It’s easy to view allergies as irritations that cause nothing more than a bit of sneezing. But the reality for many sufferers means a much more significant impact on their daily lives.

The UK has some of the highest prevalence of allergic conditions in the world, with over 20% of the population affected by one or more allergic disorder. With up to 50% prevalence among children.

So it’s good that pharmacies in the UK are starting to offer allergy services. A comprehensive service may include testing, advice on avoiding triggers as well as offering effective treatments.

According to the EAACI, “Allergy is the most common chronic disease in Europe. Up to 20% of patients with allergies struggle daily with the fear of a possible asthma attack, anaphylactic shock, or even death from an allergic reaction”.

Pharmacy can, therefore, make a difference by helping customers manage their condition and help improve their quality of life.

What is an allergy?

An allergy is an immune response to a substance that is otherwise harmless. This substance, or allergen, triggers the immune system and the response can vary from mild to severe.

According to the NHS website, allergy symptoms include:

• sneezing and an itchy, runny or blocked nose (allergic rhinitis)
• itchy, red, watering eyes (conjunctivitis)
• wheezing, chest tightness, shortness of breath and a cough
• a raised, itchy, red rash (hives)
• swollen lips, tongue, eyes or face
• tummy pain, feeling sick, vomiting or diarrhoea
• dry, red and cracked skin

In an immune reaction, the body produces a chemical called histamine. Histamines are an important part of the body’s first line of defence against pathogens. They trigger responses that help get rid of a pathogen before the pathogen can do any real harm. Vomiting, sneezing, itching and watering of the eyes are all ways to “eject” a potential threat.

But for an allergy, the allergen poses no real danger. However, the body reacts as if the threat were real. And for severe allergies, it is the allergic response that becomes the threat to the individual’s health.

An allergy is not an auto-immune disease. It is an immune response.

What are common allergies in the UK?

Common allergies in the UK include hayfever, allergies to animals, food allergies and sensitivities to moulds and dust mites.

Hayfever

Seasonal allergies include hayfever, where pollen from trees, grasses and some flowers are the allergens. Hayfever starts around March/April and can continue throughout the summer, depending on which plant species an individual is allergic to. 

Around one-third of adults self-report as having hayfever. Typically, more women than men have hayfever with younger adults being more prone to allergies than older adults.

Allergens in the home

Staying indoors to reduce the risk of exposure to pollen doesn’t mean reducing the risk to allergens. In fact, most allergens responsible for unwanted immune reactions can be found at home:

Dust mites

Dust mites are tiny creatures that feed on our dead skin cells.  House dust mite allergy is very common and associated with asthma, eczema and perennial allergic rhinitis. All houses have dust mites and they can be found in beds, carpets and soft furnishings and clothes. So whilst we cannot eliminate them completely, chores like hoovering can help reduce their numbers.

Moulds

Mould spores can trigger immune responses and are particularly troublesome for people with asthma. Mould spores thrive in damp environments so ventilation, i.e. opening the windows, is key. Other symptoms of mould allergies include eczema, itchy/runny noses and itchy eyes.

Pets

Pets are the second most cause of allergies in the home, including all furry animals but also reptiles and birds. Pet allergy is caused by a protein in the pet’s saliva, urine or dead skin particles (dander). Living in the same environment exposes us to this protein often found on animal hair and skin. But pets can also act as carriers for moulds, pollens and mites. Having pet allergies as well as hayfever, asthma or eczema is common.

Food Allergies

Food allergies are not as common as hayfever or pet allergies. But food allergies can be more severe, even life-threatening. The prevalence of food allergies in toddlers is around 5% to 8%, compared to 1% to 2% of adults. The more common food allergies include cow’s milk and nut allergies.

Some people experience reactions to food, such as gluten, making them believe they have an allergy. However, food intolerances and food allergies are not the same.

How pharmacy can help allergy sufferers

Pharmacy is the first healthcare choice for many allergy suffers. And pharmacy is well-placed to offer both great advice and effective treatments for people suffering from various allergies. So, support staff with allergy training can make a real difference to customers.

OTC treatments

Oral antihistamines

The most common form of allergy treatment is over-the-counter oral antihistamines. Typical OTC antihistamines include Cetirizine, Loratidine, Chlorphenamine, and Promethazine. Patients may need to try more than one to find the antihistamine that works best for them.

Corticosteroids

Corticosteroids treat inflammation and swelling caused by the immune reaction. They are available in various forms including nasal sprays and topical creams. For example, asthma inhalers use corticosteroids to treat inflammation in the lungs.

Emollients

Emollients are topical creams and lotions that help treat dry skin and therefore eczema. They work by creating protective barriers on the top layer of skin. This helps to reduce moisture loss and prevents allergens irritating the dry or broken skin.

Taking advice from your pharmacy

Customer-facing pharmacy staff can also discuss different ways of reducing a patient’s exposure to their trigger allergens. These simple changes could include:

• Keeping their homes well ventilated.
• Avoiding the pollen peaks during the evening by staying indoors or closing the windows.
• Regularly changing their bedding or hovering their mattresses.
• Treating damp or areas of mould in their homes.
• Hovering more often, especially where pets sleep.
• Showering or changing their clothes when they come home to reduce pollen coming into the house.
• Monitoring pollen counts issued by the MET Office.

Other Pharmacy Services

Adrenaline Auto-Injectors (AAI)

A sudden increase in high levels of histamine can cause something called anaphylaxis or anaphylactic shock. Anaphylaxis can prevent a person from breathing properly and cause a loss of consciousness, even death. Therefore, to combat anaphylaxis, adrenaline (epinephrine) is given to decrease swelling, ease breathing and to stimulate the heart.

Adrenaline auto-injectors (AAI), more commonly known as epi-pens, administer a dose of adrenaline to someone in anaphylactic shock as an emergency treatment. AAIs are therefore sometimes prescribed to people with severe allergies.

Allergy testing

Pharmacies can now offer more comprehensive allergy services in the form of allergy testing.

With the correct allergy training, skin-prick/patch tests can be performed in consultation rooms. Some allergy tests require blood samples to be sent away for analysis.

If a test proves positive for an allergen, the pharmacy will need a follow-up consultation to discuss the results and discuss a plan of treatment.

Medicines review for multiple allergy sufferers

Asthma often comes with sensitivities to other allergens such as hayfever, mould spores or pets. So, if a customer is visiting with allergy symptoms, its a good moment to discuss whether they also have other allergies or asthma. A medicines review may help identify a better treatment option for that patient. 

Allergies and COVID-19

With the COVID-19 pandemic, people with allergies will be concerned about the impact the virus could have on their health. 

Allergy UK and the Anaphylaxis Campaign have issued a Coronavirus and allergy frequently asked questions (FAQ). They recommend people with hayfever are proactive about minimising their risk such as by reducing the urge to touch the face due to an allergic itch. It’s also important to prevent the unintentional spread of coronavirus by sneezing. 

People with associated asthma need to follow NHS guidance.

Allergy training for your pharmacy team

Getting your pharmacy support staff up to speed on allergies can make a big difference to your customers – especially during hayfever season. Mediapharm offers quick and effective online allergy training for your pharmacy team.

Learn how to engage and confidently advise customers with allergies in just 20 minutes with our allergy e-learning course.

Or, our sign-up to Mediapharm’s Academy and get unlimited access to pharmacy courses including this allergy training course for all your staff for one monthly fee.

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This article was written on behalf of Mediapharm by Nicola Hasted from Pharmacy Mentor.