The most effective way to treat rhinitis is by avoiding the allergen, but it can be difficult to avoid anything carried in the air we breathe. However, there are a number of self-help tips you can provide to patients to reduce their exposure.

Dust mites – damp dust weekly to remove the allergens, ventilate the house adequately, wash bedding weekly on a hot wash (60oC), use allergy proof bedding, use a vacuum cleaner that contains a high efficiency particulate air filter (HEPA) which removes more dust than a regular vacuum. If reactions are severe then carpet may need to be replaced with wood or vinyl floor coverings.

Pets – keep pets outside or limit them to one room, wash pets at least once a week.

Fungal moulds and spores – keep windows closed to prevent spores entering the house, use a dehumidifier to reduce moisture in the air, regularly inspect high risk areas for fungal growth. Keep bathrooms, kitchens and window frames clean, ventilate well to avoid damp, and avoid steam moving through the house when cooking or bathing by keeping kitchen or bathroom doors closed.

There is extensive advice that you can provide to patients who suffer from symptoms triggered by pollen:

• Wear wraparound sunglasses when outdoors to help stop pollen from getting in the eyes.
• Stay indoors when the pollen count is high (above 50).
• Keep windows (including car windows) and doors closed as much as possible.
• After being outdoors change clothes and take a shower to remove pollen from the body.
• Avoid cutting grass or reduce exposure to grassy areas.
• Vacuum and damp dust regularly as this will stop pollen from spreading around the house.
• Keep pets out of the house as the pollen can be transferred from their fur. If they do enter the house wash them regularly.
• Avoid drying clothes outside as pollen may stick to the washing and be brought in to the house.
• Avoid cigarette smoke as breathing in smoke can make hayfever symptoms worse as it irritates the airways, nose, eyes and throat.
• Rub a small amount of a pollen barrier product available as a balm or gel or petroleum jelly inside the lower nostrils as this can stop pollen from entering the nasal passages.
• Have a shower and wash hair after spending time outdoors.

Treatment

The first line of treatment should be OTC medication but if they fail to improve the symptoms then a patient may require prescription only medication.

Antihistamines – work by blocking the effects of the chemical histamine which is released in response to an allergen when the immune system feels it is under attack by the allergen, in this case pollen. By blocking histamine they help relieve the symptoms of hayfever. Antihistamines help to treat the following symptoms but they may not unblock the nasal passages:

• itching
• sneezing
• watery eyes
• runny nose

Antihistamines are available OTC in various forms: tablets, liquids, eye-drops and nasal sprays. They can all be used in two ways:

• As and when – taken when the symptoms first appear.
• Preventative – is considered the better option and customers should be encouraged to continue taking the treatment throughout the hayfever season.

Some people are wary of taking antihistamines such as chlorphenamine as these can cause drowsiness, however there are also formulations available that are non-drowsy for example loratadine. OTC antihistamine treatments contain one of the following ingredients:

• Cetirizine – Piriteze Allergy Tablets/Syrup, Benadryl One A Day Relief, Zirtek Allergy
Relief tablets, Numark Hayfever and Allergy Relief Tablets.
• Chlorphenamine – Piriton Allergy tablets, Piriton Syrup, Numark Antihistamine Tablets/Solution.
• Promethazine – Phenergan Tablets, Phenergan Elixir Oral Solution.
• Loratadine – Clarityn Allergy 10mg Tablets, Numark Non-Drowsy Hayfever and Allergy Relief Tablets.
• Acrivastine – Benadryl Allergy Relief.

* The above list is not exhaustive.

Corticosteroids such as beclomethasone (Beconase Hayfever Nasal Spray and Numark Hayfever Relief Nasal Spray) and fluticasone (Pirinase Hayfever 0.05% Nasal Spray) are available as nasal sprays to reduce nasal inflammation and irritation associated with hayfever. They are used as preventers – meaning they should be used twice a day (beclomethasone) or daily (fluticasone) throughout the hayfever season in order to prevent symptoms occurring. These nasal sprays need to be used for a few days before they control symptoms so it is often helpful to also use a decongestant nasal spray or a antihistamine during the first week or two.

Corticosteroid nasal sprays can only be sold for use in adults 18 years and over. They should not be used for more than 3 months at a time, and if they have shown no benefit in 7 days (fluticasone) or 14 days (beclomethasone) then the patient should be referred to their GP.

Eye drops containing antihistamine e.g. Otrivine Antistin are available over the counter and help to relieve the hayfever symptoms that affect the eyes such as inflammation, redness, itchiness and watering. These drops relieve symptoms quickly but should not be used for more than seven days. Patients should be warned that they can sting when first used but this discomfort should disappear once the patient has blinked a few times.

The most commonly used eye drops, Optrex Allergy Eye Drops, Numark Hayfever 2% Eye Drops and Opticrom Allergy eye drops, contain the active ingredient sodium cromoglicate which prevents the release of histamine from mast cells in the airways and mucous membranes. It is very effective at both treating and preventing hayfever symptoms from occurring if used continuously – the drops should be used every day even if the person doesn’t have symptoms.

It is important to ensure patients use the correct technique when applying eye drops because if they are not then they will not benefit from the treatment. Refer patients to the PIL and explain how to administer the drops correctly or refer to the pharmacist.

Nasal decongestants can be used to relieve a blocked nose as they reduce swelling of the blood vessels and open the nasal passage to help with breathing. Some antihistamines include decongestants to help relieve nasal symptoms. If patients choose a product that does not contain antihistamine then it will only unblock their nose. Ensure that when you are recommending a product that you advise patients of the differences.

Topical decongestants (nasal drops or sprays) can be a short-term treatment for the nasal symptoms of hayfever. They should only be used for a maximum of seven days as they can cause rebound congestion (the symptoms of congestion worsen). They can also cause dryness and irritation in the nasal passage.

If OTC and prescribed treatments do not work then patients can be referred for immunotherapy treatment which exposes the sufferer to the allergen gradually increasing the doses to “train” the immune system to not overact. This helps to reduce the sensitivity to the allergen and can be administered by tablets or injection.