Page 79 - rp-may-2020

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CPD CREDITS
CPD ACTIVITY
77
RET AIL PHARMA C Y • MA Y 2020
ALLERGIC RHINITIS: NOTHING TO BE SNEEZED AT
LEARNING OBJECTIVES
After completing this CPD activity,
pharmacists should be able to:
• Describe the classification of
allergic rhinitis.
• List the signs and symptoms of
allergic rhinitis.
• Describe the management of
allergic rhinitis.
2016 Competency Standards:
3.1, 3.2, 3.3.
Accreditation number:
A2005RP4 (exp: 30/04/2022).
TO PAGE 78
Debbie Rigby
BPharm, GradDipClinPharm,
AdvDipNutrPharm,
AdvPractPharm, AACPA, FASCP,
FPS, FACP, FAICD, FSHP
Debbie is a consultant clinical
pharmacist from Brisbane. She
graduated with a Bachelor of Pharmacy from the
University of Queensland and has a Graduate
Diploma in Clinical Pharmacy, Certification in
Geriatric Pharmacy and Advanced Diploma in
Nutritional Pharmacy among other qualifications.
She was the inaugural recipient of the AACP
Consultant Pharmacist Award in 2008.
Debbie is a Director on the NPS MedicineWise
board and Chair of the Society of Hospital
Pharmacists of Australia (SHPA) Accredited
Pharmacist Reference Group. She conducts
home medicine reviews in collaboration with
GPs in a medical centre, as well as providing
education to pharmacists, GPs, nurses, nurse
practitioners and consumers.
Allergic rhinitis or hay fever is the most
common chronic respiratory condition
in Australia, affecting almost one in five
people. Children are less likely to have
1
allergic rhinitis (10 per cent) compared
with all other groups. Allergic rhinitis can
1
negatively impact on day-to-day activities
health-related quality of life. The goal of
2
allergic rhinitis management is to achieve
optimal symptom control and improve
quality of life.
1
Current Australian guidelines
recommend use of intranasal
corticosteroids for moderate to severe
intermittent symptoms and mild, moderate
or severe persistent symptoms of allergic
rhinitis. Despite these recommendations,
allergic rhinitis remains undertreated,
with only 15 per cent of patients selecting
appropriate over-the-counter medicines
in community pharmacies. Community
3
pharmacists can play a key role in
optimising treatment of allergic rhinitis.
Classification
Rhinitis is defined as the presence of at
least one of the following:
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• Congestion.
• Rhinorrhoea.
• Sneezing.
• Nasal itching
• Nasal obstruction.
Allergic rhinitis is a subset of rhinitis,
which also includes non-allergic rhinitis
and infectious rhinitis. Allergic rhinitis can
coexist with non-allergic rhinitis and is
referred to as ‘mixed rhinitis’.
The ‘Allergic Rhinitis and its Impact on
Asthma (ARIA) 2008’ report divides allergic
rhinitis into two categories: (Figure 1)
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1. Intermittent allergic rhinitis.
2. Persistent allergic rhinitis.
Intermittent allergic rhinitis is defined by
symptoms present for less than four days
a week, or for less than four weeks at a
time. Persistent allergic rhinitis is defined
by symptoms present for more than four
days per week, and for more than four
weeks at a time.
The severity of allergic rhinitis is
classified as either mild or moderate/
severe. With mild allergic rhinitis, there
is no impairment of sleep, daily activities,
leisure or sport, and the symptoms are
not considered troublesome by the
patient. With moderate/severe allergic
rhinitis, these impairments are present and
considered troublesome.
Before the 2008 ARIA report, allergic
rhinitis was subdivided, based on time of
exposure, into seasonal, perennial and
occupational. However, this is no longer
considered relevant. A mixed pattern
of seasonal and perennial features is
common, making it difficult to categorise
patients using this classification. More
useful in guiding management is
classification by frequency and severity.
Causes
Allergic rhinitis is characterised by
inflammation of nasal mucous membranes
in response to allergen exposure. Common
triggers of allergic rhinitis include:
• Dust mite faecal particles.
• Animal fur.
• Pollens.
• Mould spores.
• Air pollutants.
• Occupational sources.
Early phase release of histamine in
response to allergens results in sneezing,
pruritis, rhinorrhoea and congestion and
lasts for about two to three hours. The late
phase response occurs four to six hours
after allergen stimulation and results in
continued nasal congestion. The late phase
response is predominantly inflammatory
in nature.
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Genetic factors increase a person’s
susceptibility to allergic rhinitis. Atopic
individuals have an increased chance of
having allergic rhinitis as well as other
allergic conditions such as asthma,
dermatitis, and eczema.
Allergic rhinitis and asthma
Allergic rhinitis and asthma frequently
coexist. At least 75 per cent of patients
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with asthma complain of rhinitis symptoms,
and 20-30 per cent of those with allergic
rhinitis also have asthma. In 2004-05 about
8
700,000 Australians had both allergic rhinitis
and asthma.
1
The united airway disease hypothesis
or ‘one airway, one disease’ suggests that
upper and lower airway disease are both
manifestations of a single inflammatory
process. IgE-mediated allergic responses to
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inhaled allergens cause symptoms of both
asthma and rhinitis.
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Allergic rhinitis usually precedes asthma
Intermittent
Symptoms for less than four days a week,
or for less than four weeks at a time.
Persistent
Symptoms for more than four days a week,
and for more than four weeks at a time.
Mild
•
Normal sleep.
•
Normal daily activities.
•
Normal work/school.
•
No troublesome symptoms.
Moderate/Severe
One or more of the following:
•
Abnormal sleep.
•
Impairment of daily activities, sport, leisure.
•
Problems at work or school.
•
Troublesome symptoms.
Figure 1.
Classification of allergic rhinitis.