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Start early for hayfever

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Start early for hayfever

How can you help your customers to cope better with the hayfever season, as well as maximise potential for your pharmacy?

In the UK, some 36 per cent of us now live in a household where someone is a hayfever suffer, which equates to around 18 million people, according to Allergy UK. ‘A new European study has found 45 per cent of 20 to 40-year-olds are affected by hayfever in Europe, which is a large proportion,’ says nurse advisor Amena Warner at Allergy UK. 

Hayfever is an area where your customers will welcome expert advice, especially in the light of media scare stories earlier this year regarding anticholinergic medicines, including some allergy medication, and a suspected link with increased risk of dementia.

It is essential that customers are clued up on how to get the best from hayfever remedies, which is where pharmacy staff can play a vital role. ‘A YouGov poll commissioned by GSK indicates that 24 per cent of people who are aware of the allergy they suffer from tend not to start treatment until their symptoms become severe. There is a real opportunity here for pharmacies and staff to educate customers about the benefits of becoming more proactive in managing their allergy treatment regime,’ says Julia Bauer, allergy brand manager at GSK.

Here are some ideas for helping your customers to get through the season, as well as maximising potential for your pharmacy.

New sufferers

‘It’s important for customers who suspect hayfever to see their GP for a proper diagnosis,’ advises Beverley Adams-Groom at the Pollen Research Centre, Worcester University. This should be done before they self-treat. It also helps to find out what pollen your customer is allergic to.

‘Identify that it is hayfever when it occurs out of the peak season of June and July. Birch is our main allergenic tree and its pollen season can start late March and last until May. The birch pollen seasons tend to alternate between mild and severe. Due to these factors, the timing and severity of birch seasons are not the same each year and sufferers may not realise they have hayfever and treat it as a cold,’ says professor Jean Emberlin at the Pollen Research Centre.

Differentiate between a cold and hayfever. ‘If they have thick green mucus, it’s most likely to be a cold,’ says Ms Warner. ‘Runny, clear fluid and itchy eyes are typical of hayfever.’ One-sided nasal blockage is not a sign of hayfever and needs to be further investigated, as does nasal bleeding and crusting. ‘Once you’re sure the customer has hayfever, first recommend barrier balms and an isotonic saline nasal douche, which are very effective against pollen. If this isn’t enough, recommend the newer non-sedating long-acting antihistamines, as well as a nasal steroid spray for a blocked nose. It’s essential that you teach customers how to use nasal sprays correctly,’ says Ms Warner.

Right Treatment

Ensure that long-term sufferers use the right treatment. Customers who’ve suffered with hayfever for years will often take the same remedy they’ve always used and could be missing out on newer medication. Talk to customers about the different types of antihistamine and how these work.

‘Each allergy will have specific treatments, but most fall into one of these categories; 􀀀

  • Antihistamines to block histamine production
  • Steroid nasal spray to reduce inflammation
  • Cromoglicate eye drops to reduce itchiness and redness
  • Decongestants
  • Leukotiene receptor antagonists, to block effects of leukotiene released during an allergic reaction,’ explains Numark’s information pharmacist, Michael Stewart.

‘Encourage your customers to use the pollen forecast and related information to ensure they know when they are most likely to be affected,’ says Ms Adams-Groom.

‘For some customers, every hayfever season is complete misery and this indicates their symptoms are not well controlled by OTC or prescription medication. They should be referred to an allergy specialist for treatment such as desensitisation,’ suggests Ms Warner.

Triggers

Help customers to find out what triggers their allergy symptoms. Around 15 species of pollen are known to be considerably allergenic in the UK. Customers can download a pollen calendar at www.worcester.ac.uk/discover/pollen-calendar, to find out when different pollen types are most prevalent.

Customers who complain of symptoms during autumn/winter months are more likely to be allergic to fungal spores, pets or dust mites. Yearround symptoms are caused by perennial rhinitis, not hayfever.

Pollen awareness

The pollen count is the number of pollen grains per cubic metre of air sampled, averaged over 24 hours.
Low: Less than 30 pollen grains per cubic metre of air
Moderate: 30-49 pollen grains per cubic metre
High: 50-149 pollen grains per cubic metre
Very high: 150+ pollen grains.
Most sufferers start to feel symptoms from moderate onwards.

Customers with hayfever may want to consider carefully when picking a summer holiday destination. For example, countries that have low grass pollen counts in July include: Aegean Islands, Crete, Canary Islands, Corsica, Ionian Islands, Corfu, Italy and Madeira. In August, good destinations include Aegean Islands, Crete, Albania, Canaries, Corsica, Croatia, Denmark, France, Greece, Italy, Madeira, Netherlands, Spain and Sweden.

Myths and concerns

Give the right advice to patients worried about health scare stories and myths. In January, a study was published by researchers from the University of Washington that examined whether there was a link between taking anticholinergic medication, such as antihistamines, and dementia risk. The study looked over a 10-year period and found those at increased risk of dementia were people on high levels of anticholinergic medicines for at least three years. The medicines with the highest risk, according to the study, included: oxybutynin chloride 5mg, chlorphenamine maleate 4mg, olanzapine 2.5mg, meclizine hydrochloride 25mg and doxepin hydrochloride 10mg.

‘It’s important to stress that the research only looked at older antihistamines. We say the best way to treat hayfever is with the newer, nonsedating antihistamines, so if customers take these they shouldn’t be at increased risk of dementia. Patients on older antihistamines should swap to the newer ones for everyday use,’ says Ms Warner.

Mr Stewart advises: ‘Pharmacists could offer concerned patients a medicines use review to identify any adverse effects of their treatment. Where an anticholinergic is unavoidable, patients should use the lowest effective dose for the shortest period of time. Non-sedating secondgeneration antihistamines such as loratadine or cetirizine should be recommended instead of chlorphenamine.’

Self-care

Offer self-care tips to hayfever sufferers:

  • Start taking allergy medication several weeks before the pollen season begins
  • If you can’t take antihistamines, try natural remedies and barrier products
  • Check the pollen count daily. On a high count day, greatest risk is early morning and from 4pm to late evening. During tree pollen season, risk is greatest during daylight hours only
  • Stay indoors when the pollen count is high
  • Keep windows closed
  • Don’t keep fresh flowers indoors
  • Vacuum and damp dust regularly to minimise pollen
  • Wash pets regularly during hayfever season to remove pollen from their fur
  • Avoid drying clothes outside
  • Find someone else to mow the lawn
  • Wear wraparound sunglasses
  • Change clothes and shower after being outside
  • Keep car windows closed and buy pollen filters for air vents
  • ‘If you also suffer from asthma, make sure it is well controlled, especially if there is a thunderstorm at the height of the pollen season.

People should seek urgent medical help if they have difficulty breathing, and also if they are having to use their reliever inhaler often and it does not seem to be effective in controlling their asthma, advises Ms Warner.

Strong category

Ideas to help build a better hayfever category in your pharmacy, and aim for category growth. ‘Start promoting the hayfever category from April to inspire and remind customers to be prepared with appropriate products. By doing so, pharmacists can communicate the message of
treating symptoms as soon as they start,’ suggests Ms Bauer at GSK.

  • ‘It’s important that pharmacies stock a range of brand leaders, which cover a variety of formats. A range of children’s products should also be stocked and merchandised. Pharmacy should also ensure they have a value equivalent to brands both on open display and behind the counter,” says Mr Stewart. ‘Suggest larger pack sizes for regular sufferers and offer link sales of tissues and decongestants.’
  • ‘Be open-minded. There are lots of innovative products from small companies. If you come across products that have good anecdotal evidence, listing them might give your customers a better result and return you with better sales,’ says Max Wiseberg at HayMax.
  • ‘Make sure your pharmacy has a prominent allergy section so customers know where to go for hayfever relief. Try bringing popular hayfever products to the front of the store to ensure they can be found quickly during the season,’ suggests Emma Wright, Nelsons brand manager for Pollenna.
  • ‘Remember that recommendation is highly important, with 40 per cent of shoppers saying that pharmacists and assistants influence their decision to buy. One in three allergy purchases are for immediate use and 49 per cent of consumers are unhappy with their current treatments and are therefore willing to try something new,’ says Ms Bauer.
  • ‘Locate products that are likely to naturally increase in sales throughout the allergy season in close proximity of your allergy fixtures, such as tissues and decongestants, to maximise impulse opportunity,’ says Ms Bauer.
  • ‘Have a full range of medicines with active ingredients, but don’t forget about barrier nasal sprays and balms. Tissue stocks should be well maintained and easily available, as well as nasal balm for sore noses,’ advises Angela Chalmers, pharmacist at Boots UK.
  • ‘Don’t limit your allergy promotions to one month in the spring/summer – feature allergy as a category for a minimum of six months and start early,’ suggests Mr Stewart.

Comment

Fiona McElrea, Whithorn Pharmacy, Whithorn ‘We are in a rural farming community and so we certainly have plenty of pollen around. Hayfever symptoms can be treated under Scotland’s minor ailments scheme, and this generally works well for us, although we find that there are still people who aren’t eligible who we would like to be. For hayfever, we recommend that people start treating as soon as the season starts and then carry on for the rest of the season. We tend to dual site products as much as possible, so people are more likely to pick them up and it then generates discussion. We know that many people stock up on hayfever products in the supermarket, but here we can offer advice on what they can use in combination for more effective relief. On the whole, though, most people know what works for them, and many go for generic products, once they have tried them and they work.’

 

Shaheen Bhatia, P&S Chemist Health and Advice Centre, Illford ‘As we get to spring, all community pharmacies should be putting out their hayfever stock or putting out the posters to say that the advice is available, because people can still forget to make pharmacy their first port of call. More than ever, we are trying to stop people from going to the GP with their hayfever symptoms. Our practices are so heavily inundated with requests for appointments that they do suggest to people that they should use pharmacy first. We have a minor ailments scheme in our borough for people to access and hayfever is definitely one of the conditions covered under the scheme.

 

Jiten Shingdia, Berry Pharmacy, Portsmouth ‘I would say that coming up to summer, the hayfever category is very important for all community pharmacies. We mainly have people asking for a solution for their runny nose, so we tend to sell a lot of nasal sprays at this time of year and of course treatments such as cetirizine and loratadine are widely used. We most often give advice to people who are just taking a tablet for their hayfever symptoms, to combine their tablet with a nasal spray as well. The combination seems to help them to fight off the symptoms more effectively than one item on its own. It’s important that people ask for advice about the management of their hayfever, so that we can give them appropriate guidance where needed.’

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