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Summer is upon us. For some people, that means barbecues, holidays, and spending time in the sun. However, others feel a sense of anxiety as the pollen levels rise and hay fever approaches. Blocked nose, itchy eyes, and endless sneezing are just some of the frustrating symptoms associated with hay fever.
But while the warmer weather heralds the beginning of the hay fever season, several treatment options exist to minimise or eliminate symptoms.
In this guide, you'll find:
What is Hay Fever?
Hay fever, or allergic rhinitis, is caused by an allergic reaction to pollen. Like any allergic reaction, it occurs because the body's immune system wrongly flags a particular item – be it food or environmental – as a threat, marshalling a defence. Immune cells head to the contact point while histamine floods the bloodstream. We call this reaction inflammation – the term rhinitis refers to inflammation of the nose. Because pollen is present in the air, hay fever affects the vulnerable parts of the body – namely, the mouth, eyes, nose, or throat. That's why symptoms tend to occur in these areas.
Seasonality
Pollen is the fine powder produced by plants, trees, or flowers to fertilise other plants of the same species. Different species of plants and trees release pollen at different times of the year. Depending on which type of pollen you're allergic to will affect when your symptoms worsen or subside.
Grass pollen is the most common trigger for allergies, typically affecting individuals annually during the grass pollen season, which spans from May to July (late spring to early summer). However, the term "pollen allergies" is often used more broadly to include allergies caused by other types of pollen, such as tree pollen.
Tree pollen tends to affect people each year from March to May (early to late spring). Additionally, some individuals may be allergic to weed pollen, including nettles and docks. Weeds generally pollinate from early spring through early autumn.
Hay Fever Symptoms
The primary hay fever symptoms are caused by histamine. This compound triggers everything from a runny nose to itchy eyes, modifying the inflammatory reaction. The term hay fever implies that the presence of pollen causes a high temperature (higher than 38°C). However, this is not the case.
The severity of symptoms varies from person to person. Some people only have a mild case of the "sniffles," while others spend the spring or summer months with severe hay fever.
Common symptoms
These symptoms are usually present:
Runny or stuffy nose
Itchy or watery eyes
Itchy throat, mouth, or ears
Coughing
Postnasal drip
Fatigue
Less common symptoms
Other potential symptoms include:
Swollen, blue-coloured skin under the eyes (allergic shiners)
Decreased sense of smell or taste
Itchy skin or hives (less common)
Sinus pressure or pain
Headache
Asthma symptoms
Hay fever is associated with other atopic conditions, such as asthma (see below). As such, it tends to exacerbate these symptoms, including wheezing and breathlessness. It's not uncommon for people with asthma to struggle with their breathing during the hay fever season; it can even interrupt their sleep.
Who It Affects
Why does anyone develop an allergy? The answer is complicated. Usually, hay fever develops in childhood or young adulthood, gradually fading away as the person ages. However, it can develop at any age.
There is a well-known genetic component to hay fever associated with the immune system. People with hay fever often have some form of family history, increasing the likelihood of the condition. It's also linked to other atopic conditions, such as asthma and eczema. Similar to hay fever, these conditions are caused by an overactive immune system.
However, simply having the genes associated with hay fever doesn't mean you'll get symptoms. Something else needs to happen. Exposure to an environmental allergen, in this case, high pollen counts, is essential for the development of the condition. If the person smokes or has a weakened immune system, then the reaction can be more severe.
Hay Fever Treatment
Non-pharmacological prevention
The only option for prevention is to avoid pollen. Unlike other allergies, where avoiding contact is relatively simple, people with hay fever find it almost impossible to avoid pollen – it's in the air.
Simple solutions include:
Keep the windows and doors closed
Vacuum and clean your home regularly
Take off your clothes after you've been outside and have a shower
Wear wraparound sunglasses and a wide-brimmed hat
Put petroleum jelly (e.g. Vaseline) around your nostrils to trap pollen
Pharmacological treatment
Conventional treatment
The conventional treatment for hay fever is a topical therapy of eye and nose drops. Antihistamine nasal sprays, in particular, target the affected area.
For a more systemic approach, antihistamine tablets can provide longer-lasting relief for several hours. These treatments block the action of histamine. Steroid nasal sprays and drops are also available to provide stronger symptomatic relief.
Kenalog Hay fever Injection
Despite taking conventional medication, around one in ten people will continue to experience symptoms. One option is the Kenalog hay fever injection. It involves an intramuscular injection which lasts three to eight weeks. The steroid is called triamcinolone, which gradually leaks into the body from the muscle, dampening the immune response.
Previously, the injection was available via prescription; however, concerns about the side effect profile led the NHS to remove its approval. Potential side effects include high blood pressure, headache, dizziness, skin rashes, muscle weakness, breathing difficulties, abdominal pain, insomnia, and much more. Repeated steroid use also leads to bone loss – although it's unclear what effect an annual hay fever injection would have. As such, we do not advise hay fever patients to use this treatment despite the fact it is still available in some clinics and private healthcare providers.
Immune therapies
Immunotherapy, or desensitisation, aims to eliminate or greatly reduce hay fever symptoms. There are two techniques:
Subcutaneous immunotherapy (SCIT): Involves injecting pollen under the skin to desensitise the immune system, reducing allergic reactions and improving symptoms.
Sublingual immunotherapy (SLIT): Involves placing pollen under the tongue. Typically, you take one tablet daily, starting four months before pollen season and continuing for up to three years.
Don't worry. Most people only experience mild hay fever symptoms, which can be managed by topical therapy alone. Using a nasal spray daily should help you reduce symptoms alongside other practical measures.
Hay fever season is also the time when we jet off to foreign countries. Usually, people find their hay fever is milder in other climates. But there are other issues to worry about – mainly infectious diseases. That's where we can help. We provide a comprehensive range of vaccinations for foreign travel.
Simply give us a call at 02476 016519 or book online, and we'll organise your travel vaccinations. Our friendly and knowledgeable staff are here to answer your questions.
References:
Author: Dr Joseph Nightingale, MBBS, MSc
Reviewed and approved by:
Dr Ravi Gowda, Consultant in Infectious Diseases and Travel Medicine
MBBS, MRCP(UK), DTM&H, MRCGP, DCH, DRCOG, DFFP
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