For such a common allergy there is still much confusion among sufferers about the causes and treatments for hayfever – so how can you best help your customers deal with its debilitating effects? 

 

Learning objectives

After reading this feature you should be able to:

• Understand the impact hayfever has on sufferers
• Explain how different hayfever treatments work
• Help patients find the most suitable treatment for their symptoms.

A study last year by Allergy UK found that the daily routines of 89 per cent of hayfever sufferers were affected by their symptoms, while 87 per cent said their symptoms caused sleepless nights.

“Many sufferers say hayfever is similar to suffering from an ongoing head cold across the summer months,” says Stérimar brand manager Anne-Sophie Martin, “which can result in disruption and decreased quality of everyday life. It can also affect the sufferer’s ability to concentrate, and undertake simple activities such as driving.”

The impact on the economy is also significant, points out Max Wiseberg, managing director of HayMax. “The Hayfever Health Report commissioned by Kleenex indicated that hayfever could be costing British businesses as much as £7.1 billion a year in lost productivity and concentration among employees.”

A growing problem “Statistics suggest that the UK is the hayfever centre of the world and some scientists are predicting that 45 per cent of the population will be suffering by 2030,” according to a spokesperson for Zirtek manufacturer UCB. But why has the growth been so marked in recent years?

“Environmental factors such as air pollution, climate change and improved hygiene levels are having an impact on the prevalence of all allergies,” says Angela Chalmers, pharmacist for Boots UK, “and local agriculture can also make symptoms worse, depending on the person’s locality.”

The UCB spokesperson says genetics is the main player. “Children born into families where allergies already exist show a higher than average chance of developing allergies themselves. Researchers estimate that over half of children from these atopic families will go on to develop an allergic disease, while the incidence of allergy in children from families that have no allergic history is one in five. “That said, the rise in the number of sufferers within one generation has been so great, that there must be other influencing factors involved beyond genetics.”

Some studies claim that improvements in living standards and the reduced risk of childhood infections may result in greater susceptibility to developing hayfever. “By living in ever cleaner environments, we are not exposed to as many allergens early on in life,” says Janice Perkins, pharmacy superintendent at Well (previously known as Co-op Pharmacy).

“There are many studies that claim that as a result of this, our bodies fail to distinguish between harmless dust or pollen and pathogens such as bacteria that can cause more serious harm. The reaction to allergens then becomes over pronounced.” Hayfever symptoms are also likely to be worse if the pollen count (the number of grains of pollen in one cubic metre of air) is high.

Some people can develop hayfever for the first time “just because the conditions are ‘right’ that season”, says Angela Chalmers, but Amena Warner, nurse advisor at Allergy UK, also points out that we are getting better at recognising hayfever and there are more treatments for it, “so more people know what it is and how to treat it”.

Pollen is an essential part of the honey bee diet

Many sufferers say hayfever is similar to suffering from an ongoing head cold

Managing symptoms

Prevention is better than cure, says Amena Warner. “Advise your customers to start using a nasal spray two weeks before they usually get symptoms to keep the nose free of inflammation, and to keep using the minimum dose that gives the maximum effect to keep symptoms at bay.

“It’s better not to let inflammation build up, then start when the nose is so blocked that they can only breathe through the mouth because it takes much longer to treat symptoms. Start simple with a nasal douche and work up from there. If one thing doesn’t work then go to the next or use them in combination.” Yusuf Patel, a pharmacist at Superdrug recommends:

• Antihistamines to help reduce runny nose/eyes and itchy nose/eyes, in the form of tablets, nasal sprays, or eye drops
• Sodium cromoglicate eye drops to reduce red, runny and itchy eyes
• Oral or intranasal decongestants to help unblock congested nasal passages, used for a minimal period of five to seven days due to rebound congestion
• Corticosteroids to help control symptoms on a long-term basis for patients demonstrating moderate to severe symptoms, although they can take up to two weeks to work.

For patients who find it too confusing to take lots of medicines Amena Warner suggests a combined antihistamine and nasal steroid spray. “This is a good treatment, but depends on the severity of the person’s hayfever because the combination means the component doses may not be as large as taking a tablet dose and a nasal steroid dose separately.”

Some customers may prefer to use alternative remedies. “In an Australian study of hayfever sufferers being treated by their GPs, 60 per cent said their pharmaceutical treatments worked, but worked poorly,” says Max Wiseberg of Haymax. “Drug-free allergen barrier balms, acupressure bands and bee pollen based treatments are suitable for use alongside pharmaceutical solutions [which] is why the drug-free OTC market is an area which is growing.”

Customers should also be advised on how to avoid pollen and allergens. “Staying indoors when the pollen count is high would be the ideal way to minimise hayfever symptoms”, says Janice Perkins, “although the downside is that it’s not very practical.” Measures that can be taken to minimise exposure include:

• Keeping doors and windows in the house/car closed
• Avoiding cutting grass or having flowers in the house and keeping pets outside
• Vacuuming regularly and damp dusting to capture pollen grains
• Drying clothes inside, wearing sunglasses when outside and taking a shower and washing clothes after a trip out.

 

Hayfever and asthma

Worryingly, research is showing that people with allergic rhinitis may go on to develop asthma if they don’t treat it effectively.

“We try to get patients to understand that it’s ‘one airway one disease’,” says Amina Warner. “The nose is linked to the lungs so they should start by actively targeting the nose with nasal balms, to try to capture the pollen before it enters the nose, and douching with isotonic saline solution to rinse the nose out. If they are breathing up pollen through the nose, the irritant pollen allergens enter the capillary system causing the mast cells to release histamine, which leads to sneezing and a runny nose with clear fluid trying to wash it out.

“Over time, if left untreated, they’ll get inflammation in the nose, blocked sinuses so they can’t breathe, as well as a post-nasal drip down the back of the throat which causes hypersensitivity of the airways as it has the allergens in it which get into lungs – as well as the allergens directly breathed in from the mouth. This can cause inflammation in the lungs, and it’s the hypersensitivity that makes the lungs unstable, produces a cough and can lead to asthma.”

Category management

It’s important to have the full category of allergy relief available as hayfever sufferers buy early in preparation for the season. Numark’s information pharmacist Michael Stewart recommends stocking a range of brand leaders in a variety of formats to give customers a choice: “Liquids and tablets should be considered and ranged from smaller to larger pack sizes. A range of children’s products should also be stocked and merchandised within the paediatric medicines section or dual merchandised where appropriate. Critically, you should also have a value alternative to the brand, both out on open display and behind the counter.”

He also advises suggesting larger pack sizes for regular sufferers and linking sales of tissues or decongestants. “Last year the 30s packs of both cetirizine and loratadine switched from P to GSL. With more allergy products switching to GSL and many hayfever sufferers being affected by symptoms throughout the season, smaller pack sizes can be costly and inconvenient. “Stocking a 60s pack will keep your customers coming back to you as they may be less likely to pick up the smaller pack sizes from grocers.

What is important to remember, however, is that the value is in P medicines, so ensure your customers are buying the right product and pack size to meet their needs.” It is crucial that stock levels are replenished throughout the day as they sell very quickly, says Yusuf Patel. “It is also important to ensure that staff members are well trained regarding the different types of products, so they can identify a patient’s individual needs.”

Stuart White, marketing manager at Omega Pharma, agrees. “Regular training will ensure staff at all levels feel confident to offer the best customer service possible, which will help lead to significant returns. Hayfever is often misdiagnosed as a cold, so pharmacy staff should be in a position to distinguish between the two conditions.”

And it doesn’t hurt to keep your customers informed as well. “If you provide a Minor Ailments Service let people know that it also covers hayfever remedies,” says Janice Perkins. “Remember, too, that prevention is better than cure when it comes to managing allergies, so why not use your PMR to flag up patients who have used allergy treatments previously and get in touch with them before the season starts.

“It’s also a good idea to visit your local practice to see if you can work together to make the pharmacy rather than the GP surgery the first port of call for allergy-related symptoms. This is particularly useful if you can provide treatment on the NHS using a minor ailments service.”

Next steps

Michael Stewart warns that, with more P lines switching to GSL, “grocers are gaining a share of the business by cutting prices, but they cannot provide the support that pharmacy can.” Pharmacy is moving towards a service-led agenda so consideration could be giving to setting up an allergy testing service, he says.

If you don’t have the capacity to do this you can always signpost your patient on, says Amena Warner, particularly if they are experiencing severe uncontrolled hayfever that is reducing their quality of life. “They can ask their GP for a referral to an allergist/ immunologist as there are treatments that can be given in hospitals that aren’t available in primary care. Immunotherapy, for instance, comes with risks and uses some drugs off licence so has to be done in specialist centres.”

As more customers seek symptom advice and recommendations on how to manage hayfever, the pharmacist’s role will become increasingly important, says Stuart White. “When it comes to treatment success, compliance is integral, and pharmacy staff are perfectly positioned to help address issues surrounding this.

Staff should therefore use the time they have with consumers to reinforce the importance of selecting a hayfever product that suits their needs, and also using it correctly if they want to experience fast relief.”