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. 2022 Oct 5;12(10):e12183.
doi: 10.1002/clt2.12183. eCollection 2022 Oct.

Management of allergic rhinitis symptoms in the pharmacy Pocket guide 2022

Olga Lourenço  1 , Biljana Cvetkovski  2 , Vicky Kritikos  2   3 , Rachel House  2 , Sophie Scheire  4 , Elisio M Costa  5 , João A Fonseca  6 , Enrica Menditto  7 , Anna Bedbrook  8   9 , Slawomir Bialek  10 , Vitalis Briedis  11 , Koen Boussery  4 , G Walter Canonica  12 , Tari Haahtela  13 , Piotr Kuna  14 , Joaquim Mullol  15 , Valentina Orlando  7 , Boleslaw Samolinski  16 , Dana Wallace  17 , Catherine Duggan  18 , Ema Paulino  18   19 , Gonçalo S Pinto  18 , Lars-Åke Söderlund  18 , Jean Bousquet  8   9   20   21   22 , Sinthia Bosnic-Anticevich  3   23
Affiliations

Management of allergic rhinitis symptoms in the pharmacy Pocket guide 2022

Olga Lourenço et al. Clin Transl Allergy. .

Abstract

Background: Allergic rhinitis (AR) management requires a coordinated effort from healthcare providers and patients. Pharmacists are key members of these integrated care pathways resolving medication-related problems, optimizing regimens, improving adherence and recommending therapies while establishing liaisons between patients and physicians.

Methods: Allergic Rhinitis and its Impact on Asthma (ARIA) first published a reference document on the pharmacist's role in allergic rhinitis management in 2004. Several guidelines were developed over the past 20 years improving the care of allergic rhinitis patients through an evidence-based, integrated care approach.

Results: This ARIA/EAACI/FIP Position Paper is based on the latest ARIA in the Pharmacy guidelines and provides: (a) a structured approach to pharmacists identifying people with AR and/or allergic conjunctivitis as well as those at risk of poor disease control; (b) an evidence-based clinical decision support tool for optimising the management of allergic rhinitis in the community pharmacy; and (c) a framework of referral to the physician.

Conclusion: This document is not intended to be a mandatory standard of care but is provided as a basis for pharmacists and their staff to develop relevant local standards of care for their patients, within their local practice environment. Pharmacy care varies between countries, and the guide should be adapted to the local situation.

Keywords: allergic rhinitis; community pharmacy; pharmacist.

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Conflict of interest statement

Sinthia Bosnic‐Anticevich reports grants from TEVA, and personal fees from TEVA, AstraZeneca, Boehringer Ingelheim, GSK, Sanofi, and Mylan. João A. Fonseca reports personal fees from Viatris/Mylan. Piotr Kuna reports personal fees from Adamed, Berlin Chernie Menarini, Boehringer Ingelheim, Chiesi, AstraZeneca, Krka, Angellini, Novartis, Polpharma, Lekam, and GSK. Ema Paulino is the President of the Portuguese National Pharmacy Association and has been a Board member of the International Pharmaceutical Federation until October 2021. Biljana Svetkovski reports personal fees from GSK and Sanofi. Dana Wallace reports personal fees from Optinose, ALK, and Sanofi, and was a primary author on the JTFPP Rhinitis Practice Parameter Update 2020.

Figures

FIGURE 1
FIGURE 1
Recognising allergic rhinitis in the pharmacy. For more information on which patients should be referred to a physician (and in what time frame), see Appendix III. Please refer to local guidelines for additional symptoms for referral
FIGURE 2
FIGURE 2
Screening of Allergic Conjunctivitis in the pharmacy
FIGURE 3
FIGURE 3
Screening of Asthma in AR patients in the pharmacy
FIGURE 4
FIGURE 4
Determining the impact of Allergic Rhinitis and/or Allergic Conjunctivitis symptoms using VAS
FIGURE 5
FIGURE 5
Treatment of allergic rhinitis in the pharmacy (adapted from 18 , 31 ). AH, antihistamine; INAH, intranasal antihistamine; INCS, intranasal corticosteroid; IOAH, intraocular antihistamine; IOC, intraocular cromone. *If nasal congestion is the main symptom; INCS if coexisting asthma. This algorithm should be adapted to the regulations, needs, price of medications and cultural barriers of each country or region. VAS “Nose” (0–10 cm): “How much are your nose symptoms bothering you today?” VAS “Eyes” (0–10 cm): “How much are your eye symptoms bothering you today?”
FIGURE 6
FIGURE 6
Follow‐up of AR treatment. AH, antihistamine; INAH, intranasal antihistamine; INCS, intranasal corticosteroid; IOAH, intraocular antihistamine; IOC, intraocular cromone. *If nasal congestion is the main symptom; INCS if coexisting asthma. This algorithm should be adapted to the regulations, needs, price of medications and cultural barriers of each country or region. VAS “Nose” (0–10 cm): “How much are your nose symptoms bothering you today?” VAS “Eyes” (0–10 cm): “How much are your eye symptoms bothering you today?”
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