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Hay Fever - NHS Choices tell us affects in one in five people in their life. Research by Allergy UK shows 15% of sufferers are so affected by their hay fever they don’t like leaving their own house. Nearly a quarter (23%) of adult hay fever sufferers say the condition makes them miserable. 38% find it difficult to sleep, 29% feel unable to concentrate, whereas one in five (20%) say it makes it hard for them to do their job.
Rhinitis is inflammation of the nose, which is recognized by symptoms such as sneezing, runny nose, blocked/stuffy nose, itching and 'post-nasal drip' (the sensation of mucus running down the back of the throat). It can occur in association with inflammation of the eyes or sinuses. Rhinitis can have several causes, such as infection, a reaction to medication, irritation by dust, or allergy.
Hay Fever (seasonal allergic rhinitis) is caused when the body makes allergic antibody (IgE) to a substance such as pollen, house dust mites, cat, dog or moulds (called an allergen). In people sensitive to these allergens, exposure causes the release of chemicals from cells in the nasal passages, eyes or airways. This results in inflammation and irritation of the lining of the eyes, nose, and throat.
Grass pollen is the most common allergen, which affects sufferers at the specific times of the year when grass pollen is released (May-July). However, some people become allergic to tree or weed and shrub pollens, and will, therefore, be affected at different times of the year (February-June for trees; September and October for weeds). The patient who is allergic to tree, grass and weed pollens may suffer a very prolonged 'hay fever season'.
Symptoms In an attempt to rid the body of allergens, the immune system overreacts and releases chemicals (mediators) which cause inflammation. Some of these mediators (e.g. histamine) work quickly, causing sneezing, itching and runny nose. The eyes may also be affected, with itching, redness, and watering (allergic conjunctivitis). Other mediators work more slowly, causing a blocked or stuffy nose, which may lead to a headache and difficulty sleeping.
Rhinitis is often regarded as a trivial problem but studies have shown that it severely affects people's quality of life. It disturbs sleep, impairs daytime concentration and the ability to carry out tasks, causes people to miss work or school, and has been shown to affect children’s school exam results.
People who suffer rhinitis are at increased risk of developing asthma. Inflammation at one end of the airway (the nose) often spreads to the other end (the lungs), and this has led to the 'one airway' approach to treatment. Asthmatics who also suffer rhinitis have less severe asthma and less A&E and hospital admissions if their rhinitis is treated effectively.
Symptoms that continue all year are called perennial allergic rhinitis and commonly relate to indoor allergens, such as house dust mites, pets, and indoor moulds.
Pollen-food allergy Some people with pollen allergy (especially allergy to tree pollens) may be affected by cross-reactions between their pollen allergy and certain foods. For example, they may find that when eating certain fruits and vegetables, especially raw, they get an itchy mouth or throat, symptoms of oral allergy syndrome. Consumer research from Allergy UK shows 40% of hay fever sufferers also react to one or more of nuts, fruit, vegetables or spices.
Rhinitis can be managed by:
1. Avoidance of the allergic trigger (Pollens, moulds, house dust mite etc) Allergen avoidance is difficult for people with an allergy to substances in the air, such as pollen. For example, tiny pollen spores are windborne and travel for miles on air currents. However, many people do benefit from allergen avoidance to house dust mite and pets, while some simple measures can be used to help people with hay fever.
2. Treatments that suppress the symptoms of rhinitis Anti-histamines work against histamine, an important mediator in rhinitis. They are available as tablets (liquids are available for children) although anti-histamine nasal sprays are also available. There is a large range of anti-histamines; the newer ones are mostly taken once daily and do not cause drowsiness in most people. This form of treatment can be all that is needed in some people and is most effective for sneezing, an itching, and runny nose, but less so for a blocked nose. Different anti-histamines suit different people so if the first one you try is not helping, switch to another.
If symptoms persist or are more severe, the regular use of a steroid nasal-spray is often effective in relieving symptoms, especially if a blocked nose is a problem. These are available from pharmacists or on prescription from the GP. As with anti-histamines, there are different types of steroid nasal spray and a sufferer may need to try more than one to find the best solution.
Cromoglycate nasal sprays are useful alternatives to anti-histamines in some people. Additional drugs are available on prescription for people who suffer seasonal asthma as well as hay fever symptoms.
Nasal sprays that contain decongestants may be useful on the worst days but should not be used regularly, as they can make symptoms worse if used frequently.
Anti-histamines and steroid nasal sprays often control eye symptoms as well, but eye drops are available over-the-counter or on prescription if needed.
It is recommended that all rhinitis treatments should be taken regularly, starting shortly before symptoms normally begin. It is more difficult to control symptoms that are already well established. Research shows only taking medications occasionally on the worst days is much less effective.
3. Treatments that alter the immune system response to the allergen.
Desensitisation (also called immunotherapy) is a treatment where an allergic person is exposed to very small doses of allergen on a regular basis. It can be a very successful treatment for severe allergic rhinitis, as it causes the body to develop ‘regulatory’ immune cells which control the allergic reaction and results in tolerance to the allergen.
Desensitisation is available in two main forms, either as injections or as a tablet which dissolves under the tongue (sublingual therapy). To date, the most effective treatment is a course of immunotherapy, which can have long-lasting benefits. Immunotherapy is only carried out in specialist medical centres, in case a serious allergic reaction, known as anaphylaxis, occurs. As immunotherapy is so intensive and time-consuming, it is only those with extreme symptoms uncontrolled by normal medications who receive this therapy. In order to be considered for desensitisation, the individual will need to be referred to a specialist allergy clinic by your GP.
Allergy testing is not usually required in simple hay fever because the trigger substances can be easily identified from the history of when and where symptoms occur. However, in certain cases, a skin prick test or blood test might be of some value.
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