Hay fever and allergies are common problems, particular during the summer months. Here Mike Dilkes looks at allergy, hay fever and the things you can do to prevent and manage hay fever.
By far the most common allergies are those triggered by particles in the air that we breathe. From dog hair to dust mites and pollen, these inhaled allergies affect up to a third of adults globally. Unlike ingested (eaten) or skin allergies, sufferers’ symptoms can be triggered simply by a deep breath.
But, before we look into this further, just what is an allergy?
In a nutshell, it’s when the body’s immune system overreacts to a normally harmless substance.
Mast cells, which are a type of immune system cell, mistakenly release a cascade of chemicals that are actually supposed to fend off infections.
The most potent of these chemicals is histamine, which is responsible for the uncomfortable symptoms of an allergic reaction such as sneezing, runny nose and itchy, irritated and watery eyes.
It also causes a build-up of mucus in the tubes that supply air to the lungs. These reactions are designed to purge the body of harmful ‘invaders’ such as bacteria or poisons. But, in an allergy sufferer, non-threatening substances, such as grass pollen, evoke the same severe reaction a poison would.
In the case of inhaled allergies, it occurs when the substance – we call them, collectively, allergens – comes into contact with the tissues inside the mouth, nose, and throat, and eyes. The soaring temperatures during the recent Easter Bank Holiday saw millions struck down, thanks to the most common culprit: pollen. This is commonly known as hay fever, or allergic rhinitis, among doctors. While many bask in the glorious spring sunshine, the one-in-five Britons who suffer hay fever avoid it like the plague, dreading the start of months of misery.
Symptoms are usually worse during the summer months – between late March and September – when the pollen count is at its highest. While widespread, it’s no trivial matter: hay fever is linked to poor sleep: 57 per cent of adults and 88 per cent of children with the condition have sleep problems, leading to daytime fatigue and decreased cognitive functioning. In fact, research shows that two million drivers have accidents, near misses or experience loss of vehicle control as a direct result of their symptoms.
The good news? There is something you can do about it.
IS IT HAY FEVER – OR A COLD?
Many of the symptoms of hay fever are similar to those of a cold or flu, such as blocked, runny nose, cough and exhaustion. But there are a few tell-tale signs that are unique to the allergy.
Itchy eyes, for instance, do not occur with colds, like they do in hay fever. And if sniffles come with aching limbs, it’s most likely a cold, not hay fever.
Cold symptoms also dissipate after a week or two whereas hay fever persists for at least six weeks. The vast majority of hay fever sufferers will guess correctly that their symptoms are linked to pollen count, and self-diagnose.
The general advice is to note what symptoms you have, when they occur, how often and in what situations. This information can then be presented to a pharmacist who will be able to confirm that hay fever is the culprit and recommend over-the-counter treatments. Otherwise, common sense rules apply: check online weather reports for pollen counts and stay inside when the count is high.
For most people, this is enough to keep symptoms at bay. But for an unlucky few, the sniffles are relentless, making any outdoor activity an arduous task. So, if you are really suffering, your first port of call should be your GP, who may be able to offer stronger medication or recommend other approaches.
HOW TO STOP HAY FEVER FROM STRIKING
Key to preventing a flare-up of symptoms is knowing what you have to steer clear of.
While avoiding cats, if pet fur is a trigger, might be easy, it’s almost impossible to avoid all pollen without moving somewhere mountainous, dry and arid. Thankfully, there are effective methods to minimise exposure, keeping symptoms at bay.
It’s essential you are proactive – adhering to these vital steps will significantly minimise the impact of your symptoms.
1. Allergy-proof your home
Pollen counts are highest in early morning and early evening, so keep windows closed at these times. Sealed stone or tiled floors are preferable to carpets, and avoid rugs. Vacuum regularly and consider having a dust filter fitted to your vacuum cleaner. Always dust with a damp cloth so the dust is absorbed.
2. Always shower before bed
Pollen and other triggers get trapped in our hair during the day, eventually making their way into our airway. If you don’t shower at night, you essentially incubate yourself in the thing you are trying to avoid for eight hours. Launder your pyjamas and bedding regularly, too, to get rid of the dust and pollen that may accumulate.
3. Honey won’t help hay fever
Don’t believe the old wives’ tale that a spoonful of honey prevents allergic reactions to pollen. Many tout that honey contains pollens, which means a teaspoon grants the body early exposure, dampening the immune response. This is false: honey does not contain grass and tree pollen.
Honey is in fact made by honeybees from the nectar of flowers and plants, not pollen.
4. Don’t remove your nose hair... or pluck eyebrows
These hairs serve a very important function in preventing allergens in the air from entering the body.
Hypersensitive nasal hairs act as a defensive wall against inhaled allergens, and can trigger sneezing to expel any particles before they are inhaled. Likewise, particles get trapped in the eyebrows, preventing them from entering via thin membranes in the eye. But don’t panic, light trimming of unruly brows and protruding nasal hairs is fine, just as long as you don’t wax or remove the hairs completely.
THE LADDER OF ALLERGY TREATMENT
In theory, treating hay fever should be pretty straightforward: block the immune response and stop the effects of histamine in its tracks. But this line of attack often isn’t necessary, given the surprising impact of non-drug treatments.
This is why it is best to use what I call the ‘ladder of intervention’, trying one measure at a time.
If one method of treatment doesn’t work, move on to the next. Different people will respond differently to each stage of the ladder.
Work your way from number one to eight, stopping when you find an intervention that works for you.
1. Sniffing salt water
Using salted water to remove dust, pollen and debris that collects in the nose is an effective way of alleviating cold-like symptoms. This is easily achieved with a plastic device called a neti pot, which flushes out the nasal cavity. You can get them from many High Street chemists. For a detailed explanation on how this works, see the box below. Try doing it first thing in the morning and last thing at night. Research shows that thinning the mucus in your nose with water removes the allergens that cause irritation.
2. Simply use Vaseline
A thin layer of petroleum jelly rubbed around nostrils helps prevent particles entering the nasal passage. Essential at night, it also works fantastically in conjunction with the salt water washout or nasal sprays.
3. Antihistamine and sprays
Antihistamines reduce or block the histamine chemical, reducing bothersome symptoms. They are available as a nose spray and eye drops over the counter. Steroid nose sprays, available on prescription, are similarly useful as they dampen the immune system, reducing the over-reaction.
4. Mast cell stabilising sprays and eye drops
A substance called sodium cromoglycate can stop mast cells from releasing histamine, preventing symptoms. It is only effective for allergies that affect the nose, eyes or lungs and can be particularly impactful when used in combination with antihistamine and steroid sprays. The medication is available as a spray, drops and in inhaler form over-the-counter.
5. Antihistamine tablets
Stronger antihistamines are available in tablet form – both drowsy and non-drowsy types. Some are available over the counter, but the strongest require a GP prescription. When reading a label, check for the following active ingredients if looking for the drowsy type: chlorphenamine, hydroxyzine and promethazine. For non-drowsy: cetirizine, loratadine and fexofenadine.
6. Anti-asthma drugs
Anti-inflammatory medication for asthma, called anti-leukotriene, can be helpful for hay fever and other inhaled allergies, but is only available on prescription. The tablets block the chemical leukotriene. This is released by the body when allergens strike, which causes inflammation in the nose and airways.
7. Steroid tablets
Steroids work by reducing the inflammation in the lungs, nose or throat, caused by the overactive immune system. Tablet-form steroids are usually intended for short-term use due to common side-effects such as vision problems, joint pain, anxiety or loss of appetite.
If you experience any of these, contact your doctor straight away.
Don’t worry, these symptoms are only temporary, but a GP may decide to make small changes to dosage and drug type.
8. Immunotherapy: A dose of what you’re allergic to
Administering a tiny dose of the substance you’re allergic to is said to desensitise the immune system to it, reducing the adverse reaction. This type of treatment is high risk and usually only considered by a GP in severe hay fever or other inhaled allergies once all other options have failed. It is an arduous course, taking several years.
Once you stop, symptoms that were reduced significantly can start to reappear. Few qualify for it on the NHS and those who go privately will pay £9,000 for a three-year course.
Mike first wrote this article for the Mail on Sunday - you can see the hay fever article here.
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