Module 11 - Travel And Summer Health

Question 0

How long does hay fever last?

Answer 0

It depends on the individual. Some individuals are allergic to several types of pollen and will suffer for months and some are only allergic to one so may not suffer for the whole season. Hay fever usually lasts between early spring and late autumn.

Question 1

What is the other name for hay fever and what causes it?

Answer 1

Hay fever is also called seasonal allergic rhinitis. It is an allergic reaction following exposure to pollen from wind-pollinated plants or fungal spores. Most common cause is grass pollen but can also be caused by other airborne particles like oak, ash, hazel and nettle pollens.

Question 2

What are the symptoms of hay fever?

Answer 2

Runny nose, congested nose, sneezing
Dry cough, headache, slight fever 
Itchy and red eyes (allergic conjunctivitis)
Swollen eyes
Tickly throat

Question 3

When do you refer if someone has hay fever?

Answer 3

If they are first time sufferers
If there are no symptoms displayed
Elderly
Worrying symptoms - wheezing and fever
On other medication or has medical conditions
Children under 8 years
Under 18s that want corticosteroid nasal sprays
Previous use of antihistamines did not help
Symptoms have not improved within a week of treatment
Breast feeding and pregnant
No history of hay fever or allergic reactions

Question 4

What non-pharmacological advice can we give to people suffering with hay fever?

Answer 4

Wear sunglasses when you are outside.
Wear mask and goggles if working with plants.
Close all windows especially when sleeping.
Vacuum and damp dust.
Use a fan or air conditioner/filter
Do not go out between 5-7pm when pollen count is high.
Avoid additional airborne irritants like smoke and chemical fumes.
Avoid areas of high pollen concentrations - lawn mowings, long grass and wooded areas.

Question 5

Name the treatments available to treat symptoms of hay fever?

Answer 5

1. Corticosteroid nasal sprays.
2. Topical and oral decongestants.
3. Oral antihistamines.
4. Sodium cromiglicate, lodoxamide and antazoline to treat allergic conjunctivitis.

Question 6

Name the corticosteroid nasal sprays and describe how they are used to treat hay fever.

Answer 6

Corticosteroid nasal sprays reduce inflammation and therefore reduce swelling and congestion caused by prostaglandins.

They are not for pregnant women or under 18 year olds.
They are available for under 6 years old by prescription.
They include beclometasone, fluticasone and triamcinolone.

Question 7

Describe how the different corticosteroid nasal sprays are used to treat hay fever.

Answer 7

Beclometasone - also reduces ocular symptoms produced by the irritation of the nasal membrane. Fluticasone and triamcinolone also reduces inflammation. The corticosteroid nasal sprays are ineffective for acute symptoms,

Question 8

When can corticosteroid nasal sprays be used?

Answer 8

They are better to use at the beginning of the hay fever season - they take up to two weeks to achieve maximum benefit.

A prescription is needed for those who require treatment for over 3 months.

Question 9

Name the topical decongestants used to treat hay fever and how they work.

Answer 9

Examples of topical decongestants used to treat hay fever are xylometazoline and oxymetazoline.

They are not effective to reduce the symptoms of hay fever but they do reduce nasal congestion.

It is better to use topical decongestants corticosteroid nasal sprays or cromoglicates for a maximum of seven days only before the corticosteroid or cromoglicate begins to work.

Question 10

What is the danger of using topical decongestants for more than seven days?

Answer 10

Using topical decongestants for more than seven days will cause rebound congestion where instead of the nasal being decongested, it becomes worse.

Question 11

What are oral decongestants? Name two used in treating nasal congestion in hay fever and describe how they work.

Answer 11

Oral decongestants narrow blood vessels so they unblock the nose as nasal congestion is caused by swollen blood vessels. Oral decongestants include ephedrine and pseudoephredrine.

Question 12

Why is an antihistamine usually combined with an oral decongestant?

Answer 12

Antihistamines have little or no effect on nasal congestion, they only reduce itching and sneezing.

Question 13

What is the difference between an oral decongestant and a corticosteroid nasal spray?

Answer 13

Corticosteroid nasal sprays REDUCE inflammation and so reduce swelling and congestion. Oral decongestants NARROW blood vessels and so reduce congestion.

Question 14

Which groups of people must avoid oral decongestants?

Answer 14

People on other medication, diabetics, people thyroid problems, high blood pressure, heart disease and pregnant women.

Monkeys Don’t Truly BeHave Properly.

Question 15

Name the two types of oral antihistamines.

Answer 15

Sedating and non-sedating antihistamines.

Sedating - e.g. chlorphenamine, diphenhydramine, promethazine, brompheniramine and meclozine.

Non-sedating - loratidine, cetrizine and acricastine in order of increasing drowsiness.

Question 16

What are the side effects of oral antihistamines?

Answer 16

Dry mouth, blurred vision, constipation and gastrointestinal problems.

Question 17

What are the advantages of non-sedating antihistamines compared to sedating antihistamines?

Answer 17

Non-sedating antihistamines do not cause as much drowsiness but can still make individuals drowsy so alcohol must avoid. Sedating antihistamines are cheaper compared to non-sedating antihistamines.

Question 18

How is acrivastine available OTC?

Answer 18

It is available as a single drug but can be combined with pseudoephedrine, when combined with pseudoephedrine it is only suitable for over 12 years old.

Question 19

What is the disadvantage of acrivastine over the other non-sedating antihistamines?

Answer 19

It needs to be taken three times daily.

Question 20

What are the cautions for non-sedating antihistamines?

Answer 20

They are not for pregnant or lactating women and alcohol must be avoided in both non-sedating and sedating antihistamines.

Question 21

Other than the side effects, what is another disadvantage of sedating antihistamines?

Answer 21

They need to be taken several times a day for the full effect.

Question 22

What are pharmacological treatments for allergic conjunctivitis?

Answer 22

1. Sodium cromoglicate - can control both allergic rhinitis and conjunctivitis. It is not as effective as a corticosteroid. The sodium cromoglicate nasal spray can be used in children and there is no age restriction for the eye drops. But always refer under 8 years to the pharmacist. It also takes time to achieve maximum effect.
2. Lodoxamide works in a similar way to a cromoglicate. The eye drops are for over 4 years old.
3. Antazoline (a topical antihistamine) - eye drops used to test itchy eyes and also used in a combination with a topical decongestant with he aim of reducing redness.
4. Beclometasone (corticosteroid nasal spray) can also relieve allergic conjunctivitis caused by the irrational of the nasal membrane.

Question 23

What complementary therapies can be used to treat hay fever?

Answer 23

1. Echinacea - boosts immune system and so reduces sensitivity to allergens. It also reduces inflammation and dries up mucus secretions. There is little evidence for this.
2. Garlic - benefits to immune system - dries up nasal secretions.
3. Eyebright, elderflower, nettleleaf and chamomile - herbal ingredients.

Question 24

What is motion sickness and what causes it?

Answer 24

Motion sickness is caused by the body’s mechanisms of balance (ears, eyes and brain). It is a mismatch between the information received by the brain from the various senses. The brain is unable to process the conflicting input so nausea and vomiting is a result.

Question 25

What are the symptoms of motion sickness?

Answer 25

Nausea and vomiting
Palor (pale skin)
Cold sweating and abdominal discomfort.

Question 26

What are the additional symptoms of motion sickness?

Answer 26

They are usually experienced by adults who are not physically sick.
Increase in salivation and swallowing,sighing and yawning, hyperventilation (over-breathing) and headache.

Question 27

When do you refer someone with motion sickness?

Answer 27

If they are pregnant or breast feeding.
Under 8 years old.
On other medication.
Drivers who suffer from motion sickness.

Question 28

What are the other important questions to ask someone with motion sickness?

Answer 28

Duration of the journey.
If consumption of alcohol during the journey is a possibility.
Whether drowsiness is preferred or not.
If the individual has used any medication for motion sickness in the past.
If they are on other medication.

Question 29

What non-pharmacological advice can you give to someone with motion sickness?

Answer 29

Avoid heavy, rich meals or meals high in protein or salt.
Avoid alcohol and smoking.
Get plenty of fresh air.
Avoid reading or watching tv.
Look ahead in the car.
Restrict head movements by using a travel neck pillow.
If on a plane sit near the wings of the plane.
Keep the horizon in view if on a boat.
Watch the horizon in a boat or stay in the middle at seal level.

Question 30

What pharmacological treatments are available for motion sickness?

Answer 30

1. Antiemetics - prevents symptoms of nausea and vomiting.

2. Antimuscarinics - prevents the action of acetylcholine - includes hyoscine hydrobromide.

Question 31

What are the disadvantages of using antimuscarinics to treat motion sickness?

Answer 31

They have side effects (anticholinergic side effects):
Dry mouth
Dry eyes
Drowsiness
Dizziness
Blurred vision
Urinary retention (difficulty passing water)
Constipation 

However these side effects can be avoided at lower doses.

Question 32

Questions to ask people travelling to an area where malaria is an issue.

Answer 32

When they are going - leave enough time to take tablets.
Where they are going
Length of visit
Age of patients including children
Other medication and medical conditions
Pregnancy and breast feeding

Question 33

How to avoid mosquito bites.

Answer 33

Take precautions 24/7
Use DEET to repel insects - use after sunscreen. Citronella is too short acting and should not be recommended in malaria areas.
Spray insecticides
Nets impregnated with insecticide
Cover up - colour makes no difference
Insecticide coils and vapourisers in rooms.

Question 34

What about other treatments for malaria?

Answer 34

No evidence for herbal/homeopathic prophylaxis/treatment.

No evidence for B vitamins, garlic, tee tree oil or marmite having repellent effects.

Question 35

What is the only antihistamine that can be used to treat a cough?

Answer 35

Diphenhydramine - topical antihistamine.

Question 36

What is the only antihistamine used to treat nasal congestion and ocular symptoms of hay fever?

Answer 36

Antazoline which is usually used in combination with naphazoline.
Naphazoline - relieves redness and irritation of the eye - decongestant.

Question 37

Treatment for motion sickness.

Answer 37

Cinnarizine - antihistamine - drowsiness - take two hours before journey - best for journeys more than 4 hours (long journeys).

Hyoscine hydrobromide - can also cause drowsiness - should be taken 30 minutes before journey - suitable for journeys less than 4 hours.