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Hayfever

What is Hayfever?

Hayfever is the common name given to cold-like symptoms caused by an allergy to plant pollens which are inhaled at certain times of the year.

What are the causes of Hayfever?

If you are allergic to pollen, when you breathe it in it causes inflammation of the lining inside the airway, such that the lining swells. When this occurs inside the nose it is called rhinitis. Hayfever is often known as Seasonal Allergic Rhinitis, as it occurs at certain times of the year when plants release their pollen.

Pollen seasons in the UK:

  • Tree pollens – March-April
  • Grass pollen – May-July (peak in June and July)
  • Weed pollen – June-August
  • Mould spores – September-October

1 in 4 people in the UK are affected by hayfever and approximately 9 out of 10 of these have an allergy to grass pollen. Some people are allergic to both tree and grass pollen and so show symptoms for several months of the year. Hayfever often starts in childhood and then occurs every year afterwards.

Some people experience hayfever symptoms all year round, which is known as perennial rhinitis. Both seasonal and perennial rhinitis can lead to development of asthma. In known sufferers of asthma, untreated hayfever can increase the chances of having a severe asthma attack during the pollen season.

What are the symptoms of Hayfever?

The symptoms of hayfever can include:

  • Itchy nose, with or without itchy ears, throat and eyes
  • Sneezing
  • Watery discharge from the nose and sometimes eyes
  • Blocked nose
  • Oral allergy syndrome – irritation in the throat when eating certain raw fruit and vegetables, such as apples and celery. This is experienced by some people who are allergic to tree pollen and is due to a cross-reaction with pollen.
  • Poor quality sleep
  • Reduced ability to concentrate and function effectively at work or at school. Performance in examinations can be affected, especially if the sufferers are taking sedating antihistamine medication.

Some sufferers can be so severely affected that they cannot go outside during the pollen season.

How is Hayfever diagnosed?

Hayfever can often be self-diagnosed due to the regular pattern of symptoms occurring seasonally. However, if symptoms are less defined or persistent for several months, an allergy test may be required.

An allergy skin prick test is the most reliable way to diagnose hayfever. It consists of placing a small drop of fluid containing an allergen on your skin and then pricking the skin through the liquid. If you are sensitised to the allergen, a red itchy bump will appear due to your body releasing a chemical called histamine. This reaction indicates that you are likely to show allergy symptoms to that particular allergen.

Blood tests can also be carried out for those who cannot have skin prick tests such as those with severe eczema or very sensitive skin and those who are unable stop taking antihistamine medication because of troublesome symptoms.

How is Hayfever treated?

Three main methods are used to treat hayfever. These are:

  • Avoiding exposure to airborne pollen
  • Medication
  • Disease altering immunotherapy

Avoiding exposure to airborne pollen

It may seem obvious but avoiding exposure to pollen in the air can help to alleviate the symptoms of hayfever. A number of ways to help with this include:

  • Being aware of the pollen count, which is broadcast daily in the media along with the weather forecast and is reported as low, medium or high.
  • Avoid the countryside when the pollen count is high.
  • Keep your windows shut when travelling in a car and ensure your car has a pollen filter.
  • Avoid being outside at times when the pollen count is high, for example, when the air is warming in the mornings and cooling in the evenings.
  • Keep bedroom windows closed in the early morning and evening when the pollen concentration is high.
  • Hide your pillow under the bed covers during the day to prevent pollen from settling on it when the windows are open.
  • Wear glasses to protect your eyes from pollen when outside.
  • Wash your face and hair and change your clothes when coming indoors on days when the pollen count is high.
  • Wipe Vaseline around your nose and eyes to trap pollen and prevent any from entering your nose and eyes.
  • Consider using a nasal air filter – nasalairfilter.com
  • Carry out nasal douching – ( sterimarnasal.co.uk / www.neilmed.com/uk )

Medication

Many people are able to control the symptoms of hayfever using over the counter medication such as antihistamine tablets/syrup/nasal sprays and eye drops. Your pharmacist can give you advice on which of these options to consider.

You can also use saline sprays / douches to help wash away any trapped allergens, helping to reduce symptoms.

The following outlines which over the counter medications work best for each of the symptoms of hayfever:

  • Blocked nose – Steriodal nasal sprays such as Fluticasone or Beclometasone are most effective for nasal symptoms and can also help with eye symptoms. They can be used together with eye drops and antihistamine medication.
  • Itchy/watery eyes – Eye drops such as sodium cromoglycate or antihistamine tablets or syrups such as Loratadine or Cetirizine.
  • Itchy/runny nose – Antihistamine tablets or syrups such as Loratadine or Cetirizine, or nasal sprays such as Azelastine.

Nasal decongestant sprays can only be used occasionally and for up to five days, but never regularly, because they cause rebound congestion which causes swelling inside the nose when the spray is no longer used.

Steroid nasal spray treatment works best when:

  • used regularly
  • started before symptoms usually start, i.e. early in the hayfever season

If you are pregnant or breastfeeding, it is advisable to avoid antihistamine tablets, so steroid nasal sprays are the usual treatment of choice, and treatment should always be discussed with your doctor.

Using antihistamine medication will reduce symptoms of irritation but does not help to alleviate a blocked nose. They can be taken as a tablet or syrup for children and also come as nasal sprays and eye drops. If symptoms are mild or intermittent, antihistamines can be taken ‘as required’ because one dose usually starts to work within half an hour.

If your symptoms are continuous you can also take antihistamine medication daily. Non-drowsy antihistamines such as Loratadine or Cetirizine are taken only once a day and are advised over the older, cheaper types which cause drowsiness or psychomotor retardation and can cause reduced performance in examinations or driving. If the treatment you use regularly is no longer effective, you should try switching to another brand. A pharmacist can provide advice.

Some patients may need medication that is prescribed by their doctor. Recent advances include a spray which contains both antihistamine and topical steroid spray. Patients with asthma and hayfever may benefit from antileukotriene tablets.

Other options are available, such as homeopathy treatments, herbal remedies, nasal creams and powder sprays, but there is no scientific proof that they work.

Doctors sometimes prescribe short courses of steroid tablets for severely affected patients, but do not generally recommend injection steroid therapy for hayfever sufferers as this has severe side effects. Steroid tablets or injections are not recommended for use during the COVID-19 pandemic.

Disease altering immunotherapy

Immunotherapy, also known as desensitisation, consists of either a series of injections (subcutaneous immunotherapy) or daily medication under the tongue (sublingual immunotherapy). It can reduce allergy to pollen and therefore may be suggested for patients whose hayfever symptoms are severe and cannot be controlled by medication. Relief of symptoms can continue for many years, even after treatment has ended. It should start well before the pollen season begins and be used for 3 years, although most patients will see a reduction in symptoms from the first year. There is evidence that immunotherapy can also reduce the progression of rhinitis to asthma.

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