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Regular allergy sufferers may benefit from larger pack sizes, for convenience and cost-effectiveness

Allergies aren’t just a seasonal problem. Pharmacy teams should be able to spot a range of allergies year-round and offer the correct treatment, says Victoria Goldman

Allergies are often seen as a childhood issue, but over the past 40 years, there has been a dramatic rise in the number of adults with allergic rhinitis, food and drug allergies, contact dermatitis and allergy-related asthma. According to Allergy UK, around 10 million adults suffer from more than one allergy. Many find it difficult to get expert help, as there are few adult allergy specialists in the UK, so pharmacists are often their first port of call.

Pharmacists don’t have any formal training in allergy, but Royal Pharmaceutical Society board member Sid Dajani says they are well placed to offer information and advice. “People in their 30s and 40s may have frequent or prolonged colds, but don’t realise that allergies could be to blame,” he says. “If customers mention their regular use of cold remedies, pharmacists could offer allergy testing kits or advise on the benefits of allergy diaries. More adults are developing allergies as they get older, and management can be complicated if they have other chronic conditions. For example, allergy medicines can cause drowsiness or a dry mouth or may interact with other medication.”

Allergies are often viewed as seasonal, but they can be troublesome all year round. Many are life-threatening and/or interfere with people’s daily lives. “It’s important that counter staff understand that allergy sufferers don’t just appear during the spring and summer months,” says Cathy Crossthwaite, Numark’s marketing coordinator. “Allergy is not only hay fever, but can be caused by a number of triggers: nickel, pets, dust, etc. The pharmacy team can help customers identify symptoms and environmental factors that trigger them. With more and more P lines switching to GSL, the grocers are stealing share of the business by cutting prices. However, they can’t provide the support that pharmacy can.”

Allergic rhinitis

Allergic rhinitis (seasonal hay fever and perennial rhinitis) is on the rise and often co-exists with asthma. In May this year, research from Asthma UK revealed that people often confuse asthma and hay fever symptoms. This means they may fail to manage either condition, putting themselves at increased risk of a potentially fatal asthma attack. In an Asthma UK survey, nearly 60 per cent of adults thought that shortness of breath is a hay fever symptom, yet it’s one of the key indicators that asthma is getting worse.

Allergic rhinitis can often be managed with OTC products, but it’s important that pharmacy customers use the most effective medicines for their symptoms. “Many people with hay fever or perennial rhinitis use chlorphenamine as a first-line treatment, but most of them will need a long-acting non-sedating antihistamine instead,” says Amena Warner, Allergy UK nurse advisor. “Pharmacists are in a prime position to recommend other allergy medicines and products too, such as nasal barrier balms, saline douching and steroid nasal sprays. In most cases, it’s trial and error. There is now a combined antihistamine and nasal steroid spray – although this isn’t available over the counter, pharmacy customers need to know about it as they may be able to get a prescription from their GP.”

Ms Crossthwaite says that pharmacies should stock a range of brand leaders and formats to give customers a choice. “Consider liquids and tablets and a range of larger to smaller pack sizes,” she says. “Customers suffering with an allergy may also be congested so there’s an opportunity to recommend a decongestant, eye drops or packet of tissues to encourage link sales. Stock a range of children’s products and merchandise within the paediatric medicines section or dual merchandised where appropriate. Critically, pharmacists should also ensure they have a value equivalent to offer the customer a value alternative to the brand, both out on open display and behind the counter.”

Regular allergy sufferers may benefit from larger pack sizes, for convenience and cost-effectiveness. “We introduced 60s packs of loratadine and cetirizine in 2013 and sales were up 30 per cent year on year,” says Ms Crossthwaite. “Stocking a 60s pack will keep your customers coming back to you, as they may be less likely to pick up the smaller pack sizes from grocers. Remember that the value is in P medicines, so ensure your customers are buying the right product and pack size to meet their needs.”

Adrenaline use

NHS statistics in June 2014 revealed that hospital admissions in England for allergic reactions are soaring to more than 20,000 each year, with over 60 per cent of these being emergencies. In April 2015, Allergy UK warned that over two thirds of UK adults have no idea what to do if they see someone suffering an anaphylactic reaction.

A survey of over 2,000 people by the charity found that 66 per cent of UK adults don’t know how to use life-saving adrenaline pens (adrenaline auto-injectors) – the one thing that can quickly save a life. It also revealed that 68 per cent were scared, hesitant or anxious at the thought of having to give someone the easy-to-use ‘jab’.

According to the Anaphylaxis Campaign, a practical demonstration has been associated with a five-fold increase in the ability to use an auto-injector device. But researchers at Imperial College London recently found that adrenaline auto-injectors are not simple enough to use. In their study, more than half of parents of children with allergies failed to use their device correctly in a simulated emergency, six weeks after being trained. Three similar and commonly-used devices, EpiPen, Anapen and Jext, all performed poorly in the tests. Common mistakes included failing to remove all the safety caps, and not pressing the device in for long enough to inject the full dose.

“There are now three different licensed adrenaline auto-injector products,” says Ms Warner. “These all work slightly differently, so make sure customers are taught how to use the one they have been prescribed. If patients don’t have clear instructions, they may panic in an emergency, which can be very frightening.” Pharmacists also need to be able to answer common questions, such as: ‘how do I store my adrenaline pen on holiday?’, ‘how do I carry it around?’, and ‘what happens if I use the adrenaline but it wasn’t a true anaphylactic reaction?’.

Lynne Regent, chief executive of the Anaphylaxis Campaign, says that all healthcare professionals are expected to recognise and, if necessary, treat an anaphylactic reaction as part of their usual clinical role. The charity, together with production company Bare Films, has produced a film called #takethekit to alert severely allergic young people to the importance of carrying their adrenaline pen at all times. “People often seek advice or medicines for allergic reactions from pharmacists, so it’s important that pharmacists are trained to assess and manage the situation and guide patients to seek medical advice where appropriate,” she says.

Recognising the FEAR

Although allergy is a common chronic condition, Allergy UK research reveals that almost half of people in the UK have no idea what anaphylaxis is. Allergy UK is calling on people to ‘recognise the symptoms, recognise the FEAR’:

• Face – is their face or lips swollen? Have they gone pale? Are they lightheaded?
• Eyes – is there a look of fear in their eyes? Are they red, watery and puffy?
• Airways – are they wheezing/uncontrollably coughing? Do they have a shortness of breath? Are they unable to talk? Are they making a strange sound?
• Rash – is there a red, raised, itchy rash anywhere on their body especially, their face or neck?

If a combination of these symptoms is visible, the advice is to administer adrenaline into the outer thigh and call 999. If the symptoms don’t improve after five minutes, administer a second dose of adrenaline into the other thigh.