Hay fever case study – what would you do?

Hay fever affects individuals in different ways and the effect on their lives can be dramatic, creating a chain reaction that severely disrupts activities non-sufferers take for granted.

It is often dismissed as trivial or inconsequential but, while not life threatening, it can be extremely debilitating for sufferers.

For some people with hay fever the symptoms of sneezing, a runny or blocked nose, and itchy red eyes are just a minor inconvenience. But for many, the condition can lead to complications such as blocked sinuses, headaches and asthma flare-ups.

With the hay fever season now nearly upon us, how can pharmacy teams help customers deal with its debilitating effects? Here we look at a typical patient scenario: a teenager preparing for exams. Do you agree with the course of action?

Mollie, 15, is studying for her GCSEs, which begin in a couple of weeks, but is finding it hard to concentrate as she is not getting much sleep. Her nose runs constantly during the day and becomes blocked at night, exacerbating her sleep disturbance. Her eyes are red, itchy and often discharging clear tears. 

Patient history

There is a strong family history of atopic illnesses. Mollie’s father has asthma and hay fever, and her mother has hay fever and had eczema as a child. Mollie’s siblings have a variety of atopic conditions, including hay fever, asthma and eczema. Mollie herself had mild eczema as a child, which cleared up when she was around seven years old. She has had no history of other atopic conditions until now. This is the first time she has had eye and nasal symptoms.

Mollie likely has hay fever. While seasonal asthma could be a possibility, Mollie has no wheezing or shortness of breath. It is vital to control her symptoms quickly because of her imminent exams and the effects they are having on her attempts to revise. Since she hasn’t had hay fever before, Mollie should see her GP, but in the meantime you can discuss some lifestyle measures and OTC treatments with Mollie and her mother. 

Lifestyle advice

Lifestyle measures could include encouraging Mollie to change her clothes when she comes in from school and making sure to shower and wash her hair before she goes to bed to remove pollen. Laundry should be dried away from areas where pollen can build up. 

Petroleum jelly or balms may be used to prevent pollens entering the nasal airways. Also recommend allergy masks, using air conditioning in the car, keeping windows closed in the home, vacuuming, wiping surfaces with a damp cloth and avoiding pets in Mollie’s bedroom at night.

Management

OTC treatments can also be helpful. Mollie’s runny, itchy nose and eyes are her most troublesome symptoms during the day – along with the cough keeping her awake at night. An oral or topical antihistamine could be recommended but they tend to be more effective for an itchy or runny nose and are less effective for nasal congestion. 

Antihistamines, such as diphenhydramine and chlorphenamine, tend to be sedating and would not be appropriate in this case. Mollie is trying to prepare for her exams and is already drowsy during the day. However, it is important to be aware that not everyone is affected by these side-effects and Mollie may benefit from getting a good night’s sleep if she takes an antihistamine in the evening. She could try a sedating antihistamine for a couple of nights as there are still a couple of weeks to go before her exams begin. 

If she is not too drowsy, sedative antihistamines may be continued – but if they make her drowsy it is not wise to take them during the exam/assessment period. Loratadine and cetirizine are theoretically non-sedating and may be a better option, but the effect also varies from patient to patient. 

Fexofenadine, a non-sedating antihistamine in most people, does not cross the blood-brain barrier and is highly selective for H1 receptors, and is therefore a good option for those who require a high level of concentration e.g. students taking exams. In addition, studies have shown that it is less likely to cause drowsiness than cetirizine and is more effective than loratadine for symptom control particularly itchy throat.

Oral antihistamines should also relieve Mollie’s itchy eyes. Sodium cromoglicate 2% eye drops are another possibility. 

It is unfortunate that Mollie’s night-time nasal congestion can’t benefit from a corticosteroid nasal spray as these medications are only licensed for OTC use in people aged 18 years and over.

Article amended on April 4 to include more information about OTC treatment options.