Hay fever season is on its way - are you ready?
Hay fever is extraordinarily common, affecting up to one in four people. For some it can be easy to ignore: a mildly congested nose and occasional sneezing when outside.
However, severe hay fever sufferers often dread the warmer months of the year, and have symptoms that can be almost intolerable - streaming nose and eyes, complete nasal blockage and inability to sleep well. Many people suffer from hay fever symptoms in silence, without knowing that there is a wide range of treatment available to make spring and summer more comfortable.
What is hay fever?
Hay fever is the colloquial name for seasonal allergic rhinitis (also see this page). It is caused by allergy - our immune system over-reacting to pollens in the air. Pollen molecules bind to antibodies (known as IgE) in the lining of our nasal cavity, and cause our immune cells to produce chemical signals that lead to rapid inflammation in the nose.
This process leads to the lining of the nose becoming boggy and swollen, causing nasal congestion. Excessive production of nasal mucus and tears can lead to a runny nose and eyes. The inflammation also triggers our nerve reflexes to make us itch and sneeze. These symptoms are together known as rhinitis. All in all, not a recipe for a pleasant summer!
For many hay fever sufferers, May-July is the worst period (grass season), but sometimes symptoms can start much earlier in the year. Those who are allergic to weeds may experience symptoms a little later in the year, and tree allergy tends to cause earlier symptoms. Some people may have rhinitis symptoms throughout the year ("perennial rhinitis"), which may worsen in the spring and summer.
How is hay fever diagnosed?
Hay fever is a form of rhinitis, which is diagnosed on the basis of the symptoms that patients typically experience: nasal congestion, runny nose, itching and sneezing. Having a specialist examine the nose can also help to confirm the diagnosis and rule out any other cause for your nasal symptoms. Scans are not usually necessary.
It can be helpful to confirm that you have an allergy, and if possible, to determine what you are allergic to. This can help to guide you about what months of the year to take your medications, and for some sufferers may help you to reduce your exposure to pollen.
Allergy tests can be carried out in two ways: skin-prick testing and blood testing. Skin-prick testing has the advantage of giving rapid results and being very sensitive for allergy. In skin-prick testing, a small amount of solution containing each of the common airborne allergens (including pollens) is dropped onto your skin (usually your forearm). The doctor or nurse will then prick just the outermost layer of skin through each of the droplets, using a sterile lancet (this is virtually painless). After 10-15 minutes, an allergy is confirmed by a red raised patch forming at the site of the skin prick - this may be quite itchy.
How is hay fever treated?
It depends on how badly you are affected, what time of year you get your symptoms, and what your main symptoms are. Every patient should have an individualised "plan of attack" that fits their needs.
Mild sneezing, itching and runny nose can be treated with oral antihistamine pills (fexofenadine, cetirizine and loratadine are less likely to make you drowsy). These can be taken regularly, or just when you need them. Mild nasal congestion can be improved with saline irrigation (such as Sterimar or Neilmed Sinus Rinse).
If your symptoms are more severe, and particularly if you have a blocked nose, you are likely to need to take a regular nasal steroid spray. These sprays directly reduce the inflammation caused by hayfever, and should be taken regularly around the months that you have your symptoms. Some patients need to take antihistamine pills in addition to their steroid spray, and some require sprays that contain both steroid and an antihistamine in one medication.
It's important to remember that nasal steroid sprays take a few weeks to kick in. For this reason, it can be helpful to anticipate when your symptoms may start, and commence treatment 2-4 weeks in advance.
A small number of people have hay fever that doesn't respond well to any of these treatments. These patients may need to be consider for immunotherapy (as long as we can detect which specific allergies they have). This is a highly specialised treatment that aims to force the immune system to tolerate pollens, and not react when they are present in the air. It works by introducing small amounts of allergen (either as a pill under the tongue or an injection) repeatedly over a long period of time. Immunotherapy is not suitable for all patients and requires a long-term commitment to treatment, but can be hugely beneficial when straightforward treatments don't work.