AUTO - A. OTC TREATMENT OF ALLERGY-COVERED

Question 1

Hayfever

Answer 1

• allergy to pollen
• atopic conditions (asthma, eczema)
• starts at any age
• tree pollens: late march
• grass pollen may-july
• pollen count on weather forecast

Question 2

symptoms of hay fever

Answer 2

• may appear as cold-like
• worse in morning (pollen released)
• sneezing
• rhinorrhoea: runny nose
• nasal congestion
• headache and earache
• itching of nose and roof of mouth
• itchy watery eyes

Question 3

Antihistamines for hay fever

Answer 3

• Antihistamines (oral)
  GSL or oral
  non-drowsy: 1x daily
  drowsiness: >1 (good for <2 year olds?)

Cetirizine - >2
Loratadine - >2 (tablets only for >30kg)

Fexofenadine - 1x daily (120mg tablets for >12)
Chlorphenamine (Piriton) - 3/4x daily, drowsiness, >1yo
Acrivastine - non-drowsy, 3x daily

Relief in hours/day
convenient
cautions:
- prostate hypertrophy
- acute closed angle glaucoma
- liver disease
- epilepsy

Question 4

Steroid nasal sprays for hayfever

Answer 4

• > 18, non-pregnant, no glaucoma
• use regularly to prevent symptoms
• several days to build effect
• use alongside antihistamine and eye drops
• Beclometasone, Fluticasone, Mometasone

How to use nasal spray:
1. pump spray few times until fine moist comes out, do if hasn’t been used for few days
2. remove cap, gently shake bottle
3. blow nose, close 1 nostril with finger
4. bend head forward and put nozzle into other nostril, keep bottle upright
5. slowly breath in through nose and with fingers press down once on widest part of nozzle to squirt spray into nostril
6. breathe out through mouth

Question 5

other medicines for hay fever

Answer 5

Eye drops - sodium cromoglicate
- discard after 28 days, don’t need to store in fridge
- 4x daily
- stabilises mast cell membrane and prevents release of histamine
- start working in 1 hour
- OTC - 10ml, POM - 15ml

Antihistamine eye drops
- less popular
- may contain decongestant

Saline nasal drops/sprays
- drug free
- good for pregnant/breastfeeding women, young and babies

How to use nasal drops:
1. tilt head foward so nostrils are pointing up at ceiling or bend backwards over a bed but head must be upside down with nostrils pointing at ceiling
2. instil number of drops
3. maintain position for at least minutes to allow penetration of drops

Balms, allergy wipes, cooling eye masks, nasal aspirators, Vicks

Question 6

when to refer for hay fever

Answer 6

• wheezing
• breathlessness
• high chest
• severe ear/sinus pain
• failed OTC treatment
• OTC unsuitable
• no improvement after 7 days OTC treatment

Question 7

General advice for hay fever

Answer 7

• don’t cut grass
• shower in evening
• wash, change clothes
• windows closed

Question 8

contact dermatitis

Answer 8

• allergic reaction when touch/contact with irritant
• few occurs/day of exposure
• lighter skin - red
• darker skin - dark brown/purple/grey
• itchy, blistered, dry, cracked skin
• cosmetics, skin products, nickel
• handling raw, uncooked fruit and veg
• soaps and detergents, washing powder

Question 9

treatment for contact dermatitis

Answer 9

• emollient creams: regularly to decrease itching
• topical steroid creams - hydrocortisone (10) or clobetasone butyrate (12)
  1% not 0.5%
  not on face/genital areas
  7-10 days max
  separate admin from emollients (30-60 mins)
  fingertip units - sparingly and thin layer

Question 10

rhinitis

Answer 10

• seasonal (hay fever) or perennial (all year)
• non-allergic
  colds
  weather changes
  spicy foods
  hormone changes
  medicines
• allergic
  house dust mites
  pollen
  mould
  pets
  wood or flour dust

Question 11

treatment for allergic rhinitis

Answer 11

• treat like hayfever

Question 12

treatment for non-allergic rhinitis

Answer 12

• self-help advice
• antihistamines (usually with decongestant)
• decongestants ( no longer than 7 days for nasal)
• saline sprays and rinses
• steam inhalations (add menthol crystals, vapour rub to water?)
• vapour rubs
• honey and lemon
• inhalants: vicks, olbas oil

Question 13

insect or plant stings

Answer 13

• bees, wasps, hornets, caterpillars
• nettles
• itchy, painful, swollen
• lump/blistering
• red
• single sting if insect or larger if plant

Question 14

treatment for insect or plant stings

Answer 14

• remove cause if possible with tweezers for hairs, not stings
• ice pack
• elevation
• pain relief
• antihistamine tablets/creams (no cream to caterpillar hair reactions)
• hydrocortisone cream for simple bite/stings, non-broken skin

Question 15

when to refer for insect or plant stings

Answer 15

• serious reactions
• infected stings
• big areas
• sig swelling
• severe pain
• signs of anaphylaxis (swelling of throat/mouth, breathing problems)

Question 16

marine stings

Answer 16

• jellyfish/wheever fish
• seek medical advice if persistent severe pain, stung on face/genitals, stung by a stingray
• A&E for severe reactions

Question 17

treatment for marine stings

Answer 17

• rinse affected area with seawater
• removes any spines using tweezers/edge of bank card
• soak in very wam water (as hot) for 30 minutes or use hot towels
• OTC pain relief
• DON’T use vinegar, pee, ice/coldpack, touch spines with bare hands, cover/close wound

Question 18

urticaria (hives)

Answer 18

• itchy lumpy rash
• sting or burn
• white skin - pink/red
• anywhere on body
• antihistamines

refer if
- symptoms don’t improve after 2 days
- hives in children
- rash is spreading
- patients with fever, unwell
- swelling under skin

Question 19

food allergies

Answer 19

• may be contact not just when eating
• antihistamines for mild
• adrenaline for severe (epipen)
• immunotherapy?