The Pharmaceutical Journal
Vol 270 No 7242 p428
29 March 2003

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International guideline on pharmacy management of hay fever published

A guideline on the management of hay fever in pharmacies has been produced by an international group of pharmacists and doctors.

Pharmacy protocol Mild intermittent allergic rhinitis symptoms Consider recommending an oral H1-antihistamine*, a nasal H1-antihistamine, a decongestant, a nasal chromone (eg, sodium cromoglicate) or nasal saline Mild persistent or moderate to severe intermittent allergic rhinitis symptoms Consider recommending an oral H1-antihistamine*, a nasal H1-antihistamine, and/or a decongestant, a nasal steroid**, or nasal chromone. Refer to physician if no improvement after 7–15 days Moderate to severe persistent allergic rhinitis symptoms Refer to physician *Non-sedating H1-antihistamines should be used preferentially **If nasal obstruction predominates, intranasal steroids should be the first-line treatment

"The management of allergic rhinitis symptoms in the pharmacy", its authors say, will help pharmacists advise patients on how to recognise allergic rhinitis and how to assess its severity, how to understand the effect of treatment on rhinitis and co-morbidities such as asthma, and how to determine whether pharmacy management is appropriate. The guideline also provides a recommended pharmacy protocol for managing allergic rhinitis (see Panel).

The recommendations laid out in the guideline are intended for use by pharmacists throughout the world, including those working in countries where pharmaceutical care is well established. However, the authors say that they can be adopted by countries where pharmacy roles are different (for example, in developing countries) or where there is less availability of potent over-the-counter medicines (for example, France).

The guideline points out that allergic rhinitis and asthma often co-exist and suggests that patients with persistent symptoms of allergic rhinitis should be referred to their general practitioner.

Professor Christine Bond, department of general practice and primary care, University of Aberdeen, and one of the guideline's authors, told The Journal that the guideline would provide a framework for the detection of undiagnosed asthma, or worsening of diagnosed asthma in pharmacies. "Thus, it covers aspects of extended roles extremely pertinent to the current focus on pharmaceutical care," she added.

The guideline has been funded by a consortium of pharmaceutical companies and ARIA (allergic rhinitis and its impact on asthma), a non-governmental organisation that forms part of a World Health Organization initiative to prevent asthma through the management of allergic rhinitis. It is expected to be published in full on the ARIA website this month (www.whiar.com).

Professor David Price, general practice airways group, University of Aberdeen, said that a "pocket guide", specifically tailored to pharmacists in the United Kingdom, would be produced shortly.

A special feature on the management of hay fever appears on p443 as a PDF (65K).