Over 12 million people in the UK are allergic to pollen and each year suffer the sneezing, sniffling and streaming eyes synonymous with hay fever.
OTC treatments provide the lynchpin of relief from the inflammation and irritation that accompanies this allergic response to pollen, making the pharmacy the first port of call as soon as a new hay fever season sets in.
Pharmacists, therefore, have a key part to play in hay fever management, providing not only effective treatment options but also important allergy screening interventions and essential lifestyle advice.
Seasons of change
As global temperatures continue to climb, climate change looks set to signal extended hay fever seasons for many sufferers. "Generally over recent years the hay fever season in the UK has tended to start earlier and finish later," notes Professor Jean Emberlin, Director of the National Pollen and Aerobiology Research Unit at the University of Worcester.
"The grass pollen season, which affects about 95 per cent of hay fever sufferers, has tended to get longer, continuing into August rather than ending in late July," she adds. Already, warmer than average weather in the UK has led to a knock-on effect on the flowering times and pollen patterns of many plants. Birch trees, for example, have been releasing pollen an average of around five days earlier per decade over the last 40 years.
The cumulative effect of this trend is that the birch pollen season, affecting a quarter of all hay fever sufferers, now starts almost an entire month earlier than it used to. At the moment it is too early to predict what the 2009 hay fever season will bring - weather in spring and early summer will hold the key.
Hay fever remedies a growing category
As the most prevalent of all allergic conditions, hay fever is associated with a large remedies market. In fact, a recent survey indicated that 28 per cent of the UK's population had at some time purchased a hay fever treatment product.
In 2007, the total hay fever and allergy category in the UK was valued at £76.2m, with almost 70 per cent of allergy sales going through the pharmacy sector.
Oral remedies (tablets and syrup) continue to dominate the market, while steroid nose sprays remain a relatively untapped sector (despite being dubbed the most effective class of medication for the treatment of allergic rhinitis by the Allergic Rhinitis and its Impact in Asthma [ARIA] working party). Overall, more than one million new people bought into allergy in 2006, supporting the projection that long-term allergy incidence is set to grow.
A key role for pharmacists
Across the allergy arena, pharmacists are already adopting an increased role both in management and screening. Allergy UK and the NPA have recently teamed up to deliver affordable allergy diagnosis to the public via pharmacies - reflecting the fact that pharmacists are in the right place and have the right training to improve access to allergy services.
By the time the hay fever season hits this year, pharmacists could potentially be performing a dual role - offering advice on hay fever treatment while simultaneously helping sufferers pinpoint the specific type of pollen they are allergic to.
To participate in this groundbreaking allergy initiative, pharmacists must first undergo specialised intensive training provided by the Centre for Postgraduate Pharmacy Education at Manchester University and the Clinical Director of Allergy UK.
The actual running of the service itself then demands that pharmacists undertake the following practical steps:
- Provide a consultation room and display accreditation certificates.
- Take a full clinical history - including discussion of relevant lifestyle factors.
- Carry out an allergy test (if needed). Pharmacists will be equipped to test for the most common everyday allergens.
- Diagnose the allergen(s) most likely to be triggering the patient's reaction.
- Offer suggestions for better management of the allergy, including advice on OTC medication and allergen avoidance. Pharmacists should be aware that complex cases will warrant referral to a GP.
Allergy UK will follow up the screening with a tailored information pack for each customer.
Prevention advice
As part of an active role in managing hay fever, pharmacists should be prepared to offer essential self-help advice to sufferers. While it is clearly impossible to completely avoid exposure to pollen, key preventative steps can help to minimise contact:
- Advise customers to use a pollen calendar to pinpoint the culprit pollen - or take advantage of in-pharmacy allergy screening services. Symptoms starting in June or July suggest a grass pollen allergy, while spring suffering is more likely to be triggered by tree pollen and weed/nettle allergies occur later in the year.
- Suggest customers check the pollen forecast to avoid going out at peak pollen times.
- Advise customers to:
- Keep windows closed in early morning and late afternoon when grass pollen counts are high.
- Change clothes and wash hair after being outdoors. It is also a good idea to brush pets regularly as they can carry a lot of pollen in their fur.
- Wear sunglasses and a broad-rimmed hat.
- Keep doors and windows closed where possible - also keep car windows closed when driving and invest in an efficient air filter.
- Avoid drying laundry outside where it can collect pollen.
New hope for sufferers
Hay fever has recently enjoyed something of an upsurge in the development of new therapies. Although pharmacy-dispensed antihistamines and steroid sprays look set to remain the lynchpin of treatment, other exciting new options are emerging.
Most promising among these is GlaxoSmithKline's Avamys - an enhanced affinity 'furoate' form of the fluticasone steroid found in Flixonase. Importantly for sufferers, Avamys is the first steroid nasal spray to demonstrate consistent efficacy in relieving both nose and eye symptoms of hay fever. In clinical trials, Avamys significantly relieved itchy, red and watery eyes and improved hay fever sufferers' quality of life.
As a class, the pollen vaccines mark a new immunotherapeutic approach to hay fever treatment, which tackles the allergy at its underlying cause, rather than simply alleviating symptoms. Two distinct types of pollen vaccine are already available on prescription - Grazax and Pollinex - both indicated for the treatment of seasonal allergic hay fever in patients who have failed to respond to anti-allergy drugs.
Pollinex is a conventional vaccine administered by subcutaneous injection and available in two forms targeted against either tree pollen or grass and rye allergen.
Grazax, on the other hand, boasts a unique fast-dissolving sublingual tablet formulation containing allergen extracts from the Timothy grass pollen (Phleum pratense). Both vaccines work by eliciting a protective immune response that dampens down the body's overactive reaction to pollen - and may herald new hope for severe hay fever sufferers.
Hayfever product news
Available as a 7- (GSL) or 30- (P) tablet pack, Pollenshield offers effective, non-drowsy, one-a-day protection against hay fever. Unlike some other tablet formulations of cetirizine, it is also licensed for use in children aged over six years. Actavis, tel: 01271 311200.
Piriton Allergy Tablets contain chlorphenamine maleate, a highly effective antihistamine with a well-established safety record. Piriton can prove particularly helpful during the night, relieving itch and other hay fever symptoms to aid restful sleep. GSK Consumer, tel: 020 8047 5000.
Flixonase Allergy provides complete 24-hour, non-drowsy relief from airborne allergy symptoms including sneezing, itchy watery eyes, nasal congestion and runny nose. GSK Consumer, tel: 020 8047 5000.
Beconase Hayfever contains beclometasone dipropionate as its active ingredient. This intranasal steroid provides a powerful anti-inflammatory action for the complete relief of common hay fever symptoms. GSK consumer, tel: 020 8047 5000.
Piriteze Allergy Tablets contain the second-generation antihistamine cetirizine and provide long-lasting relief from hay fever and other allergies. GSK Consumer, tel: 020 8047 5000.
The first branded antihistamine to be available GSL, Piriteze Allergy Syrup contains cetirizine in a sugar-free, banana-flavoured syrup formulation that is suitable for adults and children aged six and over. GSK Consumer, tel: 020 8047 5000.
Zirtek Allergy Relief is available as tiny tablets or a sugar-free, banana-flavoured solution that can be taken by children as young as two years old. UCB Pharma, tel: 01753 534655.
Helen Boreham MSc is a freelance medical writer with over 10 years' experience. She holds a BSc (Hons) and a Masters in medicinal chemistry. Helen writes for a wide range of pharmacy and medical publications, in addition to working as a freelance writer for a number of healthcare education agencies.
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