Hay Fever

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Hay-fever is a common health problem that people suffer from, caused by an allergy to pollen. It is also known as Seasonal Allergic Rhinitis or Intermittent Allergic Rhinitis. Up to 15% of the population, suffers from hay-fever and the numbers continue to rise every year.

The symptoms are caused by the body’s immune system overreacting to the presence of external sources as if they were toxic. Grasses, flowers and trees, all produce pollen throughout the spring and summer and this is for the most part, the time of the year that most people suffer from it.

Unfortunately the peak pollen time is the early summer when school and university exams take place. This normally results in sufferers finding it difficult to revise and perform well in their exams.

The main hay-fever season is from May to September with a peak around June to July. All the different types of plants, produce their own type of pollen at different times throughout the year.

Some people are allergic to all the types of pollen there are and therefore will suffer from March until October, where others will only be allergic to one pollen type and will only present themselves with the symptoms during the period of time that types of pollen is produced. In this case, the time when they will be affected will vary, depending on the pollen to which they are allergic to:

- Tree pollens (March to May)

- Grass pollen (May to July)

- Fungal spores and mould (September to October)

People are more likely to suffer from hay-fever if there is already a family history of asthma, eczema or hay-fever.

Hay-fever tends to be worse at two specific times of the day:

- In the morning, when the pollen rises in the air (7am-10am).

- In the evening, when the pollen falls (4pm-7pm).

Other factors that affect the severity of hay-fever are the weather and the air quality.
The amount of pollen in the air is known as the ”pollen count“. This is generally higher on warm sunny days when there is a breeze, so therefore will be lower on cold, grey or wet days.

Hay-fever is often mistaken for a cold or influenza because many of the symptoms are very similar.

One way to distinguish it from a cold or influenza is because there is no fever involved with hay-fever so if someone suffers from a high temperature, it is more likely to be either a cold or influenza.

It is a fact that anybody can suffer from hay-fever, but it most commonly affects young people between 8 and 25 years old. Hay-fever can clear up and stop affecting individuals once they reach their mid-30s.

Some people can also suffer from allergies throughout the entire year. This is not known as hay-fever but as Allergic Perennial Rhinitis“.

Warning: Allergic Perennial Rhinitis is caused by allergies to house dust mites, moulds or pets and its symptoms should be treated different to those of people suffering from hay-fever.

Substances which can trigger an allergy are called allergens. All symptoms caused by allergies, will depend on the type of allergen the person has been exposed to.

SYMPTOMS OF HAY-FEVER:

Symptoms of hay-fever are due to the immune system reacting to the pollen.
Particles of pollen produce antibodies which attach themselves to special mast cells.
People breathe in the pollen that is released through the air.

The pollen also lands on the skin or the eyes, and this results in the body producing a number of chemicals (the most notable one released is histamine) in those people who are allergic to pollen. Histamine then causes irritation, inflammation and secretions from the mucous membranes in the nose (rhinitis) and the eyes (conjunctivitis), which in turn leads to the following most common symptoms:

--> Frequent bouts of sneezing

--> Runny nose 

--> Itchy nose

--> Blocked nose 

--> Sore nose

--> Itchy throat 

--> Irritating cough

--> Wheezing 

--> Watery eyes

--> Itchy eyes 

--> Swollen eyes

--> Red eyes 

--> Sore eyes

--> Loss of smell and taste

Other symptoms may include:

--> Headaches

--> Skin irritation

--> Depression

--> Irritable mood

There is research showing that there is a link between asthma and hay-fever and that many people will suffer from both at the same time. Normally people that suffer from asthma have an 80% chance of developing hey-fever when they reach middle age.

Warning: If there is any wheezing or shortness of breath at the same time as suffering from hay-fever symptoms, this could be and indication of asthma, please consult with your doctor if those symptoms become present.

Most people know when they are suffering from hay-fever but sometimes they will show symptoms of sticky eyes or green/yellow mucus from the nose, these are normally signs of infection and anybody suffering from such symptoms should seek medical advise since the use of antibiotics might be required.

GENERAL ADVICE AND PREVENTION FOR HAY-FEVER:

Sufferers of hay-fever can reduce their symptoms by avoiding the allergen that caused it. The following suggestions might be useful for anybody that suffers from hay-fever:

- Wearing dark good quality glasses to reduce the amount of pollen reaching the eyes.
- In the summer time, avoid being outside early in the morning (between 7am and 10am) and in the evening (between 4pm and 7pm) when the pollen is moving.

- Keep windows and doors closed, especially during those times and when sleeping.

- Keep the car windows and vents shut when driving.

- Use air conditioning or filters whenever possible (at home, work or car) to remove pollen and other allergens from the air.

- Use an air ioniser in your home to remove pollen and dust particles from the air.

- Dump dust and vacuum your home regularly to minimise the presence of pollen and dust.

- Avoid mowing the lawn and walking in tall grasses or near trees, as these areas have high pollen concentrations. If you need to mow the lawn, consider wearing a mask and goggles.

- Have a shower, wash your hair and change your clothes after being outside.

- Avoid unnecessary extra irritants (e.g. smoke and chemical fumes).

- If you are allergic to any pets or dust, avoid contact as much as possible.

- Eating locally produced honey is said to help the immune system recognise the pollen and reduce the symptoms.

- Check the pollen counts in the newspapers, TV or radio.
The pollen count is the number of pollen grains per cubic metre of air.
A low pollen count of around 10 at the beginning of the season will trigger hay-fever in the most sensitive sufferers, others may not react until it tips over 50.
Pollen counts peak twice daily.

TREATMENTS FOR HAY-FEVER:

Unfortunately there is no known cure available for hay-fever but there are many different types of remedies that can help control and ease the symptoms. Avoiding allergens is normally the best solution but it is almost impossible to avoid them if the allergens are pollen.

Treatment is aimed at relieving the symptoms and large number of people will need to combine more than one treatment to relieve all of them at once.

There are four main different types of treatments for hay-fever:

1) Oral and topical antihistamines
2) Decongestants
3) Symptom presenters
4) Alternative medicines

- Oral Antihistamines:
Oral antihistamines are taken by mouth and are useful to reduce hay-fever symptoms by stopping the action of histamine being released in the body once the pollen has been breathed in or has come into contact with the skin or eyes.

They work systematically to treat all the symptoms. They are normally the treatment of choice for many sufferers as they work very well to control the symptoms and are easy and convenient to use. Some are also available as a once-a-day tablet. They are effective for runny noses and sneezing, although they wont help much once there is congestion causing blockage in the nose.

Histamine is not the only chemical released in the body in response to pollen so therefore antihistamines are unlikely to ease all the symptoms in people that suffer from hay-fever. Fortunately the treatment will be effective to a certain degree.

There are two main types of oral antihistamines:

1) Those that cause drowsiness:

- Chlorphenamine
- Diphenhydramine
- Promethazine

Warning: These can also cause a dry mouth and blurred vision in some people so caution must be taken when using them.

2) Those that RARELY cause drowsiness:

- Acrivastine
- Loratidine
- Ceterizine

Warning: Always remember that everyone is different and that we all react differently to drugs and that even though these antihistamines do not normally cause drowsiness, some people can be affected by them.

It is normally useful to take them at night time if they are being used for the first time in order to make sure that you do not react to them.

Many antihistamines only need to be used when the symptoms of hay-fever are bad and often will be combined with other ingredients, such as decongestants, to clear a blocked nose. People may try several different antihistamines before finding the one which suits them best

Warning: Oral antihistamines can not be used by anybody who is pregnant or breastfeeding.

- Topical Antihistamines:
Topical antihistamines are available in the form of nasal sprays.
They normally contain Azelastine or Levocabastine and can be very effective at quickly stopping sneezing. These work more directly to treat specific symptoms.

Warning: Even though nasal sprays do not cause drowsiness, they can only be used in adults and children who are over 12 years old. They also have maximum daily doses that must be followed.

Topical antihistamines are also available as eye drops. They normally contain Antazoline or Levocabastine and can be particularly useful for itchy, red and watery eyes. They are sometimes combined with another ingredient such as a sympathomimetic (e.g. Napazoline).

Warning: If people suffer from other eye conditions other than symptoms caused by hay-fever or wear contact lenses, they should speak to their doctors, opticians or pharmacist before using these eye treatments.

- Decongestants:
Decongestants can also be taken orally, by mouth or topically in the form of a nasal sprays or drops, to help relieve congestion, blocked noses and watery eyes. They work by reducing the blood supply to the nasal membranes and eyes.

Oral decongestants can be included in combination with antihistamines in some hay-fever treatments. They normally contain Pseudoephedrine.
Napazoline is often added to eye drops.

Warning: Nasal sprays and eye drops used to treat hay-fever should not be used for more than 5-7 days at a time as they cause a side effect of rebound congestion.

Topical decongestants normally contain Oxymetazoline, Xylometazoline and Phenylephrine.

Warning: These types of nasal sprays or eye drops may not be suitable for people with hay-fever since they have a short effective time span and most hay-fever sufferers need long term treatment, so therefore after 3-4 days little effect will be obtained and they will only be useful for rapid relief.

People that suffer from hay-fever might find it beneficial to use an inhalation such us Menthol and Eucalyptus, to relieve blocked noses.

- Symptom Preventers:
The use of Sodium Cromoglicate and corticosteroids such as Beclometasone and Fluticasone, can be used on a regular basis to help prevent symptoms of hay-fever from occurring.

Sodium Cromoglicate prevents and stabilises the cells that release histamine and other chemicals into the body in response to pollen. This makes the body less sensitive to the allergen. I needs to be used on a daily basis whether the symptoms are present or not in order to stop hay-fever from occurring. This ingredient is available in a nasal spray or eye drop form.

The nasal spray can often include a decongestant combined and since it wont cause rebound congestion due to the low strength of the decongestant, it can be used in long term sufferers. Treatment is best started before the symptoms appear.

Warning: The eye drops containing this ingredient should only be used by those who have been advised to do so by their doctors.

Beclometasone and Fluticasone, come in a nasal spray form and are steroids that reduces inflammation in the nose. They can also help with symptoms in the eyes and throat.

Steroids prevent symptoms from developing rather than just treating them when they occur and they should be use during the entire hay-fever season. They need to be used continuously on a daily basis to prevent nasal congestion and sneezing even if the symptoms are not present.

They take a few days to build up before the sufferer notices any benefit so they are best used before exposure to the allergen (that means before the hay-fever season begins).

Warning: Corticosteroids should not be used by anybody under the age of 18 years and can only be used up to 3 months at a time.

There are two other active ingredients that can be used as symptom preventers, but you will need to consult with your doctor. These are Budesonide and Flunisolide.

- Alternative medicines:
Alternative medicines that can be used for hay-fever are mostly herbal or homeopathic.

Homeopathic remedies include the following ingredients: Allium Sepa, Euphrasia, Gelsenium, Pulsatilla and Sabadilla.

Warning: Remember, just because they are herbal or homeopathic, it does not mean that they do not have any side effects or that they can be used by anybody. Always seek medical advice before using any type of treatment.

IMPORTANT: Remember, anybody that has wheezing or tightness in their chest, or are taking other medication, or women who are pregnant or breastfeeding and anybody under the age of 6 years, should seek medical advice if they suffer from hay-fever and they wish to use any of the treatments available.

Occasionally a doctor may consider it necessary to prescribe either tablets containing steroids, or possibly and injection which desensitises the person against the substance to which they are allergic to. Unfortunately this can bring on a serious reaction, and is only given under close hospital supervision, so is hardly ever used.

Always check the correct dosage for your treatment and read the instructions on the packet with care and if your symptoms fail to respond to the treatments, consult with your doctor.

NEWS:

A new prescription vaccine pill is currently being researched and is offering hope to grass-pollen allergy sufferers who do not respond well to antihistamines and steroid sprays.

Working on the same principle as desensitising injections, the vaccine contains an extract of timothy grass which, taken once a day allows the body to build up immunity to the protein that triggers hay fever symptoms.

There are also drugs being developed called Allergen Delivery Inhibitors (ADIs) which are being design to disable the allergens in pollen and house dust mites before they can cause an allergic reaction. The effect will be like avoiding allergens altogether. Clinical trials could start in 2010!

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