Hay Fever or Seasonal Allergies
Hay fever-why all the fuss?
After a cold, wet and windy winter most of us look forward to Spring and Summer. With Spring comes blooming trees and flower buds with fun walks in the park, time in the garden and playing outside. If you are one of the 1 in 4 people in the UK and Europe who suffer from nose allergy in Spring and Summer however, then the common symptoms at this time of year of sneezing, a runny nose, nasal congestion and eye symptoms such as itchy and red swollen eyes can become especially bothersome.
Did you know...?
Whilst perhaps many simply refer to hay fever as irritating and annoying, medical studies have shown nose allergy shown to be very disruptive to everyday well-being. Those studies revealed that of individuals affected 59.7% feel tired and 51.5% have trouble falling asleep. This impacts on day to day well-being, school and work productivity as well as taking part routine daily activities. Alarmingly one study showed that adolescents with hay fever symptoms had a 43% greater likelihood of dropping an exam grade for an exam taken in the summer when compared with a winter exam. Amongst those taking antihistamines with a sedative effect the increased risk rose to a staggering 71%. Hay fever or seasonal nose allergy thus can impair a teenager’s life chances.
What are the symptoms?
Hay fever signs and symptoms can include:
- Itchy nose, in the roof of mouth or throat, even in the ears
- Runny nose and nasal congestion
- Watery, itchy, red eyes (termed allergic conjunctivitis)
- Swollen, blue-coloured skin under the eyes (called allergic shiners)
Asthma symptoms such as cough, chest tightness and wheezing can often co-exist feeling like having a common cold that never really gets better and which may seem worse after each exposure to an allergic trigger after for example a walk outside.
Seasonal allergies-what pollens commonly cause hayfever?
Many people think of hay fever as a summer allergy and do not associate their symptoms to hay fever earlier in the year. In early spring however tree pollen is common. With birch, alder and hazel, in that order being the most potent of allergy inducing trees. In Europe birch tree pollen is the most common cause accounting for almost 25% of patients with hay fever. The start of tree pollination and its duration is dependent on temperature and regional conditions, though often March is the peak of the birch pollen season. Hazel and alder trees however can release pollen as early as December and may persist into the following April.
In late spring and summer grass pollen is common and, can be very bothersome with a high associated prevalence of troublesome eye allergy (conjunctivitis).
Grass pollen allergy usually begins around mid-May. In hay fever sufferers at this time of year as many as 90% have sensitisation to the common grass Timothy grass (Phleum pratense). The pollination of grasses often peaks in June (exam time) and extends to late July.
A less known trigger are the spores from indoor and outdoor fungi or moulds. These spores can be both seasonal and perennial depending on climate, region and type of spore.
Hay fever (allergic rhinitis) treatment approach
Treatment of allergic rhinitis depends on the severity and the type of symptoms.
Identify the pollens that may be causing allergic rhinitis
The well-practised doctor will take a detailed clinical history which will often indicate to the experienced allergist what pollens someone may be sensitised to. Allergen testing through a painless skin prick testing is often undertaken to confirm the history and allergen profile- that is the range of triggers that nay be causing the symptoms. Knowing what someone is allergic to enables the individual to
How can I avoid pollen exposure?
It is very difficult of course to avoid exposure to pollen unless you are determined to stay indoors during the spring and summer. The tips below may help decrease your pollen exposure.
- Stop pollens coming inside the house. To do this keep windows closed day and overnight. Pollen release often occurs early morning and as air cools towards the evening, the pollens fall to the ground. Pollen counts are often higher on warm and dry days.
- Wearing sunglasses that have a ‘wrap-around the eyes’ style can help prevent a direct hit of pollens onto your eyes. For any outdoor tasks, such as gardening, a hay fever mask or nostril air filters can help but is likely to make gardening a chore rather than a pleasure.
- Do not dry clothes outside on high pollen count days.
- Keep car windows closed when driving and fit a pollen filter to reduce the impact of pollen spores. Ensure your air conditioning is set to recirculate the air inside.
- Shower and wash your hair to remove pollen if you have been outside.
- Pets can catch pollens on their coats and contaminate the house, so washing pets more frequently to wash away any trapped pollens is helpful in the spring and summer.
Key to medical treatment
BEFORE the pollen season arrives start medical therapy with an intranasal steroid (INS) at least 2-4 weeks before onset of symptoms. In individuals with moderate to severe symptoms or when nasal congestion is significant starting an intranasal steroid spray prevents immune system priming (priming means that the immune system becomes ready to mount a strong and fast response to the allergen).
Consider allergen immunotherapy (allergy desensitisation) if symptoms do not respond to standard medical intervention.
Allergen immunotherapy achieves substantial improvements in patients with hay fever by improving nasal and ocular symptoms and reducing medication need and improving quality of life. When the right patient is matched to the right allergen desensitisation product, the results can be truly amazing. In my NHS and private practice, I have treated several hundred patients over the years with outstanding clinical results.
Read about Kenalog steroid injections for hay fever.
Take home message
Doctors are getting very good at treating hay fever. There are ever more effective and new treatments available. Allergy desensitisation by a trained allergist is possible. There are several exciting vaccines either in practice or in development. There is no reason now to suffer and not to look forward to Spring and Summer.