Hay Fever

Allergic rhinitis is the medical word for hay fever - but the medical word covers more than just the pollen allergy of hayfever. It also includes other allergies which produce the same symptoms, and also those that can go on all year round. House dust mites are minute insect living in most of our homes. Many people are allergic to this, and it can produce hay fever symptoms all year round. Pets and other animals produce a dust from their skin which many people are allergic to. Feathers in duvets or pillows produce the same dust. The treatment is the same for all. As with any allergy it will not go away. Try to find what it is that you are allergic to, and avoid it whenever you can. The more you expose yourself to the problem - the more you will react to it. Some other things can also give the same symptoms - eating a curry, alcohol, some medicines and some emotional states.

Hay fever is also called a 'summer cold' - but it is an allergy, while a cold is caused by a virus. The symptoms can be the same though, with sneezing and a runny nose, but hay fever will not cause a fever, despite its name. The timing of the symptoms is the best guide to decide which is which. Colds only last a week or two, and are usually in the winter, while hay fever causes symptoms which can last longer, and can come and go, depending on the pollen levels each day, and are normally at the same time each year, in the spring and summer.

The nose is the main target for hay fever. Pollen is breathed in and sticks on the inside of the nose. If you are allergic to that pollen the nose lining will react. This reaction causes the release of chemicals, the main one being histamine. These chemicals trigger the body's defenses, and cause inflammation. Inflammation can go through three stages -

• Sneezing - this is caused by irritation of the nose lining, and is the body's natural reaction to blow out the thing causing the irritation. If this is not successful the next stage is -
• Runny nose - the lining of the nose is now starting to swell, and produce a watery liquid to wash out the irritation. If this is not successful -
• Blocked nose will result when the swelling of the lining of the nose combined with the now thicker mucus, gets so far as to start to block the air going through the nose. This is nasal congestion.

The eyes can also be affected, and can become red and itchy, and start to water.

The mouth, throat and ears can more rarely be affected. The roof of the mouth can become itchy. The throat can react by causing a cough. The ears can itch. All these reactions are the same allergic reactions that happen in the nose and eye.

There is some genetic link in hayfever. You are more likely to develop it if your parents had hay fever, or if they suffered with other allergic conditions such as eczema or asthma. So if your brother or sister already suffer from hay fever, then you may well have inherited the same sensitivity from your parents. Similarly if you had eczema or asthma as a child this makes you more likely to develop hay fever, and this is often the pattern that shows itself for someone who suffers from allergies. The peak age for hay fever is late teens and twenties. After that it usually gets gradually better, but may always give you some symptoms, especially in years with high pollen counts.

The way we live may have some effect on the development of hay fever. We are all exposed to many things every day that can cause us to become allergic to them, but most people don't. Our modern lifestyle could expose us to more of these allergy triggering substances. This allergy overload causes more people to become allergic to something. This could explain the increase in hay fever over recent years.

Treating hay fever is important to allow you to minimise the symptoms, and let you get on with your life, and stop it being a misery. Hay fever can not be cured but the symptoms can be controlled.

You can reduce hay fever symptoms by small changes in the way you do things through the hay fever season, by understanding more about pollen release, and reducing your exposure to pollen, without significantly disrupting your life.

Understand when pollen levels are high and low, and use this information to give you the edge to plan ahead for the best times to do things -

• Watch the pollen forecast, such as The Pollen Forecast on the Zirtek web site . The pollen count is measured as the number of pollen grains in a cubic metre of air, sampled over 24 hours. It is usually given as low, moderate, high, or very high. Most sufferers will start to experience hay fever symptoms at moderate levels.
• Watch the weather. Rain will wash pollen out of the air and stop plants releasing pollen. However the pollen builds up in the plants if it is not released, and so as soon as the sun comes out more pollen than normal will be released. The pollen level on this day will be higher than the pollen level on the same sort of day after several sunny days in a row.
• Watch the time of day. Grass pollen is released in the mornings from about 7.30am on a dry warm morning, however dewy mornings delay the time of release. Light to moderate winds blow the pollen around, and increase the chance of breathing it in. Still sunny days cause the pollen to rise high into the atmosphere, reducing the chance of breathing it in. The pollen falls back to earth when the atmosphere cools, typically between 8-10pm in the countryside, but slower in a city where more heat is retained in the concrete and brick. Inner city areas can have the pollen fall peak at midnight, and it may continue until 2pm.

Reducing your exposure to pollen can be done in several ways -

• Keep windows and doors closed when pollen levels are high
• Avoid cutting the grass or walking through cut grass
• Keep the house as dust free as possible, to control pollen levels
• On high pollen days change your clothes and wash your hair when you come in, as you will be bringing pollen into the house on these
• Cover your bed and pillows with a spare sheet during the day, and roll it up carefully before going to bed. This will keep your bed as pollen free as possible
• Dry clothes and bedding indoors, as pollen can stick to clothes hanging outdoors to dry
• Wear wrap-around sunglasses to keep pollen out of your eyes
• Avoid areas where pollen is being released, such as unmown grass in the mornings, or near to pollen-releasing plants (see the pollen calendar on the Zirtek web site )
• Air-conditioning can help filter pollen out of the air. This can help at work, at home, or in the car. Keep windows and vents closed when driving. Many newer cars can be fitted with pollen filters in the air intake, if so use them and change the filters as directed.. Ionisers can also help
• Keep away from pets who have been outside and avoid grooming them yourself, as they will carry pollen on their fur
• Avoid smoky or polluted atmospheres which can make irritation worse
• Do not rub your eyes. It only causes further swelling and redness.

Understanding the different treatments available is the key to successfully controlling hay fever symptoms. One product on its own will not normally be enough to fully control the symptoms, as the severity of hay fever will vary through the year, and can be worse some years than others.

There are five main types of treatment available from your pharmacy for hay fever -

1. Antihistamines neutralise the chemical histamine, which is released when the body reacts to pollen, or has a similar allergic reaction. So, even though the body is reacting in an allergic way, you will not suffer the symptoms so badly. Tablet and liquid antihistamines can be used for occasional symptoms, as they start working within about half an hour. So, if you only have symptoms when the pollen count is high, you could watch the pollen forecast, and only take them when a high count is forecast. For symptoms that occur regularly they are best used on a regular basis as a preventative, starting at the first sign of any symptoms. They can be used together with any of the other three groups of hay fever products, where one product is not enough to relieve the symptoms, or for those special occasions such as exams, interviews or weddings, where you need to be as symptom-free as possible.

Older antihistamines are still popular, but with some people can cause drowsiness, which may be a problem with driving, concentrating, and drinking alcohol. However they are often cheaper than newer antihistamines.

• Piriton Allergy Tablets (Children over 6 years & adults)
• Piriton Syrup (Children over 1 year & adults)

Newer antihistamines do not normally cause drowsiness, though some people can be affected to some degree. Many of them also work over the whole 24 hours, and can be taken as a single daily dose. There are three antihistamines to choose from -

- Acrivastine is quick acting and lasts for about 8 hours. The brands containing it are -

• Benadryl Allergy Relief Capsules (Children & adults 12 - 65 years)

- Cetirizine works over the whole 24 hours. The brands containing it are -

• Benadryl One a Day Relief Tablets (Children over 12 years & adults)
• Piriteze Allergy Tablets (Children over 12 years & adults)
• Zirtek Allergy Tablets (Children over 12 years & adults)
• Zirtek Allergy Relief For Children (Children over 6 years)

- Loratadine works over the whole 24 hours. The brands containing it are -

• Clarityn Allergy Syrup (Children over 2 years & adults)
• Clarityn Allergy Tablets (Children over 12 years & adults)

Eye drops and nasal sprays are also available as antihistamines. These are quicker acting than the tablets or syrups, and are best used for quick-acting or occasional relief of hay fever symptoms.

• Otrivine Antistin Eye Drops (Children over 5 years & adults) Also contains a decongestant

2. Anti-allergy products take a few days to start working, so start using them as early as possible at the first warning that your symptoms are starting, or when pollen warnings show your symptoms should be due. They are best then used regularly as a preventative. They can be combined with the antihistamine tablets or liquids where one product is not enough to relieve the symptoms.

Steroid nasal sprays are particularly effective where there is nasal congestion, where the lining of the nose is swollen, giving you a blocked nose. Don't be worried by the word 'steroid'. It is a very low dose, and very little is absorbed into the body generally, and so does not cause side-effects that a steroid tablet can. They should not continuously for longer than 3 months without consulting a doctor.

• Beconase Hayfever Nasal Spray (Adult over 18 years)
• Flixonase Allergy Nasal Spray (Adults over 18 years)

Mast cell stabilisers work by reducing the chances of the body's natural stores of histamine (the mast cells), releasing histamine, and thus producing the symptoms of allergy. They are not steroids, and are suitable for children.

• Opticrom Allergy Eye Drops (Children & adults - no age range given)

3. Decongestants are the same products you use for a cold. Decongestants quickly help to relieve a runny or blocked nose, and can help as a quick acting and short term fix. They can be used with the other three types of medicines. The tablets and liquids can be used for a week or two, but the nasal sprays should not be used for longer than a week, or you can become dependant on them.

• Sudafed have a tablet, liquid and nasal spray

Decongestants plus antihistamines combine the benefits of both products, and are useful where the two products need to be used together. The brands containing them are -

• Benadryl Plus Tablets (Children & adults 12 - 65 years)

4. Homeopathic products can be used on their own or combined with antihistamines and anti-allergy products if they are not strong enough to control all the symptoms.

• New Era H Hay Fever Tablets (Children & adults - no age range given)

5. Allergy filters are also popular.

• Nasal Air Guard is an air filter which is used in the nose. It is actually much more comfortable to use than it sounds. It filters out pollens and oother allergens, and stops you breathing them in to your nose in the first place.
• Nasaleze (Children & adults - no age range given) is a natural treatment for the nasal symptoms of hay fever. It is not a medicine, but an inert plant based extract, which comes as a very fine powder in a puffer bottle. A couple of puffs in each nostril coats the lining of the nose and protects its sensitive tissues from coming into contact with pollen. This helps stop the nasal symptoms of hay fever from occurring.

Seasonal hay fever is what we all think about when we us the words 'hay fever', and it has been called a summer cold. It is the most common form. However there are different seasons within the hay fever calendar -

• Spring - causes the release of tree pollens
• Summer - brings grass pollens, and the peak in hay fever
• Autumn - releases fungal spores and autumn flower pollens

The Pollen Calendar. Click here to see the pollen calendar on the Zirtek web site

You can be sensitive to just one or two types of pollen, and so your pattern of symptoms may be different to someone else's.

The exact timing can vary slightly from year to year, depending on how the weather effects pollen production. Also the warmer conditions in the south produce pollen earlier than in the north, but the general pattern is the same each year. Town and cities have different pollen mixtures to the countryside, depending on what plants grow locally.

Very high pollen counts can produce symptoms in some people who do not normally show hay fever symptoms, and so may only experience discomfort every few year.

Some people suffer all year round when they are allergic to things that are in the air all year. There are two common causes of this, and most people choose to ignore them -

• House dust mite is a minute insect living in most of our homes, and feeding on dust (which consists mainly of human skin cells). Its droppings easily get into the air, and we breathe them in
• Pet dust - in actual fact dead skin cells and hair particles from our beloved pets are dropping all around your house all the time

Other causes of symptoms can be food allergy or food intolerance or an irritation or stress reaction to either a food, flavouring, colouring, alcohol, smoke, stress, some medicines or many other triggers.

When you first suffer from hay fever it is recommended that you see your doctor, and have a proper diagnosis, even though you may be sure that you have hay fever. The information abut hay fever on this site, and whatever else you can find out from other sources, will help to stop you bothering the doctor unnecessarily. The doctor will want to record the facts on your medical records, and see how hay fever effects any other medical conditions you have, such as asthma .

Do not treat yourself for longer than 3 months without checking with your doctor, so that your doctor can check your treatment is correct. Some products state this in their information leaflet, but it is a sensible precaution for all of them.

Danger symptoms to look out for include -

• wheezing, tight chest and cough - which may be hay fever triggering asthma symptoms
• ear ache, pain on the face, and discharge from the eyes - which can be infections caused as side-effects of hay fever, in the ear, sinuses and eyes
• if your symptoms do not improve after five days of using a treatment, then this is time to review the treatment
• difficulty sleeping, showing that your hay fever is not under control, and needs reviewing

Other ways your doctor can help include prescribing medicines which you can not buy from your pharmacy, and other treatments which need specialist advice, such as desentising you to something you are allergic to. Such treatments are normally only used for severe case of hay fever, where the normal products are not enough to keep your symptoms under control.