Hay Fever

Hay Fever

Hay fever (allergic rhinitis) is a condition that results in cold-like symptoms such as sneezing, runny nose, congestion, itchy eyes, and sinus pressure. However, hay fever is not brought on by a virus as with a cold. Instead, it occurs when the body has an allergic reaction to harmless substances—referred to as allergens—that it mistakenly identifies as harmful.

Common allergens responsible for hay fever symptoms are pollen, dust mites, and pet dander (small flakes of skin that are shed by dogs, cats, or other animals with fur or feathers).

In addition to causing discomfort, hay fever can negatively impact your productivity at work or school and generally disrupt daily life. The good news is that you don’t have to suffer from these bothersome symptoms. By learning to keep off triggers and finding the right treatment, you can manage hay fever effectively.

Symptoms

Common signs and symptoms of hay fever are:

  • A runny nose and nasal congestion (stuffy nose)
  • Watery, itchy, and red eyes
  • Frequent sneezing
  • Coughing
  • Itchy nose, throat or roof of mouth
  • Postnasal drip, where mucus runs down behind the throat
  • Swelling and bruising under the eyes (allergic shiners)
  • Extreme weariness or fatigue, usually caused by poor sleep.

Hay fever triggers

Hay fever symptoms may be present all year or could become more noticeable during specific times of the year (seasonal allergies).

Common hay fever triggers are:

  • Tree pollen, usually present in early spring.
  • Grass pollen common in late spring and summer.
  • Ragweed pollen that is most prevalent in the fall.
  • Dust mites and cockroach droppings present year-round.
  • Pet dander that can trigger symptoms throughout the year, with worsened effects in winter when homes are closed up.
  • Spores from fungi and molds that can be seasonal or year-round, depending on the environment.

Causes

Hay fever occurs when the immune system mistakenly categorizes a harmless airborne substance, known as an allergen, as a threat. In response, the body releases immunoglobulin E (IgE) antibodies to defend against the allergen. If the body reencounters the allergen, these antibodies trigger the immune system to produce chemicals like histamine into the bloodstream, leading to hay fever symptoms.

Risk Factors

The likelihood of developing hay fever is higher if you:

  • Have additional allergies or asthma.
  • Have a disorder such as atopic dermatitis or eczema that causes irritated, itchy skin.
  • Have a family history of allergies or asthma, especially if it is a parent or sibling.
  • Live or work in an environment with constant exposure to allergens, like pet dander or dust mites.
  • Are exposed to strong odors or smoke that irritate the nose’s lining.
  • Have a mother who used to smoke during the first year of their life.

Complications

Hay fever can lead to various complications, including:

  • Poor quality of life: This condition can interfere with daily activities and make it difficult to be productive, hence resulting in missed work or school.
  • Poor sleep: Symptoms of hay fever can disrupt sleep, leading to exhaustion and a general sense of illness (malaise).
  • Worsening asthma: Hay fever can exacerbate asthma symptoms like wheezing and coughing.
  • Sinusitis: Chronic sinus congestion from hay fever can elevate the possibility of sinusitis, which is an infection or inflammation of the sinus lining.
  • Ear infection: Hay fever is usually a common cause of middle ear infections (otitis media) among children.

Diagnosing Hay Fever

Hay fever diagnosis usually involves conducting a physical examination and discussing your symptoms, general health, and potential triggers. Depending on the situation, one or both of the following tests may be done:

  • Skin prick test: During this test, small amounts of potential allergens are applied to pricked patches of skin, usually on the upper or back arm. The doctor will then observe the skin for any allergic reaction. If an allergy is present, a raised bump (hive) will develop at the allergen site. This reaction usually occurs in 15 – 20 minutes. Skin prick test is normally done by allergy specialists who are well equipped.
  • Allergy blood test: With this test, a blood sample is taken and sent to a laboratory, where it is analyzed to measure the response of the immune system to specific allergens. An allergy blood test checks the level of immunoglobulin E (IgE) antibodies in the blood, which are responsible for allergic reactions.

Treatment and Management

Once your allergy triggers are identified, your GP can help create a treatment plan to manage or eliminate hay fever symptoms. Treatment often includes avoiding triggers, using over-the-counter medications for mild symptoms, or prescription treatments for more severe cases. Finding the right combination of treatments may take time and experimentation.

 

If your child has hay fever, consult their pediatrician, as not all medications are safe. Also, it’s important to always read labels cautiously.

Treatment options

  1. Medications
  • Nasal corticosteroids

These drugs are effective for preventing and treating nasal congestion, itchiness, and runny nose associated with hay fever. These sprays are often the first choice for treatment for most people.

  • Non-prescription: Budesonide (Rhinocort Allergy), Fluticasone (Flonase Allergy Relief), Triamcinolone (Nasacort Allergy 24HR), and Mometasone (Nasonex 24HR Allergy).
  • Prescription: This is a combination of antihistamine and steroid. They include Mometasone and Olopatadine (Ryaltris) and Azelastine and Fluticasone (Dymista).

For the majority of people, nasal corticosteroids are safe for long-term use. However, it can cause side effects like nose irritation and unpleasant smells or tastes. It is uncommon for a nasal spray to cause negative effects from steroids.

  • Antihistamines

These treatments obstruct histamine, the chemical responsible for allergic reactions. As a result, they help relieve sneezing, itchiness, and runny nose but are less effective for congestion.

  • Oral antihistamines (non-prescription): Loratadine (Claritin), Cetirizine, Fexofenadine (Allegra).
  • Nasal sprays: Non-prescription Azelastine (Astepro Allergy), prescription Olopatadine.
  • Eye drops (non-prescription): Olopatadine (Pataday), Ketotifen (Alaway).

Side effects of antihistamines may include dry eyes, nose and mouth, and drowsiness. Oral antihistamines can cause restlessness, appetite changes, difficulty sleeping, headaches and urination, and blood pressure problems. Consult a doctor before use if pregnant, breastfeeding, or if you have an enlarged prostate or glaucoma.

  • Decongestants

These help relieve nasal swelling and congestion. Decongestants are sometimes used in combination with other medicines since they are ineffective in relieving other hay fever symptoms.

Decongestants can be given in the form of tablets, liquids, or nasal sprays and are available with prescription or over-the-counter.

  • Oral: Pseudoephedrine (Sudafed).
  • Nasal sprays: Phenylephrine (Neo-Synephrine), Oxymetazoline (Afrin).

Side effects that can result from oral decongestants are insomnia, headache, increased blood pressure, irritability, and urination problems for those with an enlarged prostate. It’s also essential to consult your GP before using decongestants if you are pregnant or have heart disease or high blood pressure.

Avoid using nasal sprays for over 2-3 days to prevent rebound congestion (the aggravation of the symptoms due to continuous use).

  • Cromolyn sodium

By inhibiting the production of histamine, cromolyn sodium helps alleviate the symptoms of hay fever. The best results from this medication come from taking it before you experience any symptoms. A non-prescription nasal spray called Cromolyn is available for use multiple times during the day. With a prescription, it can also be purchased as eye drops.

Cromolyn has no significant adverse effects.

  • Leukotriene modifier

Montelukast (Singulair) prescription tablet blocks leukotrienes, chemicals causing nasal irritation and mucus production. It is effective for allergy-induced asthma and recommended for mild asthma or when nasal sprays are intolerable.

Side effects include headaches. Rarely, it may also cause psychological reactions like anxiety, suicidal thoughts, depression, or insomnia. Seek medical care immediately if you develop such unusual responses.

  • Nasal ipratropium

Ipratropium, which is available as a prescription nasal spray, works to reduce excessive mucus production by the nose’s glands. However, it doesn’t work well for sneezing, congestion, or itching.

Nosebleeds, dry nose, sore throat, and dry and itchy eyes are some mild side effects. In rare cases, the medication may result in more serious side effects like dizziness, blurred vision, and difficulty urinating. If you have an enlarged prostate or glaucoma, this medication is not advisable.

  • Oral corticosteroids

Prednisone and other corticosteroid medications are occasionally used to treat severe allergy symptoms. Corticosteroids are typically prescribed for short periods because prolonged use can result in major side effects like osteoporosis, cataracts, and muscular weakness.

  1. Immunotherapy
  • Allergy shots: Over 3-5 years, regular injections of small amounts of allergens can help reduce sensitivity and lessen symptoms. Effective for allergens like dust mites, pet dander, and pollen. It also prevents asthma in children.
  • Sublingual allergy tablets: This involves swallowing small doses of the allergen as a tablet that dissolves beneath the tongue instead of receiving injections (sublingual delivery). These pills are taken every day and can be useful for dust mites, grass, and ragweed pollens. However, they are not effective for all allergens.
  1. Nasal Saline Rinses
  • Saline sprays: Moisturize nasal passages and thin mucus. They are safe for frequent use and don’t require a prescription.
  • Nasal irrigation: Rinse nasal paths with a saline solution using a neti pot or squeeze bottle. Only distilled, sterile, or previously boiled water is recommended to prevent infection. Clean the equipment thoroughly after each use and avoid sharing.

Prevention

It’s impossible to prevent hay fever completely. However, if you have it, the most effective strategy is to reduce exposure to the allergens that trigger your symptoms. Follow your doctor’s advice and take allergy medications before coming into contact with allergens.

Conclusion

Symptoms associated with hay fever can disrupt your quality of life and prevent you from enjoying your favorite activities. However, effective treatments are within reach. Many adults and children successfully manage hay fever through medications and lifestyle adjustments. Consult your healthcare provider to explore ways to ease your symptoms, improve your breathing, and enhance your overall well-being.

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