Suggested Learning

Not to be sneezed at

Pharmacists should get ready to respond to allergies to house dust mites, pets, and even early tree pollens – which can all occur at this time of year

Pharmacists play an important role in ensuring that allergy sufferers know the ‘hows’ and ‘whens’ of using allergy treatments ranging from antihistamines to asthma inhalers, steroid nasal sprays and adrenaline auto- injectors, according to Allergy UK’s head of clinical services Amena Warner.

With good symptomatic control and allergen avoidance, serious allergic reactions can be avoided, says Ms Warner. “When advising on antihistamines it is recommended that a long-acting, non-sedating antihistamine is used,” she says. “It is good practice to ensure that a patient knows exactly how to use devices such as adrenaline auto-injectors before they are given one to take home, making sure they know where the expiry date is located and how they should renew it just before expiry.”

In serious cases of anaphylaxis, pharmacists may have to administer adrenaline, says Ms Warner. This is an acute reaction that needs prompt recognition and treatment if the patient is to survive.

Regulation 238 of the Human Medicines Regulations 2012 allows for certain prescription-only medicines to be administered by anyone for the purpose of saving life in an emergency. One of these medicines is adrenaline 1:1,000, up to 1mg for intramuscular use in anaphylaxis. An adrenaline auto-injector should be administered intramuscularly into the upper outer thigh and an ambulance should be called. Lay the person flat with legs raised.

Allergy UK produces a range of patient information and resources that may be useful to pharmacists. There are over 100 factsheets on allergyuk.org that delve into triggers, symptoms and allergy prevention.

The Allergy UK website also includes useful tools such as a skin symptom checker to identify skin flare-ups, and a food symptoms diary for those who suspect a food intolerance.

The British Society of Allergy and Clinical Immunology (www.BSACI.org) formulates national guidelines for allergy specialists and has comprehensive information on its website for pharmacists.

Symptoms of anaphylactic reaction

  • Swelling of tongue and/or throat
  • Difficulty in swallowing or speaking
  • Vocal changes (hoarse voice)
  • Wheeze, persistent cough or severe asthma
  • Difficult or noisy breathing
  • Stomach cramps or vomiting after an insect sting
  • Dizziness/collapse/loss of consciousness (due to a drop in blood pressure)
  • Floppiness (in babies)

 

Allergy: the signs

  • Nose: an allergen, like pollen or food, causes histamine to be released from mast cells, resulting in a runny or itchy nose, sneezing (rhinitis) and itchy, red eyes (conjunctivitis)
  • Skin: symptoms include redness and nettle rash (hives and wheals)
  • Respiratory system: allergy can cause wheezing, cough and shortness of breath (asthma)
  • Gut: abdominal discomfort, nausea, vomiting, and diarrhoea may occur.
  • Severe allergy or anaphylaxis: can be life-threatening and may result in throat swelling, severe asthma, and/or a drop in blood pressure.

 

In serious cases of anaphylaxis, pharmacists may have to administer adrenaline

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Down in the mouth

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