Strategies for the management of intermittent allergic rhinitis: an Australian study.

OBJECTIVE: Allergic rhinitis is increasing globally despite treatment focussed on pharmacotherapy. This study aimed to (i) examine the range and proportion of symptoms and triggers experienced by patients with intermittent allergic rhinitis (IAR); (ii) conduct a qualitative analysis of strategies devised to control symptoms and triggers; and (iii) measure medication adherence. METHODS: A qualitative and observational study of data drawn from a randomized controlled trial on patients with IAR. Strategies collaboratively devised by participants and pharmacist staff to minimize symptoms and triggers were analysed thematically. In the 10-day observational study, the participants recorded all symptoms and triggers of IAR along with use of medications and these were analysed descriptively. RESULTS: Number of 124 participants recorded 620 symptoms and identified 357 triggers of IAR. To minimize these, 579 strategies were devised in consultation with pharmacy staff. The frequency and type of strategy varied according to whether the goals were aimed at controlling symptoms or triggers. Adherence to a course of antihistamines over the 10-day trial was self-reported by participants with 36% indicating full adherence. CONCLUSION: A large number and range of symptoms and triggers were identified, and individualized strategies were devised to minimize symptoms and triggers. Medication adherence was poor. PRACTICE IMPLICATIONS: Patients with IAR can be assisted to identify their symptoms and triggers and develop relevant strategies to manage these. This approach has the potential to facilitate patient self-management of a chronic and incapacitating condition.

The role of non-clinicians in a goal setting model for the management of allergic rhinitis in community pharmacy settings.

OBJECTIVE: To test the relative effects of a clinician versus non-clinician delivered goal setting intervention to assist patients presenting with Intermittent Allergic Rhinitis (IAR) in community pharmacies. METHODS: A 10-day mixed-method, parallel group repeated measures study was conducted in Sydney. Clinicians (pharmacists) and non-clinicians (pharmacy assistants) recruited patients suffering IAR. Intervention group pharmacy staff delivered a brief structured goal setting intervention to support IAR patient self-management whilst the control group delivered standard care. RESULTS: One hundred and fifty participants (N=77 intervention; N=73 control) were recruited at 20 community pharmacies. Both groups significantly improved on all outcome measures when assisted by either clinicians or non-clinicians. The intervention group patients supported by non-clinicians made significant improvements in self-efficacy and quality of life compared to the control group supported by non-clinicians. Strategies devised to control IAR triggers reflected practical actions whereas adherence and dose information strategies addressed IAR symptoms. Adherence did not impact significantly on self-reported symptom severity. CONCLUSION: Both clinicians and non-clinicians can deliver this service. There is a need for a detailed and practical approach to assist patients towards a goal-directed and autonomous management of IAR. PRACTICE IMPLICATIONS: With training non-clinicians can support patients with IAR, reducing the time constraints and workload for clinicians.

The psychosocial impact of self-reported morning allergy symptoms: findings from an Australian internet-based survey.

Background. Allergies can substantially impact health-related quality of life (HRQL). We investigated the psychosocial impact of morning symptoms amongst Australian adults with self-reported allergic rhinitis (AR). Method. An online survey comprising 24 questions was conducted in August 2008. Inclusion criteria were age (20-49 years) and self-reported moderate to severe symptoms of AR. Results. One thousand sixty respondents met the inclusion criteria. Amongst consumers with self-reported AR, symptoms were more severe in the morning in 597 (56%) and affected mood in 1025 (97%). Nine hundred seventy (91%) indicated that their symptoms had some impact on their day ahead and 868 (82%) reported a negative impact on relationships. Morning symptoms in particular had a substantial affect on mood for the day. HRQL impact was more pronounced in those who reported severe symptoms and in females. Discussion. Encouraging consumers with self-diagnosed AR to seek formal diagnosis and offering appropriate treatment strategies, such as those offering sustained effectiveness over 24-hours, may aid in negating the negative impact of morning symptoms.