Allergy

Prescribing Notes:

• Antihistamines may be of value in the treatment of nasal allergies, especially hay fever, and vasomotor rhinitis. They reduce rhinorrhoea and sneezing but are usually less effective for nasal congestion.
• Cetirizine and loratadine cause less sedation than chlorphenamine; they are all available over-the-counter. Drowsiness rarely occurs but patients should be advised that it is a possible side-effect and may affect performance of skilled tasks (e.g. driving); excess alcohol should be avoided.
• Loratadine may be a suitable alternative for those who develop sedation with cetirizine.
• For nasal spray preparations see the Ear, nose and oropharynx chapter of the formulary.
• Oral antihistamines are of value in preventing urticaria and are used to treat urticarial rashes, pruritus, and insect bites and stings; they are also used in drug allergies. For guidance on Urticaria please see recommendations in the Skin chapter of the formulary.

Prescribing Notes:

• Antihistamines may be of value in the treatment of nasal allergies, especially hay fever, and vasomotor rhinitis. They reduce rhinorrhoea and sneezing but are usually less effective for nasal congestion.
• Oral antihistamines are of value in preventing urticaria and are used to treat urticarial rashes, pruritus, and insect bites and stings; they are also used in drug allergies.
• For nasal spray preparations see the Ear, nose and oropharynx chapter of the formulary.
• For guidance on Urticaria please see recommendations in the Skin chapter of the formulary.

Prescribing Notes:

• Adrenaline should be given immediately for an acute anaphylactic reaction (laryngeal oedema, bronchospasm and hypotension).
• Chlorphenamine injection is a useful adjunctive treatment given after adrenaline injection and continued for 24-48 hours to prevent relapse.
• Hydrocortisone injection is of secondary value in the initial management of anaphylactic shock because the onset of action is delayed for several hours, but should be given to prevent further deterioration in severely affected patients.
• Atopic individuals are particularly at risk of anaphylactic reactions; patients with known severe allergy should carry, and receive instruction for the use of, prefilled syringes for self-administration. Patients should usually be prescribed two adrenaline prefilled syringes and advised to always carry these.
• Adrenaline for self-administration should be prescribed by brand name to ensure that the patient gets the device that they have been taught to use.
• The MHRA provides specific advice for healthcare professionals on the safe and effective use of adrenaline auto-injectors.
• Please see guidance from the Resuscitation Council UK on emergency treatment of anaphylactic reactions.

Prescribing Notes:

• Berinert is approved for the symptomatic treatment of acute attacks of hereditary angiodema under expert supervision.

Prescribing Notes:

• Antihistamines may be of value in the treatment of nasal allergies, especially hay fever, and vasomotor rhinitis. They reduce rhinorrhoea and sneezing but are usually less effective for nasal congestion.
• Cetirizine and loratadine cause less sedation than chlorphenamine; they are all available through Pharmacy First in community pharmacy. Drowsiness rarely occurs but patients should be advised that it is a possible side-effect and may affect performance of skilled tasks (e.g. riding a bike or using a scooter).
• Loratadine may be a suitable alternative for those who develop sedation with cetirizine.
• For nasal spray preparations see the Ear, nose and oropharynx chapter of the formulary.
• Oral antihistamines are of value in preventing urticaria and are used to treat urticarial rashes, pruritus, and insect bites and stings; they are also used in drug allergies. For guidance on Urticaria please see recommendations in the Skin chapter of the formulary.

Prescribing Notes:

• Drowsiness can occur with these and patients should be advised that it is a possible side-effect and may affect performance of skilled tasks (e.g. riding a bike or using a scooter).
• Antihistamines may be of value in the treatment of nasal allergies, especially hay fever, and vasomotor rhinitis. They reduce rhinorrhoea and sneezing but are usually less effective for nasal congestion.
• Oral antihistamines are of value in preventing urticaria and are used to treat urticarial rashes, pruritus, and insect bites and stings; they are also used in drug allergies.
• For nasal spray preparations see the Ear, nose and oropharynx chapter of the formulary.
• For guidance on Urticaria please see recommendations in the Skin chapter of the formulary.

Prescribing Notes:

• For Adrenaline doses, refer to Resuscitation Council UK anaphylaxis guidelines.
• Emerade 500mcg is only recommended for use in adults and children greater than 12 yrs old.
• Adrenaline should be given immediately for an acute anaphylactic reaction (laryngeal oedema, bronchospasm and hypotension).
• Chlorphenamine injection is a useful adjunctive treatment given after adrenaline injection and continued for 24-48 hours to prevent relapse.
• Hydrocortisone injection is of secondary value in the initial management of anaphylactic shock because the onset of action is delayed for several hours but should be given to prevent further deterioration in severely affected patients.
• Children should be referred to the local allergy service for initial prescribing and training.
• Atopic individuals are particularly at risk of anaphylactic reactions; patients with known severe allergy should carry, and receive instruction for the use of, prefilled syringes for self-administration. Patients should usually be prescribed four adrenaline prefilled syringes for example two for nursery/school and two for personal use and advised to always carry these.
• Adrenaline for self-administration should be prescribed by brand name to ensure that the patient gets the device that they have been taught to use.
• The MHRA provides specific advice for healthcare professionals on the safe and effective use of adrenaline auto-injectors.
• Please see guidance from the Resuscitation Council UK on emergency treatment of anaphylactic reactions.

Prescribing Notes:

• C1-esterase inhibitors are approved for the symptomatic treatment of acute attacks of hereditary angiodema under expert supervision.

Prescribing Notes:

• Non-sedating antihistamines may be of value in the treatment of nasal allergies, especially hayfever, and vasomotor rhinitis. They reduce rhinorrhoea and sneezing but are usually less effective for nasal congestion.
• Oral antihistamines may be used in pregnancy but only on medical advice.
• Acute urticaria is usually self-limiting, and if mild, treatment is often unnecessary.
• Drowsiness is rare with non-sedating antihistamines, however it can occur and may affect performance of skilled tasks, excess alcohol should be avoided.
• Sedating oral antihistamines may be particularly helpful if sleep is disturbed.
• Fexofenadine is supplied under the Pharmacy First Patient Group Directions for treatment of Seasonal Allergic Rhinitis (Hay fever). 

Examples of Counselling Points
For hayfever, start taking before season starts and continue throughout.
Avoid going out when the pollen count is high.

When to advise patient to contact GP
Wheezing or shortness of breath, tightness of chest.
Suspected drug allergy.
Persisting painful ear or sinuses.
Purulent conjunctivitis.
If patient has failed treatment options available in community pharmacy after adequate trial.

Prescribing Notes:

• Beclometasone or mometasone nasal spray is supplied under the Pharmacy First Patient Group Directions for treatment of Seasonal Allergic Rhinitis (Hay fever). 
• There is no convincing evidence that one steroid spray is more effective or better tolerated than another. Choice of nasal spray should be governed by cost, safety and patient preference. 
• For 'as-required' treatment of occasional symptoms, consider an oral antihistamine. 
• To control frequent or persistent symptoms a corticosteroid nasal spray is the recommended first line treatment. 
• It may take 1-2 weeks of treatment to obtain maximum benefit. 
• Compliance is essential for efficacy so patients should be counselled on the importance of regular treatment and good nasal spray technique in controlling symptoms.  
• Advise patients once symptoms are under control reduce to the minimum effective dose. 
• If symptoms persist, consider combining an oral antihistamine with an intranasal steroid. 
• Advise patient if symptoms do not improve or condition worsens seek further medical advice, initially from the pharmacy.  
• Failure to respond to treatment may indicate the presence of nasal polyps, requiring referral. 
• Nasal steroids may be used in pregnancy but only on medical advice.