Dr Tariq Jagnarine
Family Medicine, Endocrinology/Diabetes
Hay fever, or allergic rhinitis, is a common condition with symptoms like those of a cold. There may be sneezing, congestion, runny nose, and sinus pressure.
It is caused by an allergic response to airborne substances, such as pollen. The time of year it happens depends on what substance, or allergen, the person reacts to.
Despite its name, hay fever does not mean that the person is allergic to hay and has a fever. Hay is hardly ever an allergen, and fever is not a symptom.
SYMPTOMS
Hay fever is sometimes, but not always, related to pollen.
Symptoms can start at different times of the year, depending on what substance the patient is allergic to.
A person who is allergic to a common pollen will have more severe symptoms when the pollen count is high. Common symptoms include:
• Sneezing
• Watery eyes
• Itchy throat
• Blocked, itchy, or runny nose.
Severe symptoms may include:
• Sweats
• Headaches
• Loss of smell and taste
• Facial pain caused by blocked sinuses.
• Itchiness spreading from the throat to the nose and ears.
• Some people may experience tiredness or fatigue, irritability, and insomnia.
People with asthma may experience more wheezing and breathlessness at times when hay fever symptoms are common.
TREATMENT
A range of over the counter (OTC) treatments can help manage hay fever. Sometimes, a combination of two or three is best. A physician can advise about options.
Medications
These include:
• Antihistamine sprays or tablets: Commonly available OTC, these stop the release of the chemical histamine. They usually effectively relieve symptoms of a runny nose, itching, and sneezing, but they will not unblock congested sinuses. Older antihistamines can cause drowsiness.
• Eye drops: These reduce itching and swelling in the eyes. They are usually used alongside other medications. Eye drops often contain cromoglycate.
• Nasal corticosteroids: These sprays treat the inflammation caused by hay fever. They offer a safe and effective long-term treatment. It may take a week for benefits to show.
• Oral corticosteroids: Severe hay fever symptoms may respond well to prednisone tablets, prescribed by a doctor. These are for short-term use only. Long-term use is linked to cataracts, muscle weakness, and osteoporosis.
• Immunotherapy: Immunotherapy can provide long-term relief by gradually desensitizing the immune system to the allergens that trigger the symptoms. It is usually received in the form of allergy shots or sublingual drops for people whose symptoms are serious and have not cleared up following other treatments.
• Immunotherapy may lead to lasting remission of allergy symptoms, and it may help prevent the development of asthma and new allergies. Injections are given by a doctor, but sublingual immunotherapy, or medication that is dissolved under the tongue, can be taken at home.
Alternative therapies
Alternative therapies that claim to treat hay fever include acupuncture, but study results have not confirmed significant improvements.
No herbal remedies are recommended.
During pregnancy, it is important to speak to a doctor before taking any medication, to prevent potential adverse effects on foetal development.
DIAGNOSIS
A pinprick test can identify what is causing the allergic reaction.
To specify the correct treatment, a doctor will look at the symptoms and ask about personal and family medical history.
A blood or skin test can identify which substance the patient is allergic to.
In a skin test, the skin is pricked with a minute amount of a known allergen.
A blood test will show the level of IgE antibodies. This will be high if an allergy is present. The test takes about 20 minutes.
Zero IgE antibodies indicate no sensitivity, while 6 indicates very high sensitivity.
Another skin-prick test involves injecting an allergen under the skin and checking for a reaction around 20 minutes later.
HOME TREATMENT
An individual cannot prevent the development of an allergy, but people who experience hay fever may find some strategies useful for minimizing the impact.
Here are some tips:
• Be aware of the pollen count during susceptible months.
• Keep windows and doors shut when the pollen count is high.
• Regularly splash the eyes with cool water, to soothe them and clear them of pollen.
• Shower and change your clothes after coming indoors when pollen counts are high.
• Use wrap-around glasses to protect the eyes from pollen.
• Wear a hat to prevent pollen from collecting in the hair and then sprinkling down onto the eyes and face.
• Have cars fitted with a pollen filter, and drive with the windows closed at high-count times.
• Do not have flowers inside your home.
• Keep all surfaces, floors, and carpets as dust-free as possible.
• Choose a vacuum cleaner with a good filter.
• Use “mite-proof” bedding.
• Use a dehumidifier to prevent mould.
• Keep away from cigarette smoke, and quit, if you are a smoker.
• Wash pets when they come indoors on a high pollen count day or smooth their fur down with a damp cloth.
• Smear Vaseline around the inside edges of your nostrils, as it helps stop pollen from getting through.
• Ask a physician for a plan, if you know your susceptible time is just around the corner.
There is currently no cure for hay fever. However, symptoms can be managed during the times of the year that have a high pollen count. For treatment to work in the first year, treatment should be commenced 3 months before the season in which pollen spreads.
Continued treatment can have the effect of reducing symptoms, improving immunity to the allergen, and enhancing the quality of life. Three years of treatment has been shown to lead to long-term desensitization against pollen.
However, if symptoms do not improve significantly after one year, treatment should be discontinued as it is unlikely to work.
Hay fever can become more serious, moving into the lungs and developing into allergic asthma. People with a pollen allergy can also become more likely to develop other allergies, such as food intolerance. Severe hay fever can also make the mucous membranes of the nose more sensitive to other irritants, such as cigarette smoke or dry air. This can lead to sinusitis.
