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SIRCPPK309 Assist customers seeking to relieve common allergic symptom reactions.

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1 SIRCPPK309 Assist customers seeking to relieve common allergic symptom reactions

2 SIRCPPK309 Unit Descriptor This unit describes the performance outcomes, skills and knowledge required to assess customer needs, select and supply relevant products, and advise on self-care practices to relieve common allergic symptom reactions.

3 Allergy Allergies are very common and increasing in Australia and New Zealand, affecting around one in three people at some time in their lives. There are many different causes of allergy and symptoms and vary from mild to potentially life threatening. 3

4 Allergy Allergy is also one of the major factors associated with the cause and persistence of asthma. However, the good news is that for most allergies, effective prevention and treatment options are available.

5 Allergy Allergy occurs when a person's immune system reacts to substances in the environment that are harmless for most people. These substances are known as allergens and are found in house dust mites, pets, pollen, insects, moulds, foods and some medicines. 5

6 Allergy Atopy is the genetic (inherited) tendency to develop allergic diseases. People with atopy are said to be atopic. When atopic people are exposed to allergens they can develop an immune reaction that leads to allergic inflammation (redness and swelling).

7 Pathophysiology What happens when you have an allergic reaction? When your body comes into contact with an allergen, it sets off a chain of events within your cells. Your immune system starts to produce highly specific IgE (immunoglobulin E) which binds to a type of white blood cell called a mast cell. When IgE binds to a mast cell, it causes the mast cell to become activated. Upon activation, the mast cell will release histamine and various other mediators. 7

8 Allergy

9 Histamine release can cause allergic responses such as runny nose, itchy eyes, sneezing and constriction of the muscles in the lungs leading to breathing difficulties.

10 DVD DVD 1 to be shown in class

11 Allergy Causes of allergic reactions Dust mites Pollen Foods such as peanuts, cow's milk, soy, seafood and eggs Cats and other furry or hairy animals such as dogs, horses, rabbits and guinea pigs Insect stings Moulds Some medicines

12 Allergy Similar reactions can occur to some chemicals and food additives, however if they do not involve the immune system, they are known as "adverse reactions" rather than "allergy".

13 Allergy Which areas of the body can be affected? Depending on the allergen and where it enters your body, you may experience different symptoms. For example, pollen, when breathed in through the nose, usually causes symptoms in the nose, eyes, sinuses and throat (allergic rhinitis). 13

14 Allergy Allergy to foods usually causes stomach or bowel problems, and may cause hives (urticaria). Allergic reactions can also involve several parts of the body at the same time.

15 Allergy Which areas of the body can be affected? The nose, eyes, sinuses and throat When allergens are breathed in, the release of histamine causes the lining of your nose to produce lots of mucus and to become swollen and inflamed. It causes your nose to run and itch and violent sneezing may occur. Your eyes may also start to water and you may get a sore throat.

16 Allergy The lungs and chest Asthma can sometimes be triggered during an allergic reaction. When an allergen is breathed in, the lining of the passages in the lungs swells and makes breathing difficult. Not all asthma is caused by allergy, but in many cases allergy plays a part.

17 Allergy The stomach and bowel Most stomach upsets are caused by richness or spiciness in the food itself, rather than an actual allergy. However, foods which are most commonly associated with allergy include peanuts, seafood, dairy products and eggs.

18 Allergy Cow's milk allergy in infants may occur and can cause eczema, asthma, colic and stomach upset. It may also lead to failure to thrive. Some people cannot digest lactose (milk sugar). This intolerance to lactose also causes stomach upsets, but must not be confused with allergy.

19 Allergy Which areas of the body can be affected? The skin Skin problems such as eczema (dry, red, itchy skin) and urticaria (also known as hives) often occur. Hives are white itchy bumps which look and feel like insect bites. Food may be a factor in some cases of hives and eczema 19

20 Allergy Life threatening allergic reactions require immediate treatment Most allergic reactions are mild to moderate, and do not cause major problems, even though for many people they may be a source of extreme irritation and discomfort. However, a small number of people may experience a severe allergic reaction called anaphylaxis. 20

21 Allergy It is a serious condition which requires immediate life-saving medication. Some of the more frequent allergens which may cause this are peanuts, insect stings, drugs and shellfish. If you know that you have a very severe allergy, you should have an Anaphylaxis Management Plan from your doctor, which should include an ASCIA Action Plan for Anaphylaxis

22 Allergy Effective treatment and prevention options Allergen avoidance (or reduction) relies on identifying the cause of your allergy and then taking steps to reduce your exposure to the allergen. For instance, many people are allergic to dust mites, therefore reducing dust mite in the house is important.

23 Allergy Avoiding known allergic triggers is an important part of allergy and asthma management. Allergy testing using skin prick tests or blood tests for allergen specific IgE (RAST) helps your doctor to confirm which allergens you are sensitive to, so that appropriate avoidance advice can be given. 23

24 Allergy Which allergens should be tested for? Allergy testing is usually performed in people with suspected allergic rhinitis (hay fever), asthma or reactions to insects or food allergy. In people with allergic rhinitis or asthma, allergy testing usually includes house dust mite, cat and dog dander (perhaps other animals if contact occurs), mould spores, pollen from relevant grasses, weeds or trees and in some cases, occupational allergens. Testing can also be used to confirm suspected allergies to foods or stinging insects.

25 Allergy It is important to note that: Allergy test results cannot be used on their own and must be considered together with previous and current medical history Medicare rebates are available for skin prick tests or blood tests for allergen specific in Australia In some cases, you may be referred to a medical specialist (Allergist / Clinical Immunologist) for further detailed assessment.

26 Allergy Which allergens should be tested for? It is important to note that: Allergy test results cannot be used on their own and must be considered together with your medical history

27 Allergy Medicare rebates are available for skin prick tests or blood tests for allergen specific in Australia In some cases, you may be referred to a medical specialist (Allergist / Clinical Immunologist) for further detailed assessment. 27

28 Allergy Skin prick tests Skin prick testing is the most convenient and least expensive method of allergy testing. As results are available within 20 minutes, this allows you to discuss the results with your doctor at the time of testing. Skin prick testing has been shown to improve the accuracy of diagnosis in published clinical studies. 28

29 Allergy Skin prick testing is most commonly performed on the forearm, although the back is sometimes used. The arm is first cleaned with alcohol. A drop of commercially produced allergen extract is placed onto a marked area of skin. Using a sterile lancet, a small prick through the drop is made. This allows a small amount of allergen to enter the skin. 29

30 Allergy If you are allergic to the tested allergen, a small lump (wheal) will appear at the site of testing over minutes. 30

31 Allergy 31

32 Allergy Skin prick tests are slightly uncomfortable, but are usually well tolerated, even by small children. Local itch and swelling normally subside within 1-2 hours. More prolonged or severe swelling may be treated with an oral antihistamine, topical corticosteroid cream and an ice pack. Occasionally people will experience feel dizzy or light-headed and need to lie down. Severe allergic reactions from allergy testing in asthma or allergic rhinitis (hay fever) are very rare. 32

33 Allergy Skin prick testing should only be performed by a health professional who has been trained in the procedure, and who knows how to interpret the results. A doctor with knowledge of the management of acute allergic reactions should be present, to select the allergens, interpret the results and have access to resuscitation facilities in the case of an emergency. 33

34 Allergy Skin prick testing should only be performed by a health professional who has been trained in the procedure, and who knows how to interpret the results. A doctor with knowledge of the management of acute allergic reactions should be present, to select the allergens, interpret the results and have access to resuscitation facilities in the case of an emergency. 34

35 Allergy Medications with antihistamine like actions (such as antihistamine tablets, some cold remedies and antidepressants) should not be taken for 3-7 days before testing as these will interfere with the results of testing. You may also be advised to avoid creams and moisturisers on your forearms for a similar period of time to reduce the likelihood that allergen extracts will run into each other. 35

36 Allergy Skin prick testing is not a reliable way of confirming suspected reactions to aspirin or food additives, and you will need to discuss such concerns with your doctor. 36

37 Allergy Patch Testing Patch testing is useful for testing for contact allergic dermatitis, such as that triggered by nickel metal, cosmetic preservatives or various plants. Using hypoallergenic tape, commercial standardised allergen paste is applied to a rash free area of skin, most commonly the back. 37

38 Allergy The tapes are normally left in place for 48 hours and kept dry for the entire time. The test site is then read at different time intervals. An eczema-like rash can indicate sensitivity to a particular allergen.

39 Allergy

40

41 Alternative skin testing methods Alternative skin testing methods such as scratch testing have generally been abandoned because of greater patient discomfort. Whilst it is not widely used in Australia and New Zealand, intradermal skin testing is sometimes used to test for allergies to antibiotic drugs or stinging insects, when greater sensitivity is needed. 41

42 Allergy Blood tests for specific allergy Immunoglobulin E (IgE) antibodies directed against specific allergens can be measured with a blood test, commonly referred to as RAST tests. RAST was the abbreviation for the original name of the technology (RadioAllergoSorbent Test). 42

43 Allergy These tests are often performed when skin testing is not easily available, when skin conditions such as severe eczema exist, or when a person is taking medications (such as antihistamines) that interfere with accurate testing 43

44 Allergy Total IgE Testing Meaurement of total IgE antibodies can be estimated from a blood sample. Total IgE is often, but not always raised in people with allergies. High IgE antibody levels are also found in people with parasite infections, eczema and some rare conditions. 44

45 Allergy High IgE levels do not prove that symptoms are due to allergy, and a normal IgE level does not exclude allergy. Therefore, measuring total IgE levels has a limited role to play in allergy testing. 45

46 Allergy Eosinophil counts Eosinophils are specialised white blood cells that are designed to kill worms and parasites. They can also cause inflammation in the tissues in allergy. High levels are sometimes seen in blood samples from people with allergic rhinitis (hay fever), asthma and eczema, as well as in a number of less common conditions.

47 Allergy However, a high eosinophil count does not prove that symptoms are due to allergy, and a normal eosinophil count does not exclude allergy. Therefore measuring eosinophil counts has a limited role to play in allergy testing.

48 Allergy Unproven Methods There are several methods that claim to test for allergy. These include cytotoxic food testing, kinesiology, Vega testing, electro dermal testing, pulse testing, reflexology and hair analysis.

49 Allergy These tests have not been scientifically validated and may lead you to take unnecessary, costly and (in the case of some changes in diet) dangerous avoidance strategies. No Medicare rebate is available in Australia for these tests and the use of these methods is not advised 49

50 Allergy Allergy Avoidance Allergies are very common in Australia and New Zealand, affecting around one in three people at some time in their lives. There are many different allergic conditions, with symptoms ranging from mild hay fever (allergic rhinitis) to potentially life threatening anaphylaxis. Allergy is also one of the major factors associated with the cause and persistence of asthma.

51 Allergy Identifying causes which you can avoid or minimise exposure to, is an essential part of treating allergic diseases. Once the causes are correctly identified, then the following practical advice on avoiding or minimizing your exposure to allergens should help. 51

52 DVD DVD 2 to be shown in class

53 Allergy House Dust Mites The house dust mite is the most common allergen source in humid towns and cities and there is no easy way of removing it. Regardless of what advertisements may say, there is no vacuum cleaner, dust mite spray or dry cleaning that will completely eliminate the dust mite.

54 Allergy House dust mites can trigger respiratory or dermatological conditions including asthma and eczema. Symptoms can include: Wheezing Coughing Breathlessness A tight feeling in the chest Runny nose

55 Allergy Itchy nose Itchy eyes Itchy skin Skin rashes The allergic reaction Unlike other common household bugs (fleas, for example), dust mites don’t bite. Their bodies, secretions and faeces contain particular proteins that can trigger allergic symptoms in susceptible people

56 Allergy Common hiding spots The diet of the house dust mite includes shed skin flakes, pollen and fungal spores. It prefers warm, humid and dark environments. Common hiding spots around the home include: Mattresses and bed linen Upholstered furniture Shag-pile or long-fibred carpets Soft toys.

57 Allergy Diagnosis and treatment for dust mite allergies Allergy testing can find out whether house dust mites trigger your respiratory or dermatological symptoms. See your doctor for further information and advice.

58 Allergy If tests show that you are allergic to house dust mites, there are ways to reduce your immune system response. For example, you could undergo immunotherapy, which involves deliberately exposing you to dust mite extracts to ‘train’ your immune system not to overreact. Measures designed to reduce your household’s dust mite population may also be helpful.

59 Allergy Self care Depending on the severity of symptoms, and in the case of childhood asthma, eczema, chronic or recurrent sinusitis and middle ear infections with dust mite as a provoking trigger, the following advice may help. The first room to tackle is the bedroom and in particular the bedding, where we spend the greatest number of consecutive hours. 59

60 Allergy A combination of the following 4 measures is recommended: Wash sheets and pillow cases weekly in water hotter than 55 o C. This will kill dust mites and wash away the allergen they produce. If you cannot wash in hot water, use a commercial product containing essential oils such as tea tree or eucalyptus oils, formulated to kill dust mites in cold water.

61 Allergy If washing normally, hot tumble drying of washed items for 10 minutes after they are dry will kill mites. Dry cleaning is not as effective as it will kill house dust mites but won't remove the allergen they produce. 61

62 Allergy Remove sheepskin or woolen underlays. Remove all soft toys from the bed and bedroom. Replace them with wooden or plastic toys which can be washed. If a soft toy is allowed it should be hot washed weekly. Freezing soft toys overnight kills mites but doesn't remove allergen.

63 Allergy The following advice can be applied to bedrooms and other rooms of the house If possible, consider replacing carpets with hard floors such as wood, tiles, linoleum, concrete, where practical and affordable. Carpets can contain large amounts of house dust mite and animal allergens which cannot be completely removed by vacuuming. In general, dust mite levels are higher in more humid areas like the coast than in drier inland areas.

64 Allergy Vacuum carpets weekly. However, vacuuming increases the amount of house dust mite allergen in the air for up to 20 minutes. So if possible, ask someone else to do the vacuuming and wait for 20 minutes before re-entering the room. High efficiency particulate air (HEPA) filter vacuum cleaners may remove more allergen than other vacuum cleaners. Unfortunately, they still temporarily increase the amount of dust mite allergen in the air.

65 Allergy Reduce humidity - Have a dry and well ventilated house, adequate floor and wall insulation. Avoid using evaporative coolers (water cooled air conditioners) and gas heaters, as these both release water into the air and can increase indoor dust mite and mould levels. Windows - Venetian blinds or flat blinds are easier to clean than heavy curtains. Washable curtains or external shutters are other options.

66 House Dust mites Companion Products Cover mattress, pillow and quilt with dust mite resistant covers. Suppliers include Allergend, Allerseach and Mite guard. Some health funds may provide a rebate for the purchase of these items. The covers must be washed every 2 months. If covers are not available, wash blankets and non- encased washable doonas every 3 months in hot water. 66

67 Allergy Consider house dust mite avoidance measures when building a new home. Damp dust or use electrostatic cloths to clean hard surfaces (including hard floors) weekly.

68 Pollen Allergy In Australia and New Zealand the height of the grass pollen season occurs between late September and Christmas and the major amount of pollen in the air usually occurs between 6.00 am and noon. Depending on the weather patterns, there may be an increase of pollen in the early hours of the morning. 68

69 Pollen Allergy Although pollen is known to be blown long distances on windy days, most pollen is deposited within a short distance of its source. The highest pollen counts occur on calm, hot, sunny days in late October, November and December, although in Queensland the season is different and January is a particularly bad month.

70 Pollen Allergy Pollen allergy in tropical areas mainly occurs during the dry season. However, thunderstorms can also cause problems. When pollen granules come into contact with water, starch granules are released that are small enough to be breathed into the airways, triggering hay fever (allergic rhinitis) and asthma in some people.

71 Pollen Allergy Avoidance of pollen is difficult but the following advice may help: Remain indoors (when possible) during pollen seasons, on windy days or after thunderstorms Avoid activities known to cause exposure to pollen, such as mowing grass 71

72 Pollen Allergy Shower after activities where there is high exposure to pollen Use re-circulated air in the car when pollen levels are high Seek advice from your pharmacist or doctor about medications or treatments that will relieve your symptoms.

73 Pollen Allergy Pollen from grasses, weeds or trees can trigger symptoms of allergic rhinitis (hay fever) and asthma. Pollen seasons can last for several months and exposure is difficult to avoid. However, there are simple ways to prevent or reduce symptoms.

74 Pollen Allergy What is pollen? The word pollen is derived from the Greek word meaning 'fine flour'. The role of the pollen grain is to fertilise the female flower to reproduce plant species. Some plants (such as flowering plants, including wattle) produce small amounts of pollen which are distributed by birds and bees from one plant to another.

75 Pollen Allergy Other plants (such as pasture grasses and weeds) rely on the wind to disperse their pollen. These pollen are produced in vast quantities, blow long distances and cause allergies in people, even if they live a long way from the source 75

76 Pollen Allergy Most of the troublesome pollen is produced by airborne Northern Hemisphere grass, tree and weed pollen. Improved pasture grasses are more allergenic than Australian native grasses. Pollen from exotic trees, which are planted for their autumn colours, is more allergenic than pollen from Australian trees. 76

77 Pollen Allergy A number of weeds with highly allergenic pollen have also been introduced, including: Pellitory weed (commonly known as 'asthma weed') was accidentally introduced in a shipload of marble from Italy in the early 1900s. It is mainly found in Sydney. 77

78 Pollen Allergy Paterson's Curse (Echium plantagineum) is an attractive flowering plant that was deliberately brought from England in the late 1800's by Dr Paterson. This plant has taken over large tracts of pasture in rural Australia and produces highly allergenic pollen. 78

79 Pollen Allergy Ragweed and Parthenium weed were introduced in pasture seed imported from the United States. They have spread throughout Queensland and northern New South Wales. 79

80 Hayfever The correct name for hay fever is 'seasonal allergic rhinitis'. Even though it was known that pollen rather than hay was the cause as far back as the early 1800's, the term 'hay fever' is still frequently used. 80

81 Hayfever Hay fever is the common name for a condition called allergic rhinitis, which means an allergy that affects the nose. Most people associate hay fever with spring, when airborne pollens from grasses are at their peak. However, hay fever can occur at any time of the year. This is known as perennial allergic rhinitis, which is usually caused by a reaction to allergens around the home, such as dust mites, moulds or animal hair or fur. 81

82 Hayfever 82

83 Hayfever Signs & Symptoms Sneezing A runny or stuffy nose Itchy ears, nose and throat Red, itchy or watery eyes Headaches 83

84 Hayfever 84

85 Hayfever Refer to the pharmacist if the customer: Is pregnant or breastfeeding Is experiencing high temperatures, severe body aches and pains, thick green mucosal discharge and or sinus pain Is taking other medications Has a medical condition 85

86 Hayfever Is elderly (over 70yrs ) or very young (under 12months) Is allergic to any medicines, supplements or food Wears contact lenses – when recommending eye drops Has tried ‘everything’ but nothing works 86

87 Hayfever Treatment Less-sedating antihistamines These are medicines which inhibit the action of histamine in the body therefore eliminating the symptoms of hay fever and allergy. These are usually non-drowsy although some people may experience drowsiness with taking some medications in this class (particularly with Zyrtec).

88 Hayfever

89 Handout Handout 1 to be given to students

90 Hayfever Advise customers to avoid driving or operating machinery if this occurs. Less-sedating antihistamines are Schedule 2 – pharmacy medicine and can be purchased over the counter. (For example, Telfast, Zyrtec and Claratyne)

91 Hayfever Sedating antihistamines These are medicines which inhibit the action of histamine in the body therefore eliminating the symptoms of hay fever and allergy. As these are of an older generation of medicines, they will usually cause drowsiness and can also affect the rate of learning in children

92 Hayfever Many sedating antihistamines are in Schedule 3 (Pharmacist Only Medicine) therefore it is necessary to get the pharmacist’s advice before recommending and selling these products. (For example, Polaramine, Phenergan)

93 Nasal Sprays The different types of nasal sprays Decongestant nasal sprays Antihistamine nasal sprays Corticosteroid nasal sprays

94 Hayfever Decongestants These products can come in the form of tablets, nasal sprays and eye drops. They work to constrict the blood vessels supplying the area (for example in the eye for eye drops, in the nose for nasal sprays) and therefore reducing congestion.

95 Topical Decongestant Sprays Xylometazoline 1mg/ml Contains Benzalkonium chloride as a preservative

96 Topical Decongestant Sprays Acts quickly to relieve a blocked or runny nose caused by colds,flu,sinusitis or hay fever It works by narrowing the blood vessels in the nose area, reducing swelling and congestion Caution: Temporary stinging sensation, sneezing may occur and rebound congestion can occur if used more often than 3 days at a time

97 Topical Antihistamine Nasal Sprays Azep Nasal Spray Active ingredient :Azelastine 0.1%w/v

98 Topical Antihistamine Nasal Sprays Features Fast onset – works within 15 minutes Long duration -­‐ lasts up to 12 hours Fast relief of hayfever symptoms: Sneezing Itchy eyes Blocked and runny nose

99 Topical Antihistamine Nasal Sprays Non-­‐drowsy active ingredient Can be used continuously for up to 6 months Drink a flavoured drink after instillation to help remove any bitter aftertaste.

100 Topical Corticosteroid Nasal Sprays Mometasone furoate 50mcg/spray

101 Topical Corticosteroid Nasal Sprays Features and benefits Convenient once daily dose Helps treat nasal symptoms of both seasonal (outdoor) and year round (indoor) allergic rhinitis such as sneezing, congestion, itchy and runny nose

102 Topical Corticosteroid Nasal Sprays Regular use helps with overall effectiveness. Maximum treatment benefit is after 1-­‐2 weeks regular use Potential side effects: Nose bleeds, infections or nose and throat Non drowsy 24 hours relief

103 Topical Corticosteroid Nasal Sprays Directions for use For Adults and Children 12 years and over: Instil one spray into the affected nostril(s)once daily Use spray around the same time each day. Do not skip days. Regular daily use can keep symptoms under control.

104 Topical Nasal Sprays Flixonase Allergy Nasal Spray (was formerly known as Beconase Allergy24hr spray) Active ingredient: Fluticasone propionate

105 Topical Nasal Sprays For the short-­‐term(3-­‐6months)prevention of hayfever and other allergies. Not recommended in pregnancy or breastfeeding Convenient once daily spray Non drowsy For adults and children aged 12 and over: Instil two sprays into each nostril once daily, preferably in the morning.

106 Topical Nasal Sprays Side effects: Nosebleed, dryness and irritation in nose or throat

107 Hayfever Although these products are rather effective, decongestant sprays and drops should not be used for more than 5 consecutive days. This is because prolonged use of these products (tablet form excluded) can cause ‘rebound’ congestion whereby stopping the use of product earlier than 5 days causes the symptoms to redevelop worse than when they started. (For example, Dimetapp 12 hour nasal spray)

108 Hayfever Topical corticosteroids These products come in the inhaled, intranasal and topical cream form. They have an anti-inflammatory effect and work to subdue the immune response when contact with an allergen occurs. They are very safe and effective for people whose symptoms cannot be controlled by oral antihistamines alone.

109 Hayfever These are available over the counter and can also be purchased in a higher strength when a prescription from the doctor is presented. (For example Sudafed nasal spray)

110 Hayfever Immunotherapy – some people may benefit from immunotherapy, which exposes a person to increasing amounts of an allergen to improve tolerance and reduce symptoms. This therapy may help hay fever and some cases of asthma, but does not help food allergy. It should only be conducted under medical supervision as exposure to allergens can be dangerous and potentially life threatening 110

111 Rhinocort 111

112 What is Rhinocort Hayfever Rhinocort Hay fever is a non-drowsy once daily treatment for the prevention and relief of hay fever. It is an intranasal corticosteroid (INCS) nasal spray with the active ingredient budesonide and is an S2 medication Rhinocort Hay fever contains 32mcg of budesonide per activation Available as a 60 dose starter pack or a 120 dose economy pack 112

113 Rhinocort How does Rhinocort Hay fever Work? INCS are effective medications for controlling the range of hay fever symptoms including sneezing, itching, a runny nose, eye symptoms and nasal blockage. Rhinocort Hayfever works by reducing and controlling the inflammation that causes nasal blockage and other symptoms of hay fever. 113

114 Rhinocort Rhinocort Hayfever therefore treats, and when used early enough, can prevent symptoms. Other types of hay fever medicines, such as antihistamines, only treat the symptoms

115 Rhinocort How quickly will Rhinocort Hayfever work? Some symptoms, such as a blocked nose, can start to disappear in 3 hours, however it can take up to 2-3 days for the maximum effect of Rhinocort Hayfever to be achieved. Continuing to take antihistamines during this transition period may offer further relief 115

116 Rhinocort Take Rhinocort before hay fever starts Taking Rhinocort Hayfever 1-2 weeks before you are exposed to allergens that can trigger your hayfever (for example before the start of the pollen season) can prevent hay fever symptoms from developing. It also prevents the lining of the nose from becoming hyper reactive – extra sensitive to allergens 116

117 Preventative Use 117

118 Rhinocort How much Rhinocort should I use? Rhinocort Hayfever should be used daily for the treatment and prevention of hayfever symptoms. The starting dose is up to FOUR sprays in EACH nostril daily (8 sprays). You can take these sprays all in the morning, or TWO sprays in the morning and TWO sprays in the evening 118

119 Rhinocort Do not exceed the recommended dose of EIGHT sprays per day After the symptoms have improved you should gradually reduce the number of sprays you put into each nostril to the lowest number that controls your symptoms. This might be one spray into each nostril in the morning

120 Rhinocort StageDose Treatment2-4 sprays in each nostril daily Maintenance1-2 sprays in each nostril daily 120

121 Nasal Sprays How to administer nasal sprays Blow your nose gently to clear out mucus and to create a clear passageway for the nasal spray. Shake the nasal spray bottle and remove the cap. Tilt your head slightly forward. Exhale slowly.

122 Nasal Sprays Hold the spray bottle securely in your hand, and insert the end of the pump into your nostril. The tip of the pump should point up and slightly outward, not toward the center of your nose. Use a finger on your free hand to close the other nostril. Breathe in slowly while squeezing the spray pump. Repeat in other nostril.

123 Hayfever Self Care Stay indoors as much as possible in spring, on windy days or after thunderstorms. In the garden, choose plants that are pollinated by birds or insects, rather than plants that release their seeds into the air. Replace the lawn with bricked or paved areas.

124 Hayfever Avoid allergens such as: dust and dust mites, animals and animal hair or fur (dander). Avoid carpet or large area rugs as the fibres hold onto dust, mites, dander and pollen. (Tile and wooden floors are better) Wash bedding frequently to eliminate dust mites getting into mattresses and pillows. Make sure pillows and mattresses are in allergen- impermeable casings

125 Hayfever Smear petroleum jelly (like Vaseline) inside the nose to stop the pollen from touching the lining of the nose. Wear a dust mask when cleaning Keep pets outside of the house and away from bedrooms Use a vacuum cleaner with HEPA (High-efficiency particulate air) filters

126 Hayfever Companion products Cover mattress, pillow and quilt with dust mite resistant covers Tissues Saline sprays Humidifiers

127 Allergic Conjunctivitis The four main types of allergic conjunctivitis are: Seasonal conjunctivitis: typically caused by an allergy to pollen Perennial conjunctivitis: usually caused by an allergy to dust mites or pets

128 Allergic Conjunctivitis Contact dermato conjunctivitis: usually caused by an allergy to eye drops or cosmetics Giant papillary conjunctivitis: usually caused by an allergy to contact lenses

129 Eye Drops Allergy eye drops are liquid medicines used to treat symptoms of eye allergies. Eye allergy symptoms include: Burning of the eye Feeling like something is in the eye Itchy eyes Red (bloodshot) eyes Swelling of the eyelid Tearing

130 Eye Drops An eye allergy is linked to the same kinds of triggers that cause hay fever, such as: Pollen Dust Pet dander Eye allergies may also be triggered by certain medications or by wearing contact lenses

131 Eye Drops Which type of allergy eye drop you use depends on: The cause of your allergy Your specific symptoms How much the symptoms affect daily activities

132 Eye Drops Not all allergy eye drops treat all allergy symptoms. For example, an eye drop that relieves red (bloodshot) eyes may not stop the itching. There are many different types of allergy eye drops. Some are sold over the counter while others require a prescription from a doctor. Some relieve symptoms quickly. Others provide long-term relief.

133 Eye Drops The types of allergy eye drops include: Antihistamine Anti-inflammatory Decongestant Mast cell stabilizers Multiple action

134 Eye Drops Antihistamine Allergy Eye drops If you have itchy, watery eyes, antihistamine eye drops may make you feel better. These medicines block histamine buildup in the body. Histamine is a chemical made by your immune system when you come in contact with an allergy trigger. It causes many of your allergy symptoms.

135 Eye Drops Antihistamine eyedrops are usually recommended as the first treatment for eye allergies after you have tried non-drug methods at home. Antihistamine eyedrops can quickly relieve eye allergy symptoms. But relief may only last for a few hours. You may need to use the drops several times a day.

136 Eye Drops Anti-inflammatory Allergy Eye drops Anti-inflammatory eye drops fall into two groups: Non steroidal anti-inflammatory drugs (NSAIDs) Corticosteroids

137 Eye Drops NSAID eyedrops affect certain nerve endings. They change the way your body makes you feel itchy. Acular/Acuvail (ketorolac) is the only NSAID approved for the treatment of itchy eyes. Itching usually starts to go away about one hour after using the eyedrops. These eyedrops often cause stinging or burning when first placed in the eyes.

138 Eye Drops Corticosteroid eyedrops are used to treat severe, long-term eye allergy symptoms. Prescription steroid eyedrops include Alrex and Lotemax (loteprednol). Because of possible side effects, corticosteroid drops are not generally recommended for long- term use, except for the most severe allergic eye conditions.

139 Eye Drops When you are using corticosteroid eye drops, you should have regular checkups with an eye specialist to monitor your eye health. Corticosteroid eye drops can raise your risk for: Cataracts Eye infection Glaucoma-Increased pressure in the eye (elevated intraocular pressure

140 Eye Drops Decongestant Allergy Eye drops Decongestant eye drops can quickly brighten the whites of your eyes and reduce eye redness for a short amount of time. Such medicines are also called vasoconstrictors. They work by narrowing blood vessels in the eye area. This relieves the red, bloodshot appearance of the eyes.

141 Eye Drops Examples of over-the-counter decongestant eye drops are: Clear Eyes (naphazoline HCL) Refresh (phenylephrine HCL) Visine (tetrahydrozoline HCL, oxymetazoline HCL)

142 Eye Drops Decongestant eye drops come with some risks. Long-term use can actually make your eye problem worse. "Rebound redness" is a common problem in people who use decongestant drops for a long time. Redness and eye swelling can continue even when you stop using the drops. Decongestant (vasoconstrictor) eyedrops should never be used by people with glaucoma.

143 Eye Drops Mast Cell Stabilizer Allergy Eye drops Mast cell stabilizers are among the newest type of eye drops. They target events in the body that lead to allergy symptoms. The medicine helps prevent the release of histamine and other chemicals made by your body during an allergic reaction.

144 Eye Drops Mast cell stabilizers do not provide immediate relief of eye allergy symptoms. Instead, they are used to prevent eye allergy symptoms in people with known allergies, including seasonal allergic conjunctivitis. Customer can use these drops for many months without any side effects. Mast cell stabilizers have been shown to help contact lens users wear their lenses for longer periods of time.

145 Eye Drops Over-the-counter mast cell stabilizer drops include: Claritin Eye (ketotifen fumarate) Refresh Eye Itch Relief (ketotifen fumarate)

146 Eye Drops Multiple-Action Allergy Eye drops Some eye drops contain more than one type of active ingredient. These are called dual-action or multiple-action eye drops. Antihistamine/decongestant combination eye drops reduce eye itching, watery eyes, and redness.

147 Eye Drops Examples include: Opcon-A and Naphcon-A (pheniramine maleate/naphazoline HCL) Vasocon-A (antazoline phosphate/naphazoline HCL)

148 Eye Drops Antihistamine/mast cell stabilizer combination eyed rops treat and prevent: eye itching redness tearing burning

149 Eye Drops Side Effects and Risks of Allergy Eyedrops All medicine comes with some risk. Make sure you follow the recommended instructions when using eye drops. You should not use over-the-counter eye drops for more than two to three days. Long-term use of certain eye drops can actually make your eye symptoms worse.

150 Eye Drops You should not use eye drops if you have an eye infection or glaucoma. Some eye drops may sting or burn when you place them in your eyes. Storing the eye drops in the refrigerator may help reduce such discomfort.

151 Eye Drops Self Care Advise Many eye drops cannot be used while wearing contact lenses Remove your lenses before using the drops and waiting at least 10 minutes before reinserting them. Do not rub your eyes, even though your eyes may be itchy. Rubbing them can make your symptoms worse.

152 Eye Drops Place a cool compress over your eyes. Wetting a flannel with cool water and holding it over your eyes will help ease your symptoms. Avoid exposure to the allergen, if possible.

153 Allergic Conjunctivitis Companion Products Saline eye wash Sunglasses Eye wipes

154 Allergic Conjunctivitis Pharmacist referral situations Contact lens wearers Child or older person Pain or altered vision Glaucoma or any other eye condition Pus or clear discharge from the eye Pregnant or breastfeeding

155 Handout Handout 2 to be given to students

156 Allergy Other Causes Pets can be a major source of allergens in the home Exposure to pets (such as cats, dogs, guinea pigs, horses, rabbits, mice, rats) at home or work can trigger allergic reactions in some people. 156

157 Allergy Cats and dogs are a major source of allergens in the home environment. The allergens come from the sweat glands in all cats and salivary glands in all dogs. Although the amount of allergen released can vary between breeds, there are no hypoallergenic animals or breeds.

158 Allergy As allergens are stuck to the hair and skin of pets, the allergens become airborne when the pet sheds their hair. The allergens can remain airborne for some time. Cat allergen is especially difficult to remove from houses. It can remain in the house for months after the cat is removed. Cat allergen can be found in places where cats have never lived. For example, it can be carried around on clothing to schools and offices.

159 Allergy The most effective method of allergen avoidance for people who are allergic to pets is removal of the pets from the home. For example, if there is no doubt that cat or other animal allergen is a major cause of symptoms then the best advice is for the animal to be removed from the home. It can be an emotional decision, but health should be a priority.

160 Allergy If pets cause only minor problems, keeping pets out of bedrooms and living areas may be a compromise. Even then, it may take months after pet removal before allergen levels are reduced. The effectiveness of some measures such as washing animals frequently and using HEPA air filters remains uncertain.

161 Allergy Dogs, guinea pigs, mice and rabbits are not as allergenic as cats and are more easily kept outside, but can still cause annoying and occasionally serious problems. Horse allergy is very serious and even animal hair on clothes may be sufficient to trigger asthma.

162 Allergy Great care must be taken to shower and change clothes before returning to a home of a person allergic to horses. Birds may occasionally cause allergic symptoms. This is a different problem to pigeon fancier's lung which is a serious condition and requires complete avoidance.

163 Allergy Mould in the home can show as mould, mildew or a musty smell. It is commonly found in bathrooms, refrigerators and in places with little air circulation such as walk-in and built-in wardrobes, and in bedrooms with ensuite bathrooms. If you are allergic to mould, you may consider: Removing visible mould by cleaning with bleach or other mould reduction cleaners

164 Allergy Ensuring adequate natural ventilation including the use of extractor fans sealing leaks in bathrooms and roofs Clearing overflowing gutters and blocked under floor vents Removing indoor pot plants (which promote mould growth) Drying or removing wet carpets Not working with garden compost or mulch

165 Pet Allergy Allergies to pets, particularly to cats and dogs, are a common cause of allergic disease, including asthma and allergic rhinitis (hay fever).

166 Pet Allergy The main source of cat allergen is in the sebaceous glands in the cat's skin Cats often lick themselves and as the main source of cat allergen is in the sebaceous glands, the licking helps spread the allergen. Cat allergen is sticky, and glues itself to hairs, dust particles (forming a persistent aerosol) and all parts of the home. As all cats have sebaceous glands, all cat breeds can potentially cause allergies.

167 Pet Allergy Even after removal of the pet, cat allergen can remain distributed throughout the home for up to 6 months and in the cat's bedding for up to 4 years. The allergen is so pervasive that it can even be measured in the homes of non-pet owners and on the clothing of co-workers who don't have pets. Cat allergen has even been detected in the Antarctic, even though cats have never been there. 167

168 Pet Allergy In dogs the main source of allergen is saliva As the main source of dog allergen is saliva, dander (shed skin particles) and hair can both help spread the allergen. Therefore all breeds of dog can potentially cause allergies, although some may not shed as much hair and dander (and therefore allergen) as others. 168

169 Pet Allergy Allergies to other animals Although not as common as cat and dog allergy, allergies to other animals including horses, mice, rats, rabbits, guinea pigs and birds are important. Transmission of these allergens on clothes and other items may be sufficient to trigger allergic rhinitis (hay fever) and asthma. 169

170 Pet Allergy Testing for allergies to animals It is important to note that up to 50% of people who are allergic to animals do not get immediate symptoms. If there is some doubt as to whether a pet is causing your allergy symptoms, your doctor can confirm your suspicion using skin prick tests or allergen specific IgE (RAST) allergy tests. You may be referred to a medical specialist (Allergist / Clinical Immunologist) for allergy testing. 170

171 Pet Allergy In children a negative allergy test does not mean that a child won't become allergic to pets later. Some studies have suggested that increased exposure to cats and dogs may be associated with reduced sensitisation and allergic disease, whilst other studies have found that increased exposure is associated with increased sensitivity. 171

172 Pet Allergy What can be done to prevent a pet allergy? Changes that are simple to implement and have been proven to be effective are as follows: Do not bring a furred pet into the home Find an existing pet a new home Do not smoke, as exposure to environmental smoke makes A range of allergies (including pet allergies) more likely to develop. 172

173 Pet Allergy Changes that are difficult to implement or have not yet been proven are as follows: Restrict the pet to one area Keep the pet out of the patient's bedroom Use high efficiency air cleaners, either central or portable Remove carpet or other reservoirs for allergens in the bedroom Wash pets weekly. 173

174 Asthma and Allergy Allergy plays an important role in asthma, as one of the major factors associated with the cause and persistence of asthma. Around 8 in 10 people with asthma have positive allergy test results. Allergy and asthma are very common 174

175 Asthma and Allergy Allergy is very common in Australia and New Zealand, affecting around 4 in 10 people. Asthma is also common - affecting around 1 in 4 children, 1 in 7 teenagers and 1 in 10 adults. Globally, the prevalence of allergy is continuing to increase, particularly in developed countries, such as Australia and New Zealand. 175

176 Asthma and Allergy People with asthma experience a narrowing of the airways in the lungs, which obstructs the flow of air into and out of the lungs. This narrowing can be reversed using medications and people with asthma can therefore lead normal, active lives if they take regular preventer medication

177 Asthma and Allergy Asthma is most easily recognised by the following symptoms: Wheezing when breathing out A persistent irritable cough, especially at night Difficulty in breathing and shortness of breath Tightness and heaviness in the chest Wheezing or coughing with exercise (exercise induced asthma).

178 Asthma and Allergy Triggers for asthma include Allergens Infections Exercise Cold air Changes in temperature and cigarette smoke.

179 Asthma and Allergy How does allergy play a role in asthma? There are two main ways in which allergy plays an important role in asthma: Allergy itself can produce the allergic inflammation in the airways Exposure to one or more allergens can trigger an asthma attack.

180 Asthma and Allergy Effective management/Self care advice for asthma involves Control of allergy It is essential to determine if allergies are an important factor in your asthma. If you can reduce the amount of causative allergen/s to which you are exposed, your asthma will improve. Once you suspect that certain substances will cause an allergic reaction, you should obviously try and avoid, remove or minimise exposure to the offending allergen(s) whenever possible. 180

181 Asthma and Allergy Medication for asthma and allergy People with asthma should have a regularly reviewed ASTHMA ACTION PLAN, developed in consultation with their doctor, including asthma medications (preventers and relievers) and how these may need to be increased or decreased. If you have asthma and untreated allergic rhinitis (hay fever), it can be more difficult to control asthma symptoms. 181

182 Asthma and Allergy NASAL CORTICOSTEROIDS are the most effective long term medication for allergic rhinitis (hay fever). Like preventer medication for asthma they need to be used each day to be effective, in controlling asthma and lessening the need for asthma medication. 182

183 Asthma and Allergy NON-SEDATING ANTIHISTAMINES are used to treat allergic rhinitis (hay fever) symptoms and are safe for people with asthma. MEDICATIONS WHICH CAN CAUSE PROBLEMS for people with asthma include aspirin, non- steroidal anti-inflammatory medicines and beta blockers. 183

184 Asthma and Allergy Some ‘natural' treatments such as Echinacea and royal jelly can cause life threatening allergic reactions (anaphylaxis) in some people with asthma. It is important to advise your pharmacist and doctor of any medications or ‘natural' treatments you are taking 184

185 Asthma and Allergy Allergy and Asthma Prevention If a parent has allergies and/or asthma their children have a higher risk of developing allergies and/or asthma. Although effective treatments are available it makes sense to try to prevent allergies and asthma from developing. 185

186 Asthma and Allergy Based on current evidence, the following suggestions can be provided: Breastfeeding: Where possible, breast feed your child for at least the first 6 months of life. If it isn't possible to breastfeed, a partially hydrolysed (hypo-allergenic) formula rather than conventional cow's milk formula is recommended in the first 6 months of life. 186

187 Asthma and Allergy Smoking: Do not smoke during pregnancy, in the presence of the child or in enclosed spaces where the child will sleep or play. Even if you carry out these suggestions you may not be able to prevent children from developing allergies 187

188 Asthma and Allergy Common myths about allergies and asthma exposed Allergies and asthma are very common in Australia and New Zealand. Around 1 in 3 people will develop allergies some time during their life, and about 1 in 10 will develop asthma. 188

189 Asthma and Allergy Far from being a trivial inconvenience, allergies have a significant impact on quality of life and are associated with medical. Some allergies are even life threatening. Unfortunately, many people confuse myth with reality in the way they view and treat allergies and asthma. 189

190 Asthma and Allergy Common myths about allergies and asthma exposed Myth 1 Allergies are uncommon Reality: The frequency of allergic disease has approximately doubled in the past few decades. In Australia and New Zealand, around: 1 in 3 people will develop allergies at some time during life; 1 in 5 will develop atopic dermatitis; 190

191 Asthma and Allergy 1 in 6 will have an attack of hives (urticaria); 1 in 10 people have asthma; 1 in 20 will develop a food allergy (usually transient); and 1 in 100 will have a life-threatening allergy known as anaphylaxis. 191

192 Asthma and Allergy Myth 2 Allergies are harmless Reality: Allergies are a serious problem in Australia and should not be ignored. Untreated allergies have a significant impact on quality of life. Allergic rhinitis (hayfever) for example, results in poor quality sleep, fatigue and daytime sleepiness. Adults find it harder to think and function at work, suffer from greater absenteeism and more work- related injury. They are more irritable and moody than healthier people and find it harder to make important decisions. 192

193 Asthma and Allergy School-aged children with allergic rhinitis can do poorly in examinations and often cannot recall information taught during class. Untreated allergies can also worsen other chronic respiratory problems such as asthma, sinusitis and skin disorders such as eczema and urticaria (hives). Some allergies to foods, drugs and insect stings can lead to a potentially life threatening reaction called anaphylaxis - a systemic allergic reaction which can be fatal, and leads to the death of 10 to 20 Australians each year. 193

194 Asthma and Allergy Myth 3 Smoking does not trigger asthma Reality: Babies who are born to smoking mothers have a greater chance of developing asthma than children of non-smoking mothers. Smoking is also a known trigger of asthma attacks and should not be ignored. So if you must smoke, do it outside and away from your children. 194

195 Asthma and Allergy Myth 4 Flowering plants cause hay fever Reality: Seasonal allergic rhinitis, commonly known as hayfever, is caused by allergy to pollen, rather than hay. Pollen allergy tends to be due to air borne pollen from wind pollinated grass, weed and tree species. 195

196 Asthma and Allergy By contrast, the pollen of flowering plants is large and sticky, does not blow very far, and requires birds and bees for pollination. Therefore, when people complain that scented flowers trouble them, it is usually due to chemical irritation from the perfume that makes them sneeze rather than the pollen. 196

197 Asthma and Allergy Myth 5 Moving interstate can cure allergies Reality: Allergic rhinitis (hayfever) may be triggered by wind-blown pollen in spring and summer, or by other allergens such as house dust mite, animal danders and mould spores all year round. Moving away from the source of allergen (such as interstate, or from inland areas to the coast) may temporarily relieve allergies 197

198 Asthma and Allergy Unfortunately allergic people are also prone to developing new allergies, and often symptoms reappear within a few years with exposure to new plants, or other sources of allergen such as moulds or house dust mite 198

199 Asthma and Allergy Myth 6 Continuous exposure to animals will desensitize you to them Reality: If you are allergic to an animal, continuous exposure will not decrease your allergy. In fact, 1 in 3 people who are already allergic and exposed to indoor pets will become allergic to them as well over time. Keeping indoor pets is also associated with asthma and the need for more medication. 199

200 Asthma and Allergy If you are allergic to animals, sensitivity often worsens with ongoing exposure. The best way to relieve symptoms is to avoid the animal, minimize exposure to household pets by removing them from the home or at least keeping them out of the bedroom, have hard flooring and wash the animal regularly to reduce the amount of allergen they shed. 200

201 Asthma and Allergy Myth 7 You cannot develop an animal allergy if you do not yourself have pets Reality: Animal allergens, particularly cat and horse allergen can be carried on clothes. This may sensitize other people who do not have pets themselves and provoke symptoms in sensitized individuals. 201

202 Asthma and Allergy Allergen can continuously suspended in the air, even if the animal has been removed from the house or is not in the bedroom. While the amount of allergen shed by an individual animal may vary with a number of factors (sex, whether de-sexed or not, short or long hair, hair or 'wool'), the actual allergen is the same amongst species. Allergies to other animals such as guinea pigs, horses and mice have also been described. Even iguanas can trigger allergies. There are no hypoallergenic animals! 202

203 Asthma and Allergy Myth 8 Some animals are better for people with asthma and allergies Reality: The allergens in cats are mainly from their sebaceous glands in their skin and the main source of allergens in dogs is from their saliva. Even if some breeds do not shed hair, the allergen can still become attached to dust particles in the house (such as walls, carpets, bedding, clothing and drapes) and does not easily break down with time. 203

204 Asthma and Allergy Myth 9 Eliminating wheat and milk helps asthma and hay fever Reality: Diet plays a minor role in the management of asthma or allergic rhinitis (hayfever). While some children with food allergies go on to develop eczema, asthma or allergic rhinitis as well, taking all people off wheat or dairy products as a routine is almost always a waste of time. Such diets can adversely affect nutrition (particularly in children) and directs effort into unproductive areas. 204

205 Asthma and Allergy When food allergy does occur, reactions are usually of rapid onset, severe and obvious. They are almost always accompanied by rashes, throat swelling, vomiting or sometimes a more subtle worsening of atopic eczema. Nuts, fish, shellfish, milk and eggs are the most common food allergies in children.Scientific studies show no evidence that milk either increases mucus production or worsens asthma! Eliminating wheat and milk will help your allergy, but only if you are confirmed to be allergic to wheat and milk 205

206 Asthma and Allergy Myth 10 Colours and preservatives are a common cause of asthma Reality: Preservatives like sodium metabisulfite (220, 221, 222) in wine, dried fruits, vinegar, grapes and some fruit salads can worsen, but do not cause asthma. Inhalation of small amounts of sulphur dioxide released may cause a reflex contraction of the bronchial tubes. 206

207 Asthma and Allergy Monosodium Glutamate (MSG) also has a bad reputation for triggering asthma in some people, but scientific studies have shown this to be a relatively rare problem. Benzoates (used in cordials) can sometimes cause problems. Unfortunately, allergy testing is unreliable for confirming sensitivity to these substances. 207

208 Asthma and Allergy Myth 11 Alternative tests and treatments are just as effective as conventional tests and medications for allergy and asthma Reality: There are several unorthodox 'tests' for allergy such as cytotoxic food testing, Vega testing, kinesiology, iridology, pulse testing, Alcat testing and Rinkel's Intradermal skin testing. These have no scientific basis, are unreliable and have no useful role in the assessment of allergy. 208

209 Asthma and Allergy On the other hand, Skin tests and blood allergen specific IgE (RAST) tests are reliable and scientifically validated allergy tests. Together with a medical history and examination hese tests can help your doctor define the cause of your allergies and are rebated by Medicare in Australia. 209

210 Asthma and Allergy Myth 12 Allergies and asthma can be cured Reality: Even though effective treatments are available, there are currently no cures for asthma or allergies. The closest thing to a cure for allergy is immunotherapy (desensitisation), which is effective for treating some allergies like allergic rhinitis (hayfever), asthma and stinging insect allergy, but not currently for treating food allergies. 210

211 Asthma and Allergy Myth 13 Asthma and hay fever sprays are dangerous Reality: Inhaled medications, including corticosteroids (preventative treatment) are commonly used to treat asthma. They are very safe and effective, as long as they are used at an appropriate dose under medical supervision. 211

212 Asthma and Allergy Similar medications (intranasal corticosteroid sprays) are often used to treat moderate to severe allergic rhinitis (hayfever). There is no evidence that long term use of these medications (in appropriate dosage and under medical supervision) is harmful, although medical advice should be sought if side effects occur. 212

213 Asthma and Allergy Myth 14 Many children grow out of their asthma and allergies Reality: Allergies can unfortunately last for many years. For example, it is known that: 85 per cent of children with atopic dermatitis (eczema) improve by their teenage years, but often have dry and irritable skin and problems with soap and some cosmetics for life 213

214 Asthma and Allergy Myth 15 Allergy drugs are dangerous and make you sleepy Reality: Non-drowsy antihistamines are readily available from pharmacies. These medicines are just as effective than sedating antihistamines (and probably more so), rarely make people drowsy, have been proven to be safe when driving and hardly ever make children irritable or hyperactive. Because they last a lot longer in the body, they are also more convenient to take (typically once daily). 214

215 Asthma and Allergy Myth 16 There is no way of getting rid of house dust mites Reality: The greatest concentration of house dust mites and their allergenic faecal particles is in carpeted bedrooms and bedding and in houses where there are domestic animals, especially cats. 215

216 Asthma and Allergy Polished boards or other impervious floor coverings, regular washing of bed linen and encasing mattresses and pillows in barrier encasing will substantially reduce exposure to dust mite allergen. Although it will not eradicate the dust mite, vacuuming once per week will reduce the number of dust mites, particularly if HEPA filters are used 216

217 Asthma and Allergy Myth 17 A little bit of peanut does no harm Reality: Contact with a trace amount of peanut can be fatal for a peanut allergic individual, if they are extremely sensitive to peanuts. Myth 18 Damp houses are just as healthy as dry houses Reality: Damp houses have a higher mould content than dry homes and indoor mould is a common cause of perennial allergic rhinitis, sinusitis, bronchitis as well as asthma. 217

218 Food Allergy & Food Intolerance Food allergy and food intolerance are commonly confused as symptoms of food intolerance occasionally resemble those of food allergy. However, food intolerance does not involve the immune system and does not cause severe allergic reactions (known as anaphylaxis). Food intolerance also does not show on allergy testing.

219 Food Allergy & Food Intolerance Food allergy is increasing Allergies in general are on the increase worldwide and food allergies have also become more common, particularly peanut allergy in preschool children. About 60 per cent of allergies appear during the first year of life. Cow’s milk allergy is one of the most common in early childhood. Most children grow out of it before they start school.

220 Food Allergy & Food Intolerance Allergy can be inherited Children who have one family member with allergic diseases (including asthma or eczema) have a 20 to 40 per cent higher risk of developing allergy. If there are two or more family members with allergic diseases, the risk increases to 50 to 80 per cent.

221 Food Allergy & Food Intolerance Food intolerance is a chemical reaction Food intolerance is a ‘chemical’ reaction that some people have after eating or drinking some foods; it is not an immune response. Food intolerance has been associated with asthma, chronic fatigue syndrome and irritable bowel syndrome (IBS).

222 Food Allergy & Food Intolerance Symptoms of food allergy and intolerance It can be difficult to tell the difference between the symptoms of food allergy and food intolerance. Usually, symptoms caused by food allergy develop very soon after consuming the food but, while symptoms caused by food intolerance can be immediate, they may also take 12 to 24 hours to develop.

223 Food Allergy & Food Intolerance Food intolerance reactions are usually related to the amount of the food consumed. They may not occur until a certain amount (threshold level) of the food is eaten, but this amount varies for each person. The symptoms of food allergy and intolerance can also be caused by other conditions, so it’s important to see your doctor for a medical diagnosis

224 Food Allergy & Food Intolerance Symptoms of food intolerance can include: nervousness, tremor Sweating Palpitations Rapid breathing Headache, migraine Diarrhoea

225 Food Allergy & Food Intolerance Burning sensations on the skin Tightness across the face and chest Breathing problems – asthma-like symptoms Allergy-like reactions

226 Food Allergy & Food Intolerance The symptoms of food allergy can be life threatening. Common symptoms include: itching, burning and swelling around the mouth Runny nose Skin rash (eczema) Hives (urticaria – skin becomes red and raised)

227 Food Allergy & Food Intolerance Diarrhoea, abdominal cramps Breathing difficulties, including wheezing and asthma Vomiting, nausea

228 Food Allergy & Food Intolerance Body parts affected by food allergy Various sites on the body can be affected by an allergic reaction to food, including: eyes – itching, watering Nose – stuffiness, sneezing Mouth – itching, swelling Throat – swelling Digestive system – stomach pains, vomiting, diarrhoea

229 Food Allergy & Food Intolerance Skin – rashes, such as hives (urticaria) or atopic dermatitis Lungs – wheeze, cough, asthma, more common in children than adults Central nervous system – headache, irritability, fatigue, convulsions.

230 Food Allergy & Food Intolerance Causes of food allergy Peanuts, tree nuts, eggs, milk, wheat, sesame, fish, shellfish and soy cause about 90 per cent of food allergic reactions. Peanut allergy is one of the most common allergies in older children as only approximately one in four children will outgrow peanut allergy.

231 Food Allergy & Food Intolerance Causes of food intolerance The foods that tend to cause intolerance reactions in sensitive people include: dairy products, including milk, cheese and yoghurt Chocolate Eggs, particularly egg white Flavour enhancers such as MSG (monosodium glutamate)

232 Food Allergy & Food Intolerance Food additives Strawberries, citrus fruits and tomatoes Wine, particularly red wine Histamine and other amines in some foods

233 Food Allergy & Food Intolerance Finding the allergen When symptoms appear within a few minutes of eating the particular food, it makes pinpointing the allergen an easy task. However, if the cause is unknown, diagnostic tests may be needed, such as: keeping a food and symptoms diary to check for patterns

234 Food Allergy & Food Intolerance Removing all suspect foods for two weeks, then reintroducing them one at a time to test for reactions (except in cases of anaphylaxis). This must only be done under medical supervision Skin prick tests using food extracts Allergy blood tests

235 Food Allergy & Food Intolerance Avoiding the food The easiest way to treat a food allergy or intolerance is to eliminate the offending food/s from the diet. Sometimes, the body can tolerate the food if it is avoided for a time, then reintroduced in small doses, particularly for food intolerances. Before you eliminate or reintroduce foods, seek advice from a specialist doctor and dietitian.

236 Food Allergy & Food Intolerance Preventing food allergy in children Allergy prevention in children is an active area of research. Findings to date indicate that: Prenatal – there is no conclusive evidence that avoiding allergens in pregnancy will help prevent allergies in your child.

237 Food Allergy & Food Intolerance Postnatal – exclusive breastfeeding during the first four to six months appears to protect against the development of allergies in early childhood. Exposure to cigarette smoke and starting solids early can increase the risk of developing allergies in early childhood.

238 Food Allergy & Food Intolerance Breastfeeding – avoidance of a food by a woman while breastfeeding should only be undertaken under the advice of a clinical immunology or allergy specialist, and with the help of a dietitian. Soy formula – studies have shown that using soymilk formula does not prevent the development of allergies in children.

239 Food Allergy & Food Intolerance Partially hydrolysed formula – partially hydrolysed cow’s milk-based formula (commonly referred to as ‘HA' formula) has been processed to break down some of the proteins. These formulas have been recommended to help prevent allergies. However, recent studies suggest that partially hydrolysed formula may not always have a significant protective effect against allergic disease, as results from different studies are variable.

240 Food Allergy & Food Intolerance Self care advice for food allergies To avoid allergic foods, learn the terms used to describe these foods on food labels, for example: milk protein – milk, non-fat milk solids, cheese, yoghurt, caseinates, whey, lactose Lactose – milk, lactose Egg – eggs, egg albumen, egg yolk, egg lecithin

241 Food Allergy & Food Intolerance Gluten – wheat, barley, rye, triticale, wheat bran, malt, oats, cornflour, oat bran Soy – soybeans, hydrolysed vegetable protein, soy protein isolate, soy lecithin Salicylates – strawberries, tomatoes.

242 Food Allergy & Food Intolerance Pharmacist referral situations: Persons who experience an itchy mouth from raw fruits and vegetables Persons who have experienced allergic symptoms (urticaria,angioedema, itch, wheezing, gastrointestinal responses) in association with food exposure.

243 Food Allergy & Food Intolerance Infants with gastrointestinal symptoms including vomiting, diarrhoea (particularly with blood). Persons with a diagnosed food allergy.

244 Anaphylaxis Any substance you are severely allergic to can trigger anaphylaxis. The most common food culprits include nuts, shellfish, and eggs. Bee stings and other insect bites can cause anaphylaxis as well. Drug allergies are also common triggers; according to the World Allergy Organization, drugs may be responsible for as much as 20 percent of deaths from anaphylaxis worldwide. Some less common triggers of anaphylaxis include exercise and latex

245 Anaphylaxis Signs and Symptoms of Anaphylaxis Anaphylaxis can cause a multitude of symptoms almost immediately after exposure to the trigger. The following are possible signs and symptoms of anaphylaxis: Chest tightness Trouble breathing or speaking Feeling of a lump in the throat Tongue swelling

246 Anaphylaxis Wheezing or a high-pitched sound when breathing Coughing Feeling flushed or hot Difficulty swallowing (dysphagia) Facial swelling Hives or rash

247 Anaphylaxis Changes in the color of the skin, such as pink and flushed, pale, or blue Gastrointestinal symptoms, such as diarrhea, nausea, or vomiting Unconsciousness Death Along with the symptoms listed above, a person may also experience severe anxiety or a feeling of impending doom.

248 Anaphylaxis 248

249 Anaphylaxis Moderate to mild allergic reaction In some cases, anaphylaxis is preceded by signs of a mild to moderate allergic reaction: Swelling of face, lips and eyes. Hives or welts on the skin. Tingling mouth,stomach pain, vomiting (these are signs of a mild to moderate allergic reaction to most allergens, however, in insect allergy these are signs of anaphylaxis).

250 DVD DVD 3 to be shown in class

251 Anaphylaxis Action For insect allergy, flick out the sting if it can be seen (but do not remove ticks) Stay with person and call for help Give medications if prescribed (whilst antihistamines may be used to treat mild to moderate allergic reactions, if these progress to anaphylaxis then adrenaline is the only suitable medication) Locate adrenaline auto injector if available

252 Anaphylaxis Anaphylaxis ( Severe allergic reaction) Continue to watch for any one of the following signs of anaphylaxis (severe allergic reaction): Difficult/noisy breathing Swelling of tongue Swelling/tightness in throat Difficulty talking and/or hoarse voice

253 Anaphylaxis Wheeze or persistent cough Persistent dizziness or collapse Pale and floppy (in young children)

254 Anaphylaxis Action Lay person flat - if breathing is difficult, allow to sit - do not allow them to stand or walk Give the adrenaline auto injector if available Call Ambulance Further adrenaline doses may be given (when an additional adrenaline auto injector is available), if there is no response after 5 minutes

255 Anaphylaxis

256 An epinephrine auto injector is a medical device used to deliver a measured dose (or doses) of epinephrine (also known as adrenaline) using auto injector technology, most frequently for the treatment of anaphylaxis

257 Anaphylaxis The devices contain a spring-loaded needle that exits the tip of the device (in some cases through a sterile membrane) and penetrates the recipient's skin, to deliver the medication via subcutaneous or intramuscular injection. Epinephrine auto injectors contain a pre- determined dose of epinephrine, usually between 300 μg and 500 μg of active ingredient at a concentration of 1:1000.

258 DVD DVD 3 to be shown in class

259 Anaphylaxis


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