Top tips for a difficult hay fever season

Clinical
By
Chloe Hava
-
thunderstorm asthma

Changing weather patterns could spell trouble ahead for hay fever sufferers. Ensuring patients have optimum relief can improve their quality of life.

Spring has officially sprung, with hay fever season reported to hit early this year – particularly in the southernmost parts of Australia.

The shift from La Niña to El Niño and overall warmer weather patterns has led to early grass growth, said pollen count expert Edwin Lampugnani.

‘That generally means that people in Victoria, southern New South Wales and, to some extent, South Australia, have a lot of pollen in the air that can affect their allergies,’ he said.

Canberra has also encountered the first day of ‘long’ and ‘high’ pollen season.

The ACT is known as the ‘hay fever capital of Australia’, with around 25% of Canberrans typically affected by allergic rhinitis, said Professor Sinthia Bosnic-Anticevich FPS, Chair of PSA’s Respiratory Care Community of Speciality Interest.

‘Other states with around 20% prevalence include Victoria, Tasmania, New South Wales, South Australia and Western Australia,’ she said. ‘The prevalence is slightly lower in Queensland and in the Northern Territory.’

Pharmacists should begin initiating conversations with patients about optimum management and relief, particularly in the most affected areas.

Screening to find the right therapy

Oral antihistamines are only suitable for patients with mild, intermittent hay fever. But most patients who come into pharmacies or general practice for treatment will have moderate to severe hay fever, said Prof Bosnic-Anticevich.

So how can pharmacists ensure they are getting the right treatment? 

‘Patients often search for relief for the primary hay fever symptom, but if you ask a few more questions, you often find that they have more than one symptom, which increases the burden of the condition on the individual,’ she said. 

For example, if a patient presents with watery eyes, ask if they also have:

  • a runny or blocked nose 
  • itchy eyes
  • an itchy palate. 

Follow up by asking how impactful a patient’s hay fever symptoms are, which can provide further insight into their condition.

‘We know patients have difficulty perceiving their symptoms realistically,’ said Prof Bosnic-Anticevich. ‘So asking how bothersome rather than how bad they are tends to give pharmacists much more insight into the disease.’

Questions to ask patients include:

  • Does hay fever impact your sleep, or day-to-day life? 
  • Do you have difficulty concentrating? 
  • Are you tired when you wake up, even though you’ve had quite a few hours of sleep? 
  • Do you find that you feel fuzzy in the head? 

For these patients, the first-line treatment is an intranasal corticosteroid and/or intranasal antihistamine. 

‘Many people who have moderate to severe hay fever also will benefit from a combined intranasal corticosteroid and antihistamine, which provides anti-inflammatory effects while dampening down the allergic response,’ she said.

Up until recently, intranasal azelastine and fluticasone propionate combination products have been only available as a Prescription Only medicine, creating a barrier to access.

‘Now these medicines are available in the pharmacy without a prescription, so it really opens up that dual therapy to everyone,’ said Prof Bosnic-Anticevich.

The importance of technique

After recommending optimum therapy, it’s important to counsel patients about how these medicines should be used. 

Pharmacists should explain how best to use a nasal spray, including:

  • the head must be tilted slightly forward 
  • if spraying the medicine in the left nostril, use the right hand and aim the nozzle towards the left ear i.e. away from the middle of the nose (or septum) – and vice versa
  • the nozzle should be positioned at the base of the nose rather than up the nostril
  • it’s important to inhale gently whilst spraying, and avoid sniffing hard during or after.

The Digital Australian Pharmaceutical Formulary and Handbook provides clear and updated advice on the best way to use a nasal spray

Now that patients won’t need another script from their GP for combined intranasal medicines, pharmacists should also find ways to review the effectiveness of treatment.

‘[For example], pharmacists could schedule a text message using their pharmacy app to see how the treatment is going 10 to 14 days later,’ said Prof Bosnic-Anticevich. ‘If they’re better, we know we’re on the right track. If not, they need to go and see a doctor.’

Saline washing prior to using intranasal medicines is also recommended for all patients with moderate to severe hay fever.

‘Because allergens stick to the mucosa inside the nose, using a saline wash removes those particles from the surface of the mucosa,’ she said.

The time to start is now

Pharmacists should advise patients that intranasal medicines both treat allergic rhinitis and prevent it.

‘Patients are so used to using these medicines reactively,’ she said. ‘But if they have already got hay fever this spring, they should start using their intranasal medicine now, and continue throughout the season.’

Checking in about asthma is equally important.

‘About 80% of people with asthma have hay fever, and around 20% of people with hay fever have asthma,’ said Prof Bosnic-Anticevich. ‘The minimum treatment for people with both asthma and hay fever is the intranasal corticosteroid, which they should start using straight away – even if it’s mild.’

Some patients with asthma might not know they have allergic rhinitis, so if a patient comes in for short-acting beta agonists or preventative asthma medicines, pharmacists should ask:

  • have you ever been checked for hay fever, because we’re going into hay fever season
  • do you have something to treat your hay fever, because now might be a good time to start.

Pharmacists should also inquire about asthma control and if patients have an asthma action plan, so they know what to do should their symptoms exacerbate.

‘Take the opportunity to suggest patients go to their GP for a review of their asthma, because asthma and hay fever can make each other worse,’ she added.

Need further advice to support patients through hay fever season?  These PSA resources can help: