Customer scenario – What would you do?
Customer scenario – What would you do?
One day in early April a 22-year-old woman came into the pharmacy complaining of a persistent runny nose and itchy eyes. She told you she had experienced similar symptoms at the same time last year and has been taking OTC oral antihistamines occasionally.
After further questioning you decided she was suffering from hay fever. You know tree pollen can be a problem in March and April, and her symptoms suggested seasonal allergic rhinitis. After checking that she is not taking any other medication, and that she isn't pregnant or breastfeeding, you recommended a corticosteroid nasal spray and provided self-care advice.
You are a little taken aback when she returns a week later and tells you that the beclometasone spray you provided is not working.
How might you respond?
What might be the cause (or causes) of treatment failure?
The woman is adamant that she does not have an upper respiratory tract infection. Her nasal discharge is clear, meaning an infection is less likely. Additionally, she tells you the symptoms get much worse when she goes for her morning run in the woods and fields behind her house.
You are still sure she is suffering from hay fever.
The woman tells you she doesn’t like taking medicines unless she has to, so is only using her beclometasone nasal spray when symptoms appear.
She adds that sometimes she can taste the spray in her mouth.
You are aware that proper use of a nasal spray is key to effective treatment, so you ask the woman to demonstrate how she uses the spray. She takes out the spray bottle, tips her head back and squirts the spray hard into her nostril, inhaling sharply through her mouth.
By now you realise the woman needs reminding of self-care advice and how often to take her medication, as well as how to use a nasal spray properly.
Advice points to share:
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AVOID HER TRIGGER (POLLEN)
During her run she should opt for areas with a lower pollen count, avoiding grassy areas with few trees
When she gets home, she should change her clothes and shower.
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TREAT AND PREVENT WITH BECONASE® HAYFEVER (beclometasone)
Start using the nasal spray 2-3 days before her symptoms are expected to start and use regularly, as recommended6
Reduce the dose as recommended once control has been achieved.6
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CORRECT TECHNIQUE
Revisit the correct technique to ensure maximum effectiveness of her nasal spray
Ensure she understands common mistakes (such as inhaling sharply through her mouth) and explain how this can reduce the efficacy of the product.
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COMBINATION THERAPY
As she is particularly suffering with itchy eyes, she can use sodium cromoglycate drops alongside the nasal spray to provide additional relief
She may still use her oral antihistamines alongside these if required.
1. NICE CKS. Allergic rhinitis: How common is it? 2024. Available at: https://cks.nice.org.uk/topics/allergic-rhinitis/background-information/prevalence/
2. Scadding, G.K., et al.(2021) Allergic Rhinitis in Childhood and the New EUFOREA Algorithm. Frontiers in Allergy 2, 706589.
3. NICE CKS. Allergic rhinitis: What is it? 2024. Available at: https://cks.nice.org.uk/topics/allergic-rhinitis/background-information/definition/
4. NICE CKS. Allergic rhinitis: Scenario:management. 2024. Available at: https://cks.nice.org.uk/topics/allergic-rhinitis/management/management/
5. Meltzer et al 2012, Safety and efficacy of once-daily treatment with beclomethasone diproprionate nasal aerosol in subjects with perennial allergic rhinitis
6. SPC BECONASE® Allergy BECONASE® Hay fever. 2022. Available at: https://products.mhra.gov.uk/search/?search=Beconase&page=1
7. SPC BECONASE® Hay fever Relief for Adults 0.05% Nasal Spray. 2022. Available at: https://products.mhra.gov.uk/search/?search=Beconase&page=1
8. Corren J, et al. Nasal beclomethasone prevents the seasonal increase in bronchial responsiveness in patients with allergic rhinitis and asthma.
J Allergy Clin Immunol. 1992 ;90(2):250-6.
9. Hodgson F. Doctor shares ‘correct’ way to use nasal spray for instant relief. Mirror. 2024.
Available at: https://www.mirror.co.uk/news/health/doctor-shares-correct-way-use-31921733
10. Patient information leaflet. BECONASE® Aqueous nasal spray. 2023. Available at: https://www.medicines.org.uk/emc/files/pil.844.pdf
Online references last accessed April 2025
BECONASE® HAY FEVER RELIEF FOR ADULTS 0.05% NASAL SPRAY (GSL) contains beclometasone dipropionate. For the treatment of seasonal allergic rhinitis (hay fever) in adults over 18 years. Adults aged 18 and over: 2 sprays into each nostril morning and evening (400 micrograms/day). Not recommended for use in children and adolescents under 18 years. Contraindications: Known hypersensitivity to ingredients. Caution: Concomitant use of other corticosteroid treatments, recent nasal injury or surgery, pregnancy/lactation. Side effects: Rare cases of hypersensitivity reactions, dryness/irritation of the nose and throat, raised intra-ocular pressure, nasal septal perforation. PL 02855/0065. MAH: Omega Pharma Ltd, Wrafton, Braunton, Devon, EX33 2DL, UK. RRP (ex. VAT): £7.99.
Date of preparation: November 2022. SPC: https://mhraproducts4853.blob.core.windows.net/docs/1da61835df24c8494546ae270facd2fa53287d0f
BECONASE® HAY FEVER/BECONASE ALLERGY (P) contains beclometasone dipropionate. For the prevention and treatment of allergic rhinitis, including hay fever, in adults over 18 years. Adults aged 18 and over: 2 sprays into each nostril morning and evening (400 micrograms/day). Not recommended for use in children and adolescents under 18 years. Contraindications: Known hypersensitivity to ingredients Caution: Recent nasal injury or surgery, pregnancy/lactation. Side effects: Rare cases of hypersensitivity reactions, dryness/irritation of the nose and throat, raised intra-ocular pressure, nasal septal perforation. PL 02855/0064. MAH: Omega Pharma Ltd, Wrafton, Braunton, Devon, EX33 2DL, UK RRP (ex VAT): £10.99 Date of preparation: November 2022. SPC: https://mhraproducts4853.blob.core.windows.net/docs/3970a79d2573adc484fe9565aa96c54c112cd13c