Antihistamines

Question 1

What are the presenting symptoms of hayfever?

Answer 1

• Itchy and watery eyes
• Runny nose
• Stuffy nose
• Itchy ears and throat
• Sneezing

These can be similar to bacterial conjunctivitis - but this is usually associated with sticky eyes, with coloured discharge, and only in one eye

Question 2

What treatments are available?

Answer 2

Antihistamines 
-need to consider drowsy vs non drowsy
Nasal corticosteroids
-Can take 48-72hrs to be effective so ideally take a few days before you think symptoms may start and do not stop taking them if you are concerned you have not felt benefits
Eye drops
-Sodium cromoglicate - mast cell stabiliser 
Decongestants 
-5 day use maximum
-Must not give to people with high BP

Question 3

What advice can you give to hay-fever sufferers?

Answer 3

• Wear wraparound sunglasses to prevent pollen getting into eyes
• Close windows as much as you can, particularly in morning and evening when pollen counts are at the highest
• Shower and wash clothes after going outdoors
• Apply vaseline to nose openings
• Clean house regular, damp dusting

Question 4

What treatments are there for motion sickness?

Answer 4

Antihistamines
Cinnarizine e.g. Sturgeon
Promethazine e.g. Phenergan
*Avoid alcohol as this can increase side effects

Hyoscine hydrobromide e.g. Kwells

Question 5

Advice for motion sickness

Answer 5

-Accupressure
Tight wrist bands to apply pressure
-Ginger
-Close eyes and breathe slowly
-Focus on a set point straight ahead
-Car journeys, sit in the front
-Break up long journeys
-No big meals beforehand

Question 6

What are important questions to ask to find the cause of insomnia?

Answer 6

Are you taking any regular medication?
*many medications such as SSRIS, amphetamines, caffeine/alcohol
Are you under any stress?
Are you suffering from anxiety or depression?
Do you work nights or do shift work?
How long has it been since you changed your mattress and pillows?

Question 7

What is the advice/treatment for insomnia?

Answer 7

• Get into a routine
• Make sure your bed is comfortable
• Set up your bedroom comfortably- blackout blinds
• Try mindfulness
• Exercise regularly during the day as this will tire you out
• Put phone away and turn TV well before bed
• No big meals before bed

Drowsy antihistamines e.g. Promethazine
1 at night up to 1hr before bed

Question 8

Insomnia Referral

Answer 8

Under twelve
No known cause
After a period of time, there has been no improvement
Over three weeks

Question 9

Patient comes in looking for advice on their symptoms. It is summertime. Provide your usual care.

Answer 9

What symptoms are you experiencing? Itchy/puffy eyes, stuffy nose, sneezing
How long has this been going on? About two weeks
Have you experienced them before? No
Are both eyes affected or just one? Both
Is there any liquid coming from your eyes? Is it clear or coloured? Yes it is clear
Do you feel well in yourself? Yes
Do you have any allergies? Not that I know of
Have you tried anything for it? No
Do you take any regular medication? Anything OTC/herbal? No
Do you have any medical conditions? No

Sounds like hay-fever. Your body has become sensitised to pollen granules and is initiating an immune response against it. Cells called mast cells degranulate releasing histamine, an inflammatory cytokine, causing your symptoms.

I would recommend taking an antihistamine to combat the histamine being released in your body. What job do you do? For a taxi driver I would recommend non drowsy and drowsy ones may affect your ability to drive. Allacan tablets contain cetirizine. Take one tablet daily with a glass of liquid.

For treating your stuffy nose, you could try a nasal spray like Beconase Hayfever. 2 sprays into each nostril morning and evening. Maximum 8 sprays in 24 hours.
Nasal corticosteroids can take 48-72hr to see effects to be patient with it and consistent with dosing.

For general advice, wear wraparound sunglasses to keep pollen out of eyes. After going outdoors take a shower and change your clothes. Keep windows and doors shut where possible, particularly first thing in the morning and evening as pollen count is higher. Vaseline placed on nostril entrance will trap pollen to stop it getting into your nose. Damp dust the house and hoover as often as you can.

Opticrom eye drops could also be an option to treat your itchy eyes. These are mast cell stabilisers, so stop them releasing histamine.