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Experts call for healthcare professionals to take heed of official guidelines to better manage hay fever and asthma patients

One Airway, One Disease: An expert report into the true impact of hay fever and asthma, supported by Allergy UK in partnership with MEDA Pharma, reveals that 63% of patients surveyed are not being treated for both conditions in parallel, in line with official British Society of Allergy and Clinical Immunology (BSACI) guidelines.1

The report, released today, highlights ways in which GPs and pharmacists can improve efficiencies and patient outcomes in the management of moderate-to-severe allergic rhinitis and asthma. It suggests that greater adherence to the guidance at a primary care level would help reduce thousands of avoidable emergency hospital admissions for asthma every year that are a direct result of uncontrolled rhinitis.2,3

Commenting on the report, Consultant Paediatric Allergist, Dr Adam Fox said: “While the BSACI guidance was developed by specialists, it should be applied among all healthcare professionals, including those in primary care who see people presenting with rhinitis and asthma symptoms every week. As a multidisciplinary team, we need to consider how we can foster a culture of considering rhinitis and asthma together as part of a united allergic airway.”

The report estimates that as many as 50,000 people with allergic rhinitis are being admitted to hospital with asthma every year.3,4 The report also warns that over 15 million people whose hay fever symptoms are not controlled are up to three times more likely to develop asthma.5-8

Recommendations from the World Health Organisation (WHO) ‘Allergic Rhinitis and its Impact on Asthma’ (ARIA) workshop, suggested a new classification of allergic rhinitis, based on the presence of asthma and the frequency and severity of symptoms. The ARIA guidelines, subsequently incorporated into the UK British Society of Allergy and Clinical Immunology (BSACI) guidelines, which aimed at improving the management of ‘one airway, one disease’, recommend that all asthma patients are evaluated for allergic rhinitis and that in planning treatment, both conditions should be considered together.9

However, new research suggests that thousands of people suffering from both hay fever and asthma are not being treated according to the guidelines, which could put them at an increased risk of asthma exacerbations and, in the most extreme cases, hospitalisation.1,2 The research, conducted among over 2,000 hay fever sufferers, showed that 41% of people with hay fever and asthma had never received a dedicated consultation to discuss hay fever and asthma symptoms together, and a further 22% of sufferers had never discussed both conditions at the same time in a consultation, even if the subject had come up.1

GP and allergy specialist Dermot Ryan commented: “The presence of rhinitis is much more likely to result in poorer asthma control with consequent increases in exacerbations and hospitalisations for asthma. In accordance with the ARIA guidelines, those suffering with rhinitis should be asked about asthma symptoms to enable any co-existing asthma to be treated. Similarly, those with asthma should have enquiries made concerning the presence of nasal symptoms.”

The report also highlighted that a more coordinated approach to tackling allergic rhinitis and asthma between GPs and pharmacists could lead to improved patient outcomes. While the research found that the majority of people with allergic rhinitis suffer moderate-to-severe symptoms (77%), this was treated mostly in pharmacy, with many patients still not achieving symptom relief due to over-the-counter oral antihistamine tablets only recommended for treating mild symptoms.1,9

Furthermore, only 18% of people with allergic rhinitis had visited their GP in the last two years. The report also highlighted that this lack of professional advice has led to most hay fever sufferers’ ‘self-treating’ the condition, with 85% of sufferers admitting to not changing their approach to treatment for three years or more.1

The report highlights that there is a significant role for pharmacists in managing hay fever, and an opportunity to manage patients with hay fever more closely. The survey found that 93% of GPs and 97% of pharmacists believed that the increasing role of pharmacists in the management of hay fever would benefit NHS resources.1 However, only 23% of pharmacists reported holding consultations with patients presenting with hay fever symptoms.1

Up to 40% of hay fever sufferers have or will develop asthma, representing approximately 6.4 million people in the UK.10 It is estimated that every day in the UK, 200 people are hospitalised because of their asthma and three of these people will die as a result.3 Furthermore, an increasing number of people are reported to be developing hay fever, with some studies indicating that prevalence rates of the condition may have almost doubled in the last fifteen years alone.11,12

Dr Jean Emberlin, Scientific Director of Allergy UK, commented: “While we are unable to put an exact figure on it, the evidence available indicates that the overall prevalence of hay fever in the UK has at least doubled over the last 30 years. Reasons for this may include increased awareness among hay fever sufferers and healthcare professionals, leading to improved identification and recording of cases. Also a hygiene hypothesis has been put forward. This theory suggests that as a result of cleaner living, the population is less exposed to endotoxins in early life leading to a greater tendency for allergies to develop. Furthermore, we are experiencing longer and more severe pollen seasons as a result of climate change.”

Maureen Jenkins, Clinical Services Director, Allergy UK, commented: “The vast majority of hay fever sufferers experience moderate-to-severe symptoms, yet spend hundreds of pounds on treatments that simply do not work for them. Meanwhile, they continue to suffer symptoms, and the connection with asthma is never made, even though allergic rhinitis can impact hugely on this chronic life-long disease.”

Source

1. New market research, data on file

2. Thomas M. Allergic rhinitis: evidence for impact on asthma. BMC Pulmonary Medicine. 2006

3. Asthma UK. Press release: Asthma UK warns of ‘alarming variation’ in asthma hospital admissions. May 2013. Available from: http://www.asthma.org.uk/News/alarming-variation-in-asthma-hospital-admissions, [Last accessed: April 2014]

4. Scadding G and Walker S. Poor asthma control? – then look up the nose. The importance of co-morbid rhinitis in patients with asthma. Primary care respiratory journal. 2012;21(2):222-228

5. Bauchau V, Durham S. Prevalence and rate of diagnosis of allergic rhinitis in Europe. European Respiratory Journal. 2004;24:758-764

6. Office for National Statistics. Population. 2012. Available from: http://www.ons.gov.uk/ons/taxonomy/index.html?nscl=Population. [Last accessed: April 2014]

7. Price D, Bousquet J et al. Sub-optimal control of allergic rhinitis: the need for a new and more effective treatment option. Presented at EAACI 2013, Milan, Italy

8. Guerra S, Sherrill D, et al. Rhinitis as an independent risk factor for adult-onset asthma. Journal of Allergy and Clinical Immunology. 2002;109(3):419-425

9. Scadding G, Durham S et al. BSACI guidelines for the management of allergic and non-allergic rhinitis. Clinical and Experimental Allergy. 2008;38:19-42

10. Nathan R. Management of Patients with Allergic Rhinitis and Asthma: Literature Review. Medscape. 2009

11. Warm K, Lindberg A et al. Increase in sensitization to common airborne allergens among adults – two population-based studies 15 years apart. Allergy, Asthma & Clinical Immunology. 2013, 9:20

12. Daily Telegraph. Hay fever among adults soars in 15 years. Available from: http://www.telegraph.co.uk/health/healthnews/10176067/Hay-fever-among-adults-soars-in-15-years.html [Last accessed: April 2014]

Allergy UK and MEDA Pharma