OTC spotlight: hay fever tablets, nasal sprays and eye drops

Why this matters

Hay fever is an allergic reaction to pollen. It brings sneezing, a runny or blocked nose, and itchy, red or watery eyes, and it can also cause an itchy throat, headache and tiredness. The NHS describes symptoms as usually worst between late March and September. Unlike a cold, which usually clears in one to two weeks, hay fever can go on for weeks or months.

That makes it one of the busiest counter topics of the year. Customers often ask for a product by name and expect a quick sale. Most of the time the sale is simple, but the products are not all the same. Age limits vary, some cause drowsiness, and a few symptoms need the pharmacist. Learning the product groups now, outside the rush, means you are ready when the season starts.

The three product groups

• Antihistamine tablets and liquids. The NHS groups these as non-drowsy (acrivastine, cetirizine, fexofenadine and loratadine) and drowsy (chlorphenamine is the one you will see most for allergy). Non-drowsy types are generally the better choice. There is little evidence that one antihistamine works better than another, so a customer may need to try more than one.
• Steroid nasal sprays, such as beclometasone. These treat the nose symptoms. They need to be used regularly, take a few days to work, and can take two weeks or more to reach full effect.
• Eye drops for allergy. The NHS says a pharmacist can advise on eye drops or antihistamines for eyes affected by hay fever.

'Non-drowsy' does not mean nobody feels sleepy. Some people still do. The advice is the same for every antihistamine: if it makes you sleepy, do not drive, cycle or use tools or machinery. Alcohol can add to the sleepiness.

Age limits to check on the pack

Ages are where hay fever sales most often go wrong. These are the positions set out on the NHS medicines pages, but the pack in front of you always has the final word for that product:

• Cetirizine: tablets and liquid can be bought for people aged 6 and over. Liquid for children aged 2 to 5 is bought from a pharmacy. For a child aged 1 it needs a prescription.
• Loratadine: suitable for most adults and children aged 2 and over.
• Fexofenadine: the 120mg tablet for hay fever can be bought for adults and children aged 12 and over. Tablets for children under 12 need a prescription.
• Chlorphenamine: can be taken from 1 year, but it is a drowsy antihistamine and has a longer list of cautions. Refer requests for young children.
• Beclometasone nasal spray: can only be bought for adults aged 18 and over. For younger people it needs a prescription.

Two extra points are worth knowing. Fexofenadine should be taken with water, because apple, orange and grapefruit juice can make it work less well. And a bought steroid nasal spray is not for use without a break for ever: the leaflet states how long it can be used continuously before speaking to a pharmacist or doctor, usually between one and three months.

WWHAM in practice

Who is it for, and how old are they? What are the symptoms: nose, eyes, or both? How long have they had them, and do they get them every year? Action already taken: what have they tried, and did they take it every day? Medicines: what else do they take, and do they have any long-term conditions?

Listen for doubling up. Some cough and cold remedies contain an antihistamine, so a customer could end up taking two without realising. Ask about driving and work as well. A customer who drives for a living, or who has exams coming up, needs to know which products are more likely to make them sleepy.

You can also share simple NHS self-care advice with confidence: a little petroleum jelly around the nostrils to trap pollen, wraparound sunglasses, showering and changing clothes after being outdoors, keeping windows and doors shut where possible, and not drying washing outside.

When to refer to the pharmacist

• Anyone who is pregnant or breastfeeding
• A young child, or anyone below the age on the pack
• An older person, especially if frail, asking for a drowsy antihistamine
• Anyone taking other medicines
• Heart, liver or kidney disease, epilepsy, glaucoma, difficulty passing urine or an enlarged prostate
• Asthma or another breathing condition, and any wheezing or breathlessness: tell the pharmacist straight away
• For a steroid nasal spray: recent or current use of other steroid medicines, nose surgery or an infection in the nose
• Eye pain, sensitivity to light, changes in vision or a very red eye: tell the pharmacist straight away
• A contact lens wearer with eye symptoms
• Symptoms that are getting worse, or that have not improved with pharmacy medicines

If you are not sure whether something on this list applies, it is always acceptable to ask the pharmacist.

PPets learning connection

This spotlight supports the OTC consultation, WWHAM and red flags learning in the Level 2 Certificate. Our free OTC red flags guide is a useful counter reference.

Record this as CPD

Registered pharmacy technicians can use this article towards GPhC revalidation, as an unplanned CPD entry or as the starting point for a reflective account. Pharmacy assistants and trainees can use it as evidence of reflective practice. Note down three things:

1. What you learned from this article
2. How you have applied it, or will apply it, in your own role
3. The benefit to the people who use your pharmacy's services

Sources and further reading

• NHS: hay fever
• NHS: antihistamines
• NHS: cetirizine
• NHS: loratadine, who can and cannot take it
• NHS: fexofenadine
• NHS: chlorphenamine
• NHS: beclometasone nasal spray
• NHS: conjunctivitis

Related from PPets

• OTC consultation training
• Community pharmacy red flags
• WWHAM training

This article is for general educational purposes only. It is not legal advice, professional regulatory advice or clinical advice about an individual patient. Always follow your pharmacy's SOPs and check current official guidance and product information.

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