Hay fever

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Seasonal allergic rhinitis, also called pollinosis, hay fever or nasal allergies, and often also written together as hayfever, is a collection of symptoms, predominantly in the nose and eyes, that occur after exposure to airborne particles of dust, dander, or the pollens of specific seasonal plants in people who are allergic to these substances.

When these symptoms are caused by pollens, the allergic rhinitis is commonly known as "hay fever", after the fact it is most prevalent during haying season.

Causes

Allergies are caused by an oversensitive immune system, leading to a misdirected immune response. The immune system normally protects the body against harmful substances such as bacteria and viruses. Allergy occurs when the immune system reacts to substances (allergens) that are generally harmless and in most people do not cause an immune response.

As noted above, hay fever involves an allergic reaction to pollen. A virtually identical reaction occurs with allergy to mold, animal dander, dust, and similar inhaled allergens. Particulate matter in polluted air and chemicals such as chlorine and detergents, which can normally be tolerated, can greatly aggravate the condition.

The pollens that cause hay fever vary from person to person and from region to region; generally speaking, the tiny, hardly visible pollens of wind-pollinated plants are the predominant culprits. Pollens of insect-pollinated plants are too large to remain airborne and pose no risk. Examples of plants commonly responsible for hay fever include:

• Trees: such as birch (Betula), alder (Alnus), hazel (Corylus), hornbeam (Carpinus), horse chestnut (Aesculus), willow (Salix), poplar (Populus), plane (Platanus), linden/lime (Tilia) and olive (Olea). In northern latitudes birch is considered to be the most important allergenic tree pollen, with an estimated 15-20% of hay fever sufferers sensitive to birch pollen grains. Olive pollen is more important in Mediterranean regions.
• Grasses (Family Poaceae): especially rye (Lolium sp.) and timothy (Phleum pratense). An estimated 90% of hay fever sufferers are allergic to grass pollen.
• Weeds:ragweed (Ambrosia), plantain (Plantago), nettle/parietaria (Urticaceae), mugwort (Artemisia), Fat hen (Chenopodium) and sorrel/dock (Rumex)

In addition to individual sensitivity and geographic differences in local plant populations, the amount of pollen in the air can be a factor in whether hay fever symptoms develop. Hot, dry, windy days are more likely to have increased amounts of pollen in the air than cool, damp, rainy days when most pollen is washed to the ground.

The time of year at which hay fever symptoms manifest themselves varies greatly depending on the types of pollen to which an allergic reaction is produced. As most pollens are produced at fixed periods in the year, a long-term hay fever sufferer may also be able to anticipate when the symptoms are most likely to begin and end, although this may be complicated by an allergy to dust particles.

When an allergen such as pollen or dust is inhaled by a person with a sensitized immune system, it triggers antibody production. These antibodies bind to cells that contain histamine. When the antibodies are stimulated by pollen and dust, histamine (and other chemicals) are released. This causes itching, swelling, and mucus production. Symptoms vary in severity from person to person. Very sensitive individuals can experience hives or other rashes.

Some disorders may be associated with allergies. These include eczema and asthma, among others.

Allergies are common. Heredity and environmental exposures may contribute to a predisposition to allergies.

Symptoms

Hayfever can vary greatly. Some people may only be mildly afflicted, where as others may suffer greatly. The symptons are generally;

• coughing
• headache
• itching nose, mouth, eyes, throat, skin, or any area
• runny nose (and occasionally nosebleeds)
• impaired smell
• sneezing
• stuffy nose (nasal congestion)
• tearing eyes
• sore throat
• wheezing
• fever
• cross-reactivity allergy to some fruits
• conjunctivitis

Signs and tests

The history of the person's symptoms is important in diagnosing allergic rhinitis, including whether the symptoms vary according to time of day or the season; exposure to pets or other allergens; and diet changes.

Allergy testing may reveal the specific allergens the person is reacting to. Skin testing is the most common method of allergy testing. This may include intradermal, scratch, patch, or other tests. Less commonly, the suspected allergen is dissolved and dropped onto the lower eyelid as a means of testing for allergies. (This test should only be done by a physician, never the patient, since it can be harmful if done improperly.)

In some individuals who cannot undergo skin testing (as determined by the doctor), the RAST blood test may be helpful in determining specific allergen sensitivity.

Sufferers might also find that cross-reactivity occurs. For example, someone allergic to birch pollen may also find that they have an allergic reaction to the skin of apples or potatoes. A clear sign of this is the occurrence of an itchy throat after eating an apple or sneezing when peeling potatoes. This occurs because of similarities in the proteins of the pollen and the food. There are many cross-reacting substances.

Prevention

Avoiding exposure to pollen is the best way to decrease allergic symptoms.Healthlink

• Remain indoors in the morning when outdoor pollen levels are highest.
• Wear face masks designed to filter out pollen if you must be outdoors.
• Keep windows closed and use the air conditioner if possible in the house and car.
• Do not dry clothes outdoors.
• Avoid unnecessary exposure to other environmental irritants such as insect sprays, tobacco smoke, air pollution, and fresh tar or paint.
• Avoid mowing the grass or doing other yard work, if possible.
• Regular hand- and face-washing removes pollen from areas where it is likely to enter the nose.
• A small amount of vaseline around the eyes and nostrils will stop some pollen from entering the areas that cause a reaction

Also:

• It may be helpful to humidify the room you are in to help clean the allergens out of the air, perhaps by using a humidifier, leaving a bowl of water around or leaving a wet towel in the room.
• You may find it useful to breathe through a wet towel or tissue when you feel the symptoms are acute, if you dont have access to a face mask.

Treatment

The goal of treatment is to reduce allergy symptoms caused by the inflammation of affected tissues. The best "treatment" is to avoid what causes your allergic symptoms in the first place.

Medication

The most appropriate medication depends on the type and severity of symptoms. Specific illnesses that are caused by allergies (such as asthma and eczema) may require other treatments.

Options include the following:

• Fast-acting strong antihistamines such as drugs including chlorphenamine which relieve the symptoms after a hayfever "attack"
• Short-acting antihistamines, which are generally over-the-counter (non-prescription), often relieve mild to moderate symptoms, but can cause drowsiness. A pediatrician should be consulted before using these medicines in children, as they may affect learning. One formerly prescription medication, loratadine (Claritin®), is now available over the counter in many countries. It does not tend to cause drowsiness or affect learning in children. Azelastine (Astelin®) is the only antihistamine available as a nasal spray.
• Longer-acting antihistamines cause less drowsiness, can be equally effective, and usually do not interfere with learning. These medications include fexofenadine (Allegra), and cetirizine (Zyrtec).
• Corticosteroid nasal sprays are effective and somewhat safe, and may be effective without oral antihistamines. These medications include fluticasone (Flonase/Flixonase [1]), budesonide (Rhinocort), mometasone (Nasonex), triamcinolone (Nasacort) and beclomethasone (Beconase®).
• Topical decongestants may also be helpful in reducing symptoms such as nasal congestion, but should not be used for long periods as stopping them after protracted use can lead to a rebound nasal congestion (Rhinitis medicamentosa).
• Cromolyn sodium (or cromoglycate) is available as a nasal spray (Nasalcrom) for treating hay fever. Eye drop versions of cromolyn sodium (Crolom) are available for allergic conjunctivitis.
• "Allergy shots" (Hyposensibilization, immunotherapy) are occasionally recommended if the allergen cannot be avoided and if symptoms are hard to control. This includes regular injections of the allergen, given in increasing doses (each dose is slightly larger than the previous dose) that may help the body adjust to the antigen. These tend to be offered as a last resort as the therapy is more expensive and can increase the risk of triggering a secondary allergic reaction such as an asthma attack.
• Herbs like Eyebright (Euphrasia officinalis), Nettle (Urtica dioica), and Bayberry (Myrica cerifera) can help to reduce the symptoms of nasal-pharynx congestion. In addition, Feverfew (Tanacetum parthenium) and Turmeric (Curcuma longa) have been shown to inhibit phospholipase A2, the enzyme which releases the inflammatory precursor arachidonic acid from the bi-layer membrane of mast cells (the main cells which respond to respiratory allergens and lead to inflammation). Their established traditional use as antiinflammatories further supports this application.

Expectations

Most symptoms of allergic rhinitis can be readily treated.

In some cases (particularly children), people may outgrow an allergy as the immune system becomes less sensitive to the allergen. However, as a general rule, once a substance causes allergies for an individual, it can continue to affect the person over the long term.

More severe cases of allergic rhinitis require immunotherapy (allergy shots) or removal of tissue in the nose (e.g., nasal polyps) or sinuses.

Complications

• drowsiness and other side effects of antihistamines
• side-effects of other medications (see the specific medication)
• sinusitis
• nasal polyps
• disruption of lifestyle (usually not severe)

Frequently asked questions

1. What should sufferers of hay fever avoid? Answer: If you have hay fever, you should avoid being outside during peak pollen times, which are often early morning and late afternoon. In addition, it is advised to keep windows and doors closed, avoid mowing the lawn, and limit exposure to common allergens such as pet dander, mildew, and dust mites.
2. What are the most severe hay fever symptoms? The most severe symptoms of hay fever are itchy eyes, a runny nose, sneezing, nasal congestion, and postnasal drip. Additionally, some individuals may develop weariness, headaches, and sinus pain or pressure.
3. How long does a case of hay fever last? Depending on the individual and the severity of their symptoms, the duration of a hay fever episode can vary. Some people may experience symptoms for a few days, while others may experience symptoms for several weeks or even months.
4. How can you prevent hay fever from worsening? It is recommended to avoid outdoor activities during peak pollen hours, to keep windows and doors closed, to use air conditioning, and to limit exposure to other allergens to prevent hay fever from worsening. Additionally, it is advised to take drugs as prescribed by a physician or as indicated on the packaging.
5. What is the worst month for hay fever? Answer: Depending on geography and the type of pollen to which a person is allergic, the peak pollen season for hay fever might vary. Typically, the worst months for hay fever are spring and early summer.
6. What time of day is hay fever most severe? When pollen concentrations are highest in the morning and evening, hay fever symptoms are typically at their worst.
7. What foods worsen hay fever symptoms? Certain meals, such as dairy products, alcohol, and spicy foods, may aggravate the symptoms of hay fever in some individuals.
8. Can someone with hay fever take a shower? Pollen and other allergens that may have accumulated on the skin and hair can be washed away by taking a shower.
9. What beverage is helpful for hay fever? Drinking plenty of water will help maintain the nasal passages' hydration, which can minimize hay fever symptoms. Some individuals find relief from chamomile or peppermint herbal teas.
10. Why do I feel so terrible when I have hay fever? The symptoms of hay fever can induce exhaustion, headaches, and sinus pain or pressure, which can make a person feel terrible. The continuous sneezing, runny nose, and itchy eyes can also interfere with sleep and lead to fatigue and irritability.
11. How do you relieve hay fever symptoms? Answer: It is advisable to take antihistamines, decongestants, or nasal sprays as directed to alleviate hay fever symptoms. In addition, it is advised to use saline nasal spray to keep the nasal passages wet, to use a humidifier to add moisture to the air, and to prevent exposure to allergens.
12. Does hayfever get worse with age? There is no conclusive evidence that hay fever symptoms worsen with age, but some individuals may experience a worsening of their symptoms as they age.

External links

• Information on hay fever and children from Seattle Children's Hospital
• NIH site on Allergic Rhinitis
• eMedicine Health
• Hayfever forum
• Could you host a hookworm? Nottingham (UK) Hayfever Hookworm Trials

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