RESPONDING TO THE SYMPTOMS OF MINOR AILMENTS FOOD AND DRUG ALLERGY
Minor ailments are generally defined as medical conditions that will resolve on their own and can be reasonably self-diagnosed and self-managed with over the counter medications.
Community pharmacists are seen as one of the most accessible health care professions since many pharmacies can be found on the high street and no appointment is necessary.
Responding to symptoms is one of the important role of community pharmacist so as to be able to provide the proper pharmaceutical care.
They supply medicines in accordance with a prescription or when legally permitted, dispense them without a prescription.
FOOD ALLERGY
Food allergies occur when the body's immune system reacts to certain proteins in food.
Food allergic reactions vary in severity from mild symptoms involving hives and lip swelling to severe, life-threatening symptoms, often called anaphylaxis, that may involve fatal respiratory problems and shock.
There are many food allergies.
Food allergies occur when the body's immune system reacts to certain proteins in food.
Food allergic reactions vary in severity from mild symptoms involving hives and lip swelling to severe, life-threatening symptoms, often called anaphylaxis, that may involve fatal respiratory problems and shock.
There are many food allergies.
ROLE OF COMMUNITY PHARMACIST IN MANAGING FOOD ALLERGIES
DRUG ALLERGY
A drug allergy is the reaction of the immune system to a medicine.
Any medicine nonprescription, prescription or herbal can provoke a drug allergy.
Include inactive or nonmedicinal ingredients into computer allergy database.
Perform independent double checks during order entry and dispensing as well to prevent incidences of allergic reactions undetected by the computer software.
The pharmacist should instruct the patient to carry a Medic Alert card or bracelet to avoid future accidental prescription/dispensing of any drugs to which he or she is allergic.
Pharmacists should educate patients about drug allergies.
Patients and family members should be educated on the generic names of the drugs they are allergic to and other potentially cross-reacting drugs.
The pharmacist can also help families know if a related drug might cause a similar reaction
Pharmacists can help patients and families identify drug allergies by asking questions such as:
When did your reaction occur?
Have you had any recent drug changes?
What were your symptoms?
Does anything make you feel better or worse?
Whenever a person presents with a suspected drug allergy, a detailed record should be taken to include the generic and brand names of the drug, its strength and formulation and which drugs, or drug classes, should be avoided in future
Pharmacists can help treat drug allergies by stopping the drug, using a different dose or form of the drug, or using additional drugs to relieve allergy symptoms (Antihistamines, Corticosteroids).
Hospital & community pharmacy M.Pharm
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FOOD AND DRUG ALLERGY
1. RESPONDING TO THE
SYMPTOMS OF MINOR
AILMENTS
FOOD AND DRUG ALLERGY
PRESENTED BY:
LINCY ASHA.S
M.PHARM SEMESTER I
PHARMACY PRACTICE
1
2. MINOR AILMENTS
• Minor ailments are generally defined as medical conditions
that will resolve on their own and can be reasonably self-
diagnosed and self-managed with over the counter
medications.
Eg. Headache, Pyrexia, Insect bites, Nasal congestion,
Back pain, sore throat, constipation, allergies,
Menstrual pain, etc.
2
3. WHY COMMUNITY PHARMACIST?
• Community pharmacists are seen as one of the most accessible health care professions since many pharmacies
can be found on the high street and no appointment is necessary.
• Responding to symptoms is one of the important role of community pharmacist so as to be able to provide the
proper pharmaceutical care.
• They supply medicines in accordance with a prescription or when legally permitted, dispense them without a
prescription.
ACTIVITIES INCLUDE:
• Understand and manage the common problems that present in the pharmacy.
• Be equipped to correct information about medicines and to offer general health advice.
• Ensuring an accurate supply of appropriate products
• Counseling of patients at the time of dispensing of prescription and non-prescription drugs.
• Describe the common adverse effects of over the counter medicines
• Provide referral for chronic conditions
3
4. STRUCTURED APPROACHES
• ESTABLISHING PATIENT IDENTITY
The pharmacist should establish the identity of the patient
Ex.
Name
Gender
Place
Pharmacist should be familiar with the patient
• ESTABLISHING PROFILE OF THE SYMPTOMS
The pharmacist asks the patient
1. To describe the nature and severity of the symptoms
2. About the onset and duration of the symptoms
3. Whether he/she experiences any accompanying symptoms
4. Whether there is anything which makes the symptoms worse or better.
4
5. • ESTABLISHING A TREATMENT HISTORY
The pharmacist asks
1. Whether self medication was attempted
2. Whether a medical doctor was consulted for this symptoms.
3. Whether any medication was prescribed or used for this symptom in a previous occurrence.
• DETECTION OF SERIOUS SYMPTOMS
The pharmacist attempts to detect symptoms suggestive of serious disease
• MANAGEMENT OF THE CONDITION
The pharmacist recommends medications and lifestyle modifications to reduce the symptoms.
5
6. • RECOMMENDATION OF A COURSE OF ACTION
The pharmacist explains how to carry out home nursing and remedies only
The pharmacist supplies a non-prescription medicine and gives details on
1. Action of medicines supplied
2. Manner in which it is taken
3. Duration of treatment
4. Possible side effects, contraindications and interactions
5. Economic choice
• FOLLOW UP
The pharmacist
1. Provides information on the health condition
2. Helps the patient to feel in control of, take responsibility for and manage the disease.
3. Informs the patient to come again or seek medical advice if symptoms exist.
6
7. • REFERRAL
The pharmacist
1. Refers the patient to the patient’s regular family doctor.
2. Offers to phone and make an appointment for the patient with doctor.
3. Advise a general practitioner and provides patient with his details (i.e, telephone
number, clinic times)
7
9. FOOD ALLERGY
• Food allergies occur when the body's immune system reacts to certain proteins in food.
• Food allergic reactions vary in severity from mild symptoms involving hives and lip swelling to severe, life-
threatening symptoms, often called anaphylaxis, that may involve fatal respiratory problems and shock.
• There are many food allergies.
• The federal government requires label listing of only 8 food allergens
• Milk
• Eggs
• Fish
• Crustacean shellfish
• Tree nuts (walnuts, pecans, almonds)
• Peanuts
• Wheat
• Soybeans
9
10. Common Food Allergy Symptoms
Reaction Time Range from minutes to days
Mild to severe symptoms
Skin = itchiness, flushing, hives, swelling, eczema
Gastrointestinal = nausea, vomiting, abdominal pain/cramps, diarrhea, colic
Respiratory= runny nose, wheezing, throat closing/swelling, asthma
Circulatory = dizziness, faintness, heart irregularities, “sense of impending doom”
Anaphylaxis = constricted airways in lungs, very low blood pressure and shock, suffocation by throat swelling
Food Allergy Treatment
• Avoid trigger food/beverage
• Medications
• Antihistamine
• Bronchodilator
• Epinephrine
10
11. ROLE OF COMMUNITY PHARMACIST IN MANAGING FOOD
ALLERGIES
Counseling Patients with Allergies
Identify the culprit
• What are the symptoms present?
• How long have the symptoms been present?
• Food taken
• Family history of allergies
• Site of symptoms
• Intensity of symptoms
• Type/nature
• Duration
• Onset
• With (any other symptoms)
• Aggravated by?
• Medication being taken?
After the food triggering the reaction has been identified, the patient must be advised to stop eating that food.
11
12. • Mild allergies can be treated completely with OTC medications, requiring no visit to a physician and no
prescription.
• Pharmacists can help patients acquire the right oral antihistamines or steroid based on symptoms.
• Severe allergic cases are referred to the specialist.
Review things that can worsen symptoms
• Although patients may attempt to avoid allergens’ triggers, they may be unaware of exacerbating
environmental conditions including aerosol sprays, air pollution, cold temperatures, humidity, irritating
fumes (including perfume), tobacco and wood smoke, and poor housekeeping.
Discuss changes patients can make to minimize symptoms
Always read labels
• Food labels include important allergy information such as whether any additives contain milk protein or
byproducts of wheat, or whether a food was produced in a facility that processes nuts.
12
13. • Read every label, every time even if purchased the item hundreds of times before.
• Manufacturers frequently change ingredients and an allergen may be part of a new formulation.
Food allergens are identified on food labels in one of three ways:
1.Ingredient name. For example, the allergen name “milk” may be included in the ingredient name
“buttermilk.”
2.Following the ingredient name. The food allergen may appear after the ingredient, such as “whey (milk),”
3.After the ingredients list. A “contains” statement may appear next to the list of ingredients, such as “contains
milk, soy, and wheat.”
• Always be cautious when buying products without labels — such as a cake from a pastry shop.
Take care when cooking
• Recommended to have separate cooking and eating utensils — one exclusively for the allergic person to
avoid cross-contamination.
13
14. • All dishes and utensils should be thoroughly washed in hot, soapy water between uses.
Dine out defensively
• It's wise to let the chef know about your food allergy before you order.
• People with food allergies should carry a chef card — a printed note specifying all the ingredients they are
allergic to.
Wear a medical ID bracelet.
• Make sure it lists relevant information about the food allergy.
Always carry your medication
Educate patients on the difference between food intolerance and food allergies
• Many people confuse food allergies with more common food intolerances.
• Allergies involve an immune reaction; food intolerances stem from the inability to digest certain foods.
• Symptoms are similar, but milder. 14
15. Discuss anaphylaxis
• Those with severe reactions have increased risk for anaphylaxis.
• Inform patients they need to call or go to the emergency department.
• Foods like peanuts, fish, shellfish, milk and eggs are common triggers for anaphylaxis.
• Emphasize to patients that a history of mild reactions does not preclude from having a future anaphylactic
reaction.
• Treatment starts with epinephrine, followed by antihistamines or corticosteroids.
• Epinephrine works best when injected within minutes of an allergic reaction
• It is essential that the patient and the family members learn how to use an epinephrine auto-injector so
there is no delay in receiving the drug.
• A delay in using epinephrine is a decline in well-being and even death from anaphylaxis within 30–60
minutes.
15
16. • To carry epinephrine auto-injector at all times and make sure that it is easily accessible and can be quickly
located.
• Each time they receive a refill for the injector, the patient and the family member should always review the
instructions.
• Instructions sometimes change and may differ between one auto-injector and another.
• It can also be helpful to watch videos or view pictures of how to administer the prescribed auto-injector.
• Always be sure to replace epinephrine before its expiration date or it may not work properly.
• Patients should always carry an anaphylaxis wallet card that notes the allergy, name, and number of
emergency contact.
Review cross-reactivity and cross-contact
• Cross-reactivity = allergic reaction to 1 item in a food group resulting in an allergic reaction to other
items in the same food group is common.
16
17. • Eg. People allergic to shrimp are also prone to be allergic to other shellfish.
• The immune system may identify the food as being the same and cause an allergic reaction.
• Cross-contact occurs when an allergen is unintentionally transferred from a food that contains the allergen
to a food that does not contain the allergen.
Address unproven treatments
• A quick Internet search uncovers a host of unproven diagnostics and treatments for allergies including
acupuncture, and herbal medicine.
• Unproven treatments are not necessarily harmless and some can do real harm.
• Discourage patients from trying these treatments without first discussing them with their physician.
Probe for comorbidities
• Food allergies tend to coexist with other conditions like asthma.
17
18. • Allergy treatments may improve some of these other symptoms.
• Pharmacists should routinely query about asthma when counseling on allergies.
Address patient’s misconceptions
• Many patients have misconceptions about food allergies.
• Eg. Myth = Once I find an allergy-free food, I no longer need to read the label.
Fact = Always read food labels, manufacturers change ingredients constantly
Review side effect profiles
• Patients using antihistamines for the first time need to be counseled about their sedating effects and to
refrain from driving or using dangerous equipment until they know how the antihistamines will affect them.
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20. DRUG ALLERGY
• A drug allergy is the reaction of the immune system to a medicine.
• Any medicine nonprescription, prescription or herbal can provoke a drug allergy.
DRUGS CAUSING ALLERGIES
• Antibiotics such as penicillin and sulfa antibiotics such as sulfamethoxazole-trimethoprim
• Aspirin
• Nonsteroidal anti-inflammatory medications, such as ibuprofen
• Anticonvulsants such as carbamazepine and lamotrigine
• Drugs used in monoclonal antibody therapy such as trastuzumab and ibritumomab tiuxetan
• Chemotherapy drugs such as paclitaxel, docetaxel, and procarbazine
20
21. SYMPTOMS
• skin rash
• hives
• itchy skin or eyes
• fever
• joint aches or swelling
• tender lymph nodes
• Anaphylaxis - constricted airways in lungs, very low blood pressure and shock, suffocation by throat
swelling
DRUG ALLERGY TREATMENT
• Withdrawal of the drug
• Antihistamines.
• Corticosteroids
• Treatment of anaphylaxis with epinephrine injection.
21
22. ROLE OF COMMUNITY PHARMACIST IN MANAGING DRUG ALLERGIES
• Pharmacists can help patients and families identify drug allergies by asking questions such as:
When did your reaction occur?
Have you had any recent drug changes?
What were your symptoms?
Does anything make you feel better or worse?
• Whenever a person presents with a suspected drug allergy, a detailed record should be taken to include the
generic and brand names of the drug, its strength and formulation and which drugs, or drug classes,
should be avoided in future
• Pharmacists can help treat drug allergies by stopping the drug, using a different dose or form of the
drug, or using additional drugs to relieve allergy symptoms (Antihistamines, Corticosteroids).
22
23. • For many patients, OTC treatments will not successfully resolve their symptoms, requiring them to seek
further care.
• For these patients, a pharmacist will refer them to a primary care provider or an allergy specialist.
• Pharmacist will explain or demonstrate how to correctly use a prescribed medication.
what dosage to use
when to use it
how it works
how it will help
In case of anaphylaxis how to use the epinephrine auto injector
• Pharmacists can help prevent drug-related allergic reactions by making sure that a patient’s medication
profile is up to date and includes all medicines and drug allergies.
• The pharmacist can make sure that a patient does not receive these specific drugs in the future.
23
24. Missing documentation
Prescriber Error
• Example) Our pharmacy system indicated a penicillin allergy; however the doctor’s office did not have the patient’s
allergic information. The pharmacist advised the patient to stop the medication and had amoxicillin switched to a
more appropriate choice.
Recommendation : Always obtain and record the patient’s list of drug allergies. Keep their medical profile
up to date.
Pharmacy Error
• Example) A child’s penicillin allergy was not documented on her profile however it was discovered while
counselling was provided to the child’s father. The previous reaction was described as "a rash and hives on her back
Recommendation : Have dialogue with patients and/or the patient’s caregivers to mitigate potential incidents
(e.g. as an additional routine check, always ask about patient allergies upon medication pick-ups).
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25. • A pharmacist may help in improvement of pharmacy computer system functionality for allergy findings by
ensuring that inactive ingredients of treatment were included in the database and by having dialogue with the
patient and/or the caregiver for detection of likely errors e.g. as an extra check afore medication provision,
ask the patient about drug allergy.
Computer detection incapacity
• Example: A patient has a peanut allergy and was prescribed Prometrium® as part of a hormone replacement
therapy. The patient’s husband picked up the prescription and was not counselled by the pharmacist nor asked
about the patient’s peanut allergies. The patient later read the medication information sheet and saw the
allergy warning. The pharmacist reacted by contacting the software provider. Their response was that because
the peanut oil isn’t an active ingredient, the system will not catch it.
Recommendation :
Consider enhancing the pharmacy computer system for improved allergy detection.
25
26. Include inactive or nonmedicinal ingredients into computer allergy database.
Perform independent double checks during order entry and dispensing as well to prevent incidences of
allergic reactions undetected by the computer software.
• The pharmacist should instruct the patient to carry a Medic Alert card or bracelet to avoid future
accidental prescription/dispensing of any drugs to which he or she is allergic.
• Pharmacists should educate patients about drug allergies.
• Patients and family members should be educated on the generic names of the drugs they are allergic to
and other potentially cross-reacting drugs.
• The pharmacist can also help families know if a related drug might cause a similar reaction.
26
