Hay fever

allergies

Here comes hay fever!

Winter is nearly over! That means spring is almost here and spring means allergies.  Or does it? Pollens from plants are more common in spring and this can definitely mean that hayfever symptoms are more common then.  Hay fever due to dustmites, animal hair and mould, amongst other things, can occur at any time of year.

                            Symptoms of hay fever                                                       

otherwise known as allergic rhinitis (rhin = nose, itis= inflammation), include

Sneezing

Blocked or runny nose

Itchy nose, ears, throat and eyes

These symptoms can then lead to others such as tiredness, irritability and trouble sleeping.

One way to tell if someone is an allergy sufferer is to look at their nose. If they have a line going across the middle of the nose this is a tell tale sign of allergies.  It comes about because the person pushes up on their nose frequently because it is itchy, runny or blocked.  I am the owner of one of these nose lines.

Why does hay fever occur?

Our noses use tiny hairs to filter and stop particles from the outside world getting inside our bodies.  Hay fever occurs when our body has an allergic reaction to this particle and does all it can to rid it from the body including sneezing and extra mucus production.

Hay fever treatment

Antihistamine tablets, especially the non-sedating ones, are helpful if you have both nose and eye symptoms.

Corticosteroid nasal sprays used to be available on prescription only but are so helpful for nasal symptoms they available over the counter.  They are better than decongestant sprays for hay fever and can be used for longer than five days unlike decongestant sprays.

Antihistamine and other allergy eye drops are available.  These are helpful particularly if eye symptoms only are being suffered.  The eye drops for allergy that also contain decongestants should be used for 5 days only however there are drops that can be used for longer.

In severe cases an antihistamine tablet can be used in combination with a corticosteroid nasal spray.

Let’s look at………..codeine

codeine

Codeine

                                                                                   

Codeine is a medication that is available over the counter in combination with paracetamol, ibuprofen or aspirin.  Codeine belongs to the group of medicines called opioids.  All other opioid medications are available on prescription only.  From February 2018 codeine will also be available on prescription only.  This is because many people have developed a dependence on codeine and often misuse it.  Over the counter codeine was only ever intended for short term use but many people use it excessively with sometimes dire consequences.

When can codeine be taken?

Codeine can be used to treat pain that is not effectively controlled with paracetamol or ibuprofen or both of these together.  As codeine is not available over the counter on its own it is taken in combination with paracetamol, Ibuprofen and sometimes aspirin.  Codeine can also be used to stop coughing and stop diarrhoea.

Codeine products are not available without consultation with a Pharmacist as there are many precautions with its use.

When should codeine not be taken?

As codeine can make you drowsy it should not be taken if you are about to drive or operate machinery etc.

Codeine should not be taken in breastfeeding or by children under 12 years unless advised by a specialist.

Codeine should be avoided or used cautiously in people who have asthma or other breathing conditions and gastrointestinal conditions.

It should be used short term in people taking certain medications such as antidepressants.

How to take codeine

Codeine with paracetamol can be taken as 1-2 tablets every 4-6 hours as needed up to a maximum of 8 tablets per day.

Codeine with ibuprofen can be taken as 1-2 tablets every 4 hours as needed up to a maximum of 6 tablets daily.

Codeine with aspirin can be taken as 1-2 tablets every 4 hours as needed up to a maximum of 8 tablets daily.

Be careful!

As codeine is available with paracetamol, ibuprofen and aspirin care should be taken not to take more than one product at a time containing codeine.  Currently codeine is available in some cold and flu medications also.

Side effects

Drowsiness, dry mouth, nausea and vomiting, constipation and difficulty breathing are the most common side effets.

Dependence can occur whereby someone who is using the medication frequently will experience withdrawal symptoms if they stop using it suddenly.  These withdrawal symptoms include diarrhoea, nausea and vomiting, sweating and feeling anxious.

What about?

Taking codeine long term is not recommended for several reasons.  Side effects and dependence are two reasons.  Interactions with other medicines are possible.

It has also been discovered that continued use of codeine changes how pain is perceived in our brain and can actually make pain worse if it is taken regularly.  It is suggested not to take codeine for more than three days in a row.

Conjunctivitis

conjunctivitis

Conjunctivitis

 

The suffix “itis” appears at the end of a lot of medical words and means inflammation.  Therefore conjunctivitis means inflammation of the conjunctiva, a layer of the eye.  There are three types of conjunctivitis.  Most people automatically think of a bacterial cause and want antibiotic treatment for this however this is the least common type.  Allergic conjunctivitis is the most common followed by viral then bacterial.

Allergic conjunctivitis

The eye has a watery discharge, is itchy and may be swollen or red.

Allergy eye drops and lubricating eye drops are the recommended treatment as well as trying to avoid what is causing the allergy eg pollen, dust, animal fur.

Viral conjunctivitis

The eye has a watery discharge, no itch, mild swelling and looks pinkish.

There is no effective treatment for most viral cases .  If there are sores on the eyelids or around the eyes it is essential to see a Doctor or optometrist as this could be caused by the herpes virus.

As it is very contagious it is important to wash hands well and wash bedding and towels and not share towels.  Avoid swimming as it can be spread through pool water.

Bacterial conjunctivitis

There is usually pus in the form of discharge, no itch, some swelling and the eye looks very red.

Cold or warm compresses and flushing with saline all feel nice but may not speed up healing.  Most cases resolve without treatment in 5-10 days.

Chloramphenicol antibiotic drops can be obtained by the pharmacist for patients two years and above.  These are used as one drop every 2 hours initially then every 4-6 hours for up to 5 days.  The eye can only hold one drop so any more is a waste.  Any time an eye drop is used it is a good idea to place a finger on the inner corner of the eye for a minute to stop the drop draining straight out and down the back of the nose.  Wash hands really well before and after using eye drops and be careful not to touch the bottle on to the eye or it can become contaminated.

If there are symptoms such as pain, loss of vision, cloudy eyes, reduced eye movement, changed pupil size, contact lens wear or possible foreign body a Doctor or optometrist should be seen.

Let’s look at…….paracetamol

paracetamol

Paracetamol

 

Paracetamol (known as acetaminophen in the US) is one of the most commonly used over the counter pain medications.  Unfortunately it is easy to intentionally and unintentionally overdose on paracetamol as it is contained in so many different products and in different strengths.

When can paracetamol be taken?

Paracetamol is the medication that is recommended first to take for pain that is acute (has just started) or chronic (ongoing pain) such as headache, toothache, temperature (fever), osteoarthritis, aches and pains due to colds and flu and other non-inflammatory conditions.

Paracetamol is safe to take during pregnancy and breastfeeding.

When should paracetamol not be taken?

Anyone with liver problems should check with their Doctor or Pharmacist before taking paracetamol.

There is no point taking, or giving to children, paracetamol for cold symptoms such as a runny nose.  If there is no temperature or aches and pains paracetamol and other pain medications will not help and should not be given.

How to take paracetamol

For adults and children over 12 years 1-2 (500mg) tablets every 4-6 hours is the recommended dose with a maximum of 8 tablets (4 grams) in 24 hours.

If taking the slow release 665mg tablets the dose is 1-2 tablets every 6-8 hours with a maximum of 6 tablets (4 grams) in 24 hours.

The 500mg tablets are best for acute pain and the 665mg slow release tablets are best for ongoing chronic pain where it should be taken regularly three times daily to prevent and treat the pain.

For children it is very important to check the dosage instructions each time a dose is given as the strength varies depending on the ages recommended on the bottle. The dose for the same child will be different depending on whether the infants, 1-5 years or 5-12 years product is used.  Children’s Panadol brand also make soluble and chewable tablets as well as suppositories.  Just as with adults children should not be given paracetamol more frequently than every 4-6 hours and no more than 4 doses per 24 hours.

Be careful!

Most people know that Panadol is a product that contains paracetamol.  There are so many other brands of paracetamol and it is important to make sure that only one brand is taken at a time to avoid overdose.  Overdose occurs usually when someone takes more than one product containing paracetamol at a time.  Cold and flu preparations usually contain paracetamol and most Lemsip products contain paracetamol too.  Care needs to be taken to avoid doubling up.

Liver damage and liver failure requiring liver transplant can and do occur every year.  Usually liver damage is unintentional but can occur if more than the recommended dose is taken or sometimes even if less is taken.  Older people, those who drink a lot of alcohol and those who have poor nutrition are more likely to suffer liver damage from less than the recommended paracetamol dose.

Side effects

All medications can potentially cause side effects.  Paracetamol rarely causes side effects when taken at the recommended dose.  Skin rash is possible though unlikely.

What about?

Can I take three paracetamol tablets at once to make my headache go away quicker?- NO you cannot! Taking three tablets at once will only give your liver a hard time trying to break down the medication and will not give you more pain relief.

 

Next week we’ll look at codeine.

Cold sores

cold sores

Cold Sores

 

Cold sores. Yuck! Sufferers dread the tingling and itching that signal a cold sore is on the way.  These symptoms can occur up to two days before there is anything visible at the usual cold sore hangouts around the mouth or nose.

Cold sores are usually caused by the herpes simplex virus 1(HSV1) which stays in our bodies for life after we have been exposed to it.  Other herpes viruses that cause different conditions also stay in our body for life after we have been exposed to them.

HSV1 is so common that 90% of us carry it though only 30% actually get cold sores.  People usually get the virus as a child or young adult though often cold sores don’t occur when we first get the virus.

 

How is the cold sore virus spread?

It is spread from person to person through contact with saliva or by touching the blister.  Unfortunately the virus can be present in the skin cells when there are no visible signs of a cold sore and so it is spread without knowing.

It is important NOT to share

  • drink bottles
  • cutlery and drinking glasses
  • towels
  • lip balms/lipsticks

and anything else that involves contact with the mouth and saliva.

Kissing is a common way to transfer the virus.  It is important not to kiss young babies and children or those with lowered immune system on the face to prevent virus transfer.

 

What triggers a cold sore?

What causes the body to activate the virus and make cold sores appear? They usually occur when our immune system is lowered ie when we are run down.  Cold sores often occur after experiencing something like a cold, hence the name.  Exposure to sun or wind as well as stress and general illness can lead to an outbreak.

 

Symptoms of cold sores

Tingling and itching, as mentioned above, are often the first symptoms experienced.  Fluid filled blisters that are often painful occur next.  The blisters can burst after a few days and become dry crusted sores that heal.

 

Treatment of cold sores

Cold sores do go away on their own if left alone.  It is tempting to scratch or pick at them which can lead to a bacterial infection of the sore or even viral infection of the eye if someone touches their cold sore and then their eye.

To shorten the duration of a cold sore it is very important to start treatment when the tingle or itch first appears.

  • Aciclovir 5% cream should be applied 5 times daily for 5 days when symptoms first occur. Once the cold sore is out this is not effective
  • Antiviral tablets available from the Pharmacist are effective if taken on the day the tingle/itch first appears
  • If the cold sore is already out there are topical treatments that can help prevent secondary bacterial infection and also help with the pain and discomfort
  • Hydrocolloid dressings are also available when the sore is present to seal off the wound to allow it to heal in a clean environment
  • Lysine supplements help to treat cold sores and prevent them in people prone to outbreaks.

 

Prevention of cold sores

Basically if we avoid getting stressed and sick we can avoid cold sores!  This is easier said than done!

Other, more manageable, prevention tips include wearing sunscreen, keeping out of the wind, avoiding close contact with someone who has a cold sore and NO lip licking.

 

If you think you have a cold sore please speak with your Pharmacist who can provide the best treatment for you.