General practice pilot to ease ‘significant impacts’ of hay fever

In a bid to improve outcomes for young people who experience hay fever, 17 general practices and allergy clinics across Australia are taking part in a new trial.
 
As part of the Murdoch Children’s Research Institute, the National Allergy Centre of Excellence (NACE) has partnered with the clinics to launch the ARISE Trial.
 
Allergic rhinitis is one of the most common respiratory conditions in Australia, but NACE researchers identify that many people do not seek medical treatment, or use treatment nasal sprays incorrectly – leading to ongoing symptoms. 
 
The trial will examine 14–29-year-olds with hay fever to follow a specifically designed education package alongside their daily nasal spray, to assess whether they experience fewer symptoms and have better quality of life. The researchers expect it will improve management of the common allergy, reducing symptoms and ease pressures on the healthcare system.
 
Tasmanian GP Dr Nicholas Cooling is Chair of RACGP Specific Interests Allergy and works in one of the practices recruiting patients for the study, where he sees firsthand that hay fever is ‘a big problem’.
 
‘Allergic rhinitis has a significant impact on quality of life,’ he told newsGP.
 
‘It’s not just a sniffle, a sneeze and a blocked nose – in children it can cause significant impacts on nose breathing which in turns affects sleep, tiredness and knock-on effects on emotional wellbeing, poor concentration and parental distress.
 
‘In adolescents it increases school absences and poorer performance due to distraction, fatigue and irritability.
 
‘The condition should be highlighted as an important problem, with far-reaching health impacts, but which can be easily managed, once identified. It should appear on any chronic disease management plan as a bone fide chronic disease.’
 
Dr Cooling said GPs’ role is to identify the condition, assess its impact, and set up a management plan, including advising about reducing exposure to the allergen and providing evidence-based medication, especially intranasal steroids.
 
‘Using an ASCIA Allergic Rhinitis Treatment Plan template can organise this process better,’ he said. ‘It also includes pictorial advice on how to effectively use the nasal spray.’
 
With the ARISE Trial aiming to ‘help participants better manage their symptoms to reduce the risk of adverse side effects taking over their lives’, it highlights the significant role GPs have, including ensuring patients use their treatment nasal spray properly.
 
The researchers say that most people do not seek medical care for the condition, and those who use nasal sprays often do not use them as consistently or for as long as recommended, leading to ongoing symptoms. 
 
Dr Cooling adds that among younger age groups, adherence to nasal sprays is ‘the biggest problem’ in treatment of allergic rhinitis.
 
‘There is strong evidence that intra-nasal steroid sprays, with or without antihistamines, improve symptoms of allergic rhinitis and they are the central part of medication treatment,’ he said.
 
‘The barriers to using these nasal sprays are summarised as ‘why, how and when’. This includes: understanding why they should use it as a preventive medication and the motivation to take this spray regularly; how to actually use it to improve effectiveness and reduce side effects (such as nose bleeds); and when to use it – usually twice daily perennial or seasonal.’
 
But with GPs often time-poor, Dr Cooling said the ARISE Trial will hopefully ease those pressures.
 
‘GPs don’t have much time to educate patients about treatment of allergic rhinitis, often it’s the last on a long list of health problems and may be seen as less important,’ he said.
 
‘This study will show the benefit of an allergic rhinitis treatment plan, the value of follow up and outsourced automated smart tech savvy education – which is more time efficient for the healthcare provider and may yield more persuasive messaging for the patient.’
 
Allergic rhinitis affects around one quarter of Australians. While it impacts all age groups, the majority of allergy symptoms experienced by young people are attributable to the condition, including 10% of 1–14-year-olds and 21% of 15–24-year-olds.
 
In collaboration with peak national allergy organisations, the NACE team has developed the trial’s education package, which is designed to help improve young people’s knowledge and adherence to the correct use of their intranasal steroid spray. Over three months, participants will complete three online surveys and video calls with the study team, who will monitor whether the group records better outcomes than those who only receive standard education from their doctor.
 
Dr Arif Kozgar is a general paediatrician at Victoria’s Latrobe Regional Health, one of the ARISE recruitment sites. He told newsGP the trial will support GPs and paediatricians in their management of hay fever in young people.
 
‘This includes weekly electronic alerts on how and when to use intranasal steroid spray, their region’s pollen count, tips for managing symptoms and the latest research,’ Dr Kozgar said.
 
‘Research shows an urgent need to improve education about managing allergic rhinitis, especially for young people when effectively using their treatment medication.
 
‘The best thing about this trial is that it’s online, meaning hay fever patients in both urban and regional areas can participate.
 
‘If successful, it will change how GPs and paediatricians across Australia can help young people manage hay fever, reducing the burden on those living with Australia’s most common allergic disease, their families and the healthcare system.’
 
In addition to the 17 general practices and allergy clinics across Australia, the NACE study is also seeking further trial sites.
 
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allergic rhinitis allergy allergy nasal spray general practice trial hay fever respiratory conditions young people’s health