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Anaphylaxis is on the increase, so pharmacy staff should all be clued up about the use of adrenaline pens. Victoria Goldman describes an important role for the pharmacy team

Millions of adults and children in the UK suffer from allergies, with numbers rising each year. Most allergic reactions are mild and can be relieved with antihistamines at the first sign of symptoms. However, more severe reactions will occur occasionally – and these should not be underestimated. Anaphylaxis, at the extreme end of the allergy spectrum, is potentially life- threatening and requires immediate treatment with adrenaline.

The World Allergy Organisation (WAO), as part of its annual World Allergy Week held in April, called for more education, preparation and resources for the treatment and prevention of anaphylaxis. According to the UK’s Anaphylaxis Campaign, there are around 20 deaths every year from anaphylaxis and thousands more near-fatal reactions. These occur after severely allergic individuals come into contact with their trigger allergen, such as foods like nuts, eggs or milk, or other substances like latex, drugs or even insect venom. In some cases, the trigger can’t be identified, which means patients have no idea what they should be avoiding, causing extreme worry and frustration.

The incidence of anaphylaxis in the general population has increased seven- fold over the past decade, and UK hospital admissions for food allergies have increased by 500 per cent since 1990. “There are 30,000 A&E admissions in the UK every year for anaphylactic reactions,” says Lynne Regent, chief executive of the Anaphylaxis Campaign. “Fortunately, the number of deaths is small, but they do occur. In Scotland, there is an ongoing programme to ensure that every pharmacist has a general adrenaline injector available for customers if it is required in an emergency. There is also a similar project in Ireland. We would like to see this happen across England and Wales as well.”

Training matters

The Anaphylaxis Campaign recently teamed up with Boots UK to create a new online course for Boots pharmacists to improve their care of patients with severe allergies. Produced in association with ALK- Abello, the training builds on pharmacists’ existing knowledge of severe allergies, to ensure they have a solid clinical knowledge and the emergency treatment options for anaphylaxis.

With so many people suffering from allergic reactions, the category is also an important one for independent pharmacies. The pharmacy team need to be able to help customers understand their condition and manage their symptoms effectively, reducing the risk of severe reactions and complications.

“We run several AllergyWise online training courses (for families and individuals, GPs and health visitors and other healthcare professionals) and realised there was a gap in the market for pharmacists,” says Ms Regent. “We are now trying to expand the course to other pharmacies, including the independents. In the meantime, we would love pharmacists to visit our website and become professional members, so they can access the information on there and keep up to date.”

Food intolerances

Food intolerances are more common than food allergies, but can have a number of different causes. While they are often dismissed as a minor inconvenience, some can cause serious or troublesome symptoms, such as diarrhoea and vomiting, skin rashes, joint pain and an irritable bowel. The onset of food intolerance symptoms is usually slower than that of a food allergy, and may be delayed by many hours after eating the culprit food. The symptoms may also last for several hours, sometimes days, or even longer.

One in every 100 people in the UK suffers from coeliac disease, caused by intolerance to gluten. Only 10-15 per cent of those who have the condition have been diagnosed, which means there are currently half a million people who have coeliac disease but don’t yet know it. Untreated coeliac disease can lead to anaemia, osteoporosis, infertility problems and a slightly increased risk of bowel cancer.

“People suffering from potential symptoms of coeliac disease (eg, diarrhoea) may be visiting their pharmacy for a solution,” says Norma McGough, director of evidence and policy at Coeliac UK. “Pharmacists are in the firing line for information and will be in a better position to advise customers if they have an understanding of coeliac disease. They should be able to signpost customers to sources of further information, such as Coeliac UK, and help them manage their symptoms with a gluten-free diet.”

The Centre for Pharmacy Postgraduate Education (CPPE) launched the coeliac disease floor on theLearningpharmacy.com, in association with Coeliac UK in February. “We are delighted to have been able to work with CPPE to jointly develop this online training to support community pharmacy teams and other healthcare professionals in the management of coeliac disease,” says Ms McGough. “Pharmacists are not only integral in helping those already diagnosed to keep to their gluten- free diet and assist with the provision of their gluten-free food on prescription, but they can also provide information to those experiencing the symptoms associated with coeliac disease.”

An Anaphylaxis Campaign survey found that only 66 per cent of respondents always carry their adrenaline auto-injectors. Yet the charity’s golden rule for patients is to carry their adrenaline (if prescribed) everywhere at all times, without exception. In fact, MHRA guidance issued this month recommends that patients should always carry two auto-injectors with them. It also recommends calling an ambulance after every use of an auto-injector (even if symptoms are improving), that patients should lie down with their legs raised and not be left alone if possible. If the patient does not start to feel better, the second auto-injector should be used five to 15 minutes after the first.

 

"The incidence of anaphylaxis in the general population
has increased seven-fold over the past decade"

 

Lindsey McManus, deputy chief executive at Allergy UK, says that patients should also make other people around them aware of their allergies. “Pharmacies can signpost customers with severe allergies to Allergy UK and the Anaphylaxis Campaign, as well as to companies like Yellow Cross for medicine bags, and MedicAlert and Medi-Tag for ID bracelets,” she says.

Each adrenaline auto-injector brand works in a different way, so it is helpful if the pharmacist can answer patient questions and is able to demonstrate how to use each device. Trainer pens are available from manufacturers, so that patients can practise regularly. “Too many medicines – such as adrenaline pens, for example – are not used properly,” says Ms McManus. “Adrenaline can also go out-of- date without people realising it, as it sits in a bag without being used.”

Medicines management

Regular MURs are important in the management of allergies. “A lot of people can’t get the action right with asthma inhalers – pumping, breathing and holding. They may then experience thrush at the back of the throat or stop using their medicines, thinking they don’t work. Giving them a spacer may help.”

The misuse of hay fever medication can lead to a worsening of asthma symptoms, according to Allergy UK. The charity’s research revealed that 62 per cent of hay fever sufferers say that their hay fever medication isn’t effective, with only 4 per cent saying that it actually eliminates their symptoms.

More than one in three hay fever sufferers use a corticosteroid nasal spray, yet only 14 per cent are actually using it correctly. “Our research shows how reliant sufferers are on hay fever medication but for so many it simply isn’t working, or is being used ineffectively,” says Maureen Jenkins, director of clinical services, Allergy UK. “We are urging people to check whether they are using their medication correctly, rather than just soldiering on and prolonging their suffering. If symptoms aren’t improving with treatment, it’s so important to get medical advice to control this debilitating condition.”