ARIA in the pharmacy: management of allergic rhinitis symptoms in the pharmacy

Allergic rhinitis is a symptomatic disorder of the nose induced by an immunoglobulin (IgE)-mediated inflammation of the nasal membranes in response to allergen exposure (1). Predominant symptoms are rhinorrhea, nasal obstruction, nasal itching and sneezing, which improve spontaneously or with treatment (1–3). The high prevalence of allergic rhinitis and its effect on quality of life have led to its being classified as a major chronic respiratory disease (1, 4). It is reported to affect 10% to 40% of the global population and its prevalence is increasing both in children and adults. Allergic rhinitis can significantly reduce quality of life (5), impairing sleep and adversely affecting leisure, social life, school performance (6) and work productivity (7). The direct and indirect financial costs of allergic rhinitis are substantial. Indirect costs include sick leave, school and work absenteeism and loss of productivity (8, 9). Asthma and rhinitis are common co-morbidities suggesting the concept of ‘‘one airway, one disease’’ (1). In addition, allergic rhinitis is associated with conjunctivitis and sinusitis. Recently, advances in our understanding of the mechanisms underlying inflammation of the upper and lower airways have led to improved therapeutic strategies for managing allergic rhinitis. Practice guidelines incorporating these advances have been developed (1). In addition, a new classification of allergic rhinitis aids the establishment of appropriate initial treatment strategy based on the duration and intensity of the patient’s symptoms and lifestyle limitations (1, 10). Many patients who suffer with allergic rhinitis do not recognise the process as such anddonot consult a physician (10, 11). Others commonly seek self-treatment for relief of symptoms using proven or unproven therapies. Worldwide, pharmacists receive sophisticated clinical training. Given the well-known and well-publicised recognition of iatrogenic disease, pharmacists’ skills represent an enormous potential resource to maximise the benefits and minimise the adverse events associated with pharmacotherapy (12). Pharmaceutical care includes prevention, treatment or cure of a disease (13). Interest and expectation that pharmacists provide broader ‘‘pharmaceutical care’’ services has therefore increased (14). Pharmaceutical care for the patient is likely to be optimal when there is collaboration between pharmacists, patients and other health care professionals, specifically physicians. In many countries, advice in pharmacies may not necessarily be from a qualified pharmacist but from a member of staff under the supervision of a pharmacist. Members of the workshops* Paris, October 23, 2002 San Antonio, November 17, 2002