Results of a survey launched today revealed that GPs are not referring their severe seasonal allergic rhinitis patients to secondary care, forgoing patient choice and care. The findings demonstrate that GPs cannot see the benefit of referring or feel that they are able to manage their severe allergy patients in their own clinics, despite an increasing number of patients presenting with the condition and concerns about symptom breakthrough on current therapies. This practice is occurring in spite of evidence which shows that advanced management in secondary care during the winter months can improve patient outcomes ahead of the upcoming pollen season.1
Findings from the 2008 severe seasonal AR survey of more than 400 GPs and 500 AR patients revealed that two-thirds (65%) of GPs remarked that their biggest concern in treating severe seasonal AR patients was symptom breakthrough. Likewise, over two-fifths (42%) of patients surveyed rated their symptoms to be worse in 2008 compared to 2007 with almost one-in-three (29%) patients’ saying they were still experiencing symptoms last summer despite regular treatment from their GP. Patients also rated long-term efficacy of their current treatment and reliance on multiple therapies as two further issues of concern.
Despite this concern among patients GPs are not taking action with two-thirds (65%) not referring any of their severe seasonal AR patients who could benefit from advanced management, even when they were aware that local secondary care allergy services were available in their area.
“GPs can successfully manage patients with seasonal allergic rhinitis. However more severe patients will still experience symptom breakthrough and can be held as virtual prisoners in their home during the pollen season; affecting not only them but their whole family. For these patients, GPs should consider referral to a GPwSI or a specialist centre in order to access advanced treatments such as immunotherapy which can help symptom control and improve patient quality of life,” said Dr. Dermot Ryan, GP from Loughborough, Clinical Research Fellow, Department of General practice and Primary Care, University of Aberdeen.
The study also found that over half of GPs in the UK (53.1%) had seen as many as 20 severe seasonal AR patients during 2008’s pollen season. This figure shows a marked increase on current approximations which suggest that each GP in the UK will see an average of 1.53 severe seasonal allergic rhinitis patients.2,3
26% of adults suffer from AR in the UK, 4 typically suffering from symptoms such as a runny or blocked nose, frequent sneezing, itchy or watery eyes and an itchy throat, mouth, nose and ears5. These symptoms affect sleep, concentration and productivity at work or school.6,7 People with severe seasonal AR experience further deleterious symptoms and a worsening of co-existing conditions such as asthma.8
Despite an increasing number of severe seasonal AR patients presenting to their GP, there are still improvements to be made in the management of these patients. BSACI guidelines underpin allergy referral, highlighting that patients should be referred if uncontrolled on conventional therapies.8
Secondary care offers GPs an advanced management option for their patients with severe allergy. Management programmes such as immunotherapy offer an effective approach in tackling allergy, addressing the underlying cause of the disease instead of patients relying on antihistimanines and nasal sprays which only address the symptoms of their condition.9 Immunotherapy may also provide sustained treatment prevention and reduce long-term reliance on these rescue medications.9 However, GPs are relatively unaware of these advanced management options with 80% of GPs from the survey not aware of the benefits of immunotherapy.
Health professionals should take an active role in referring appropriate patients and can locate specialist local allergy services through visiting whttp://www.bsaci.org.uk
The 2008 severe seasonal AR survey was sponsored by ALK-Abelló Ltd.
About ALK-Abelló
ALK-Abelló is a research-based pharmaceutical company and a world leader in allergen specific immunotherapy with more than 80 years of experience in allergy treatment and diagnostics. Headquartered in Hørsholm, Denmark the company employs more than 1,200 employees worldwide. http://www.alk-abello.com
References
1. Calderon M A, Birk A.O, Andersen J S et al. Prolonged preseasonal treatment phase with Grazax sublingual immunotherapy increases clinical efficacy. Allergy 2007: 62: 958-961
2. White P, Smith H, Baker N et al. Symptom control in patients with hay fever in UK general practice: how well are we doing and is there a need for allergen immunotherapy? Clin Exp Allergy 1998; 28: 266-270.
3. Number of GPs in the UK. Royal College of General Practioners: Patient information factsheet. Accessed: 16 October 2008; http://https://www.rcgp.org.uk/patient_information/what_is_general_practice.aspx
4. Bauchau V and Durham SR. Prevalence and rate of diagnosis of allergic rhinitis in Europe. Eur Respir J 2004;24:758-64.
5. NHS Direct. Patient Information Leaftlet: Hay fever. Accessed: 16 October 2008; http://cks.library.nhs.uk/patient_information_leaflet/hay_fever
6. Crystal-Peters J, Crown WH, Goetzel RZ et al. The cost of productivity losses associated with allergic rhinitis. Am J Manag Care 2000;6(3):373-8.
7. Walker S, Kahn-Wasti S, Fletcher M et al. Seasonal allergic rhinitis is associated with a detrimental effect on examination performance in United Kingdom teenagers: case-control study. J Allergy Clin Immunol 2007 Aug;120(2):381-7.
8. Scadding G.K et al. BSACI guidelines for the management of allergic and non-allergic rhinitis. Clinical and Experimental Allergy 2008; 38: 19-4. (BSACI Guidelines)
9. Bousquet J et al. WHO Position paper: Allergen immunotherapy: therapeutic vaccines for allergic diseases. J Allergy Clin Immunol 1998; 102: 558-562.
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