- hold in mouth for 30 seconds, then swallow. Do not take within half an hour of tea, coffee, alcohol, cigarettes, toothpaste and other medications
· Medicine Tree Galphimia Breathease
- very effective, helps to desensitise person to certain pollens
- Dose: Chronic = 10 drops in water, 4 times daily
