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Hay fever is caused by an al ergy to pol en. Common hay fever symptoms are a runny, itchy and/orblocked nose, sneezing and itchy eyes. Common treatments are an antihistamine nasal spray ormedicine, and/or a steroid nasal spray. Other treatments are sometimes used if these commontreatments do not work so wel .
Pollen is the name given to the fine powder that is produced by plants, trees or flowers to fertilise other plants,trees or flowers of the same species. Strictly speaking, hay fever is caused by an allergy to grass or hay pollens.
Grass pollen is the most common cause and tends to affect people every year in the grass pollen season fromabout May to July (late spring to early summer). However, the term is often used when allergies are caused byother pollens such as tree pollens. Tree pollens tend to affect people from March to May (early to late spring)each year. Other people may be allergic to weed pollens (including nettles and docks). Weeds tend to pollinatefrom early spring to early autumn.
Symptoms are due to your immune system reacting to the pollen. Cells on the lining of the nose and eyesrelease histamine and other chemicals when they come into contact with pollen. This causes inflammation in thenose (rhinitis) and eyes (conjunctivitis). Sometimes the sinuses and throat can also be affected.
Hay fever is also called seasonal allergic rhinitis because symptoms tend to occur at the same time, or in thesame season, each year.
Hay fever is very common. It affects about 2 in 10 people in the UK. It often first develops in school-age childrenand during the teenage years. Symptoms return for a season each year. But, the condition eventually goes awayor improves in many cases (often after having had symptoms each season for several years).
Hay fever tends to run in families. You are also more likely to develop hay fever if you already have or. Equally, if you have hay fever, you are more likely to develop eczema or asthma. The conditionsasthma, eczema and hay fever are known together as atopic conditions or atopy. A tendency to atopy can run infamilies.
The symptoms of hay fever can vary from person to person. Some people only have mild symptoms that tend tocome and go. Others can be severely affected with symptoms that are present every day during the pollenseason:
- these include a runny and itchy nose, a blocked nose, sneezing, itchy and
watery red eyes and an itchy throat. In some cases only nasal symptoms occur and in some cases
only eye symptoms occur.Less common symptoms
- these include loss of smell, face pain, sweats and headache.Asthma symptoms
- such as wheeze and breathlessness, which may get worse if you already have
asthma. Some people have asthma symptoms only during the hay fever season. If you have hay fever,
you are more likely to develop asthma.
The symptoms may be so bad in some people that they can affect sleep, interfere with school and examinations,or interfere with work.
You doctor can usually diagnose hay fever from your typical symptoms that can occur during the hay feverseason. They may also ask if there is a history in your family of hay fever, asthma or eczema.
If hay fever is suspected, your doctor will usually suggest treatment for your symptoms (see below). If thesymptoms respond to treatment, this can help to confirm the diagnosis. In rare cases when the diagnosis is indoubt, your doctor may suggest blood tests or skin prick testing to confirm your pollen allergy. See separateleaflet called for further detail. Very occasionally, tests to check the airflow through yournostrils or scans may be needed to rule out other causes of the symptoms.
It is impossible to avoid pollen totally. However, symptoms tend to be less severe if you reduce your exposure topollen. The pollen count is the number of pollen grains per cubic metre of air. The pollen count is often given withTV, radio, internet, or newspaper weather forecasts. A high pollen count is a count above 50.
. The following may help when the pollen count is high:
Stay indoors as much as possible and keep windows and doors shut.
Avoid cutting grass, large grassy places, and camping.
Shower and wash your hair after being outdoors, especially after going to the countryside.
Wear wrap-around sunglasses when your are out.
Keep car windows closed and consider buying a pollen filter for the air vents in your car. These shouldbe changed at every service.
The commonly used hay fever treatment options are: antihistamine nasal sprays, antihistamine tablets, steroidnasal sprays, and eye drops. If your hay fever symptoms are not controlled on the medication that you are takingafter 2-4 weeks, you should discuss this with your doctor. You may need to try a different treatment or add inanother treatment.
If you are taking hay fever medication regularly and your hay fever is well controlled on your current treatment, youshould continue this treatment until the end of the pollen season.
Antihistamine nasal spray
A dose from an can rapidly ease itching, sneezing and watering (within 15 minutes or
so). It may not be so good at easing congestion. Antihistamines work by blocking the action of histamine. This is
one of the chemicals involved in allergic reactions. A spray can be used as required if you have mild symptoms. It
can also be taken regularly to keep symptoms away.
Antihistamine tablets (or liquid medicines)
taken by mouth (tablets or liquids) are an alternative. They ease most of the symptoms but may
not be so good at relieving nasal congestion (blocked nose). Antihistamines taken by mouth are good if you have
eye symptoms as well as nasal symptoms. They are also usually given to small children instead of a nasal spray.
A dose usually works within an hour. Therefore, one can be taken as required if symptoms are mild, or come and
go. One can also be taken regularly if symptoms occur each day.
There are several brands of antihistamines that you can buy at pharmacies or get on prescription. Older brandssuch as work well but make some people drowsy. So, they should not be taken if you are drivingor operating machinery. There are several that cause less drowsiness. Ask your pharmacist foradvice.
If you are pregnant or breast-feeding, it is advised to try to avoid antihistamines, if possible. Treatment with asteroid nasal spray is usually tried first (see below). An antihistamine may sometimes be used if your symptomsare not controlled. Discuss with your doctor or pharmacist if you are pregnant or breast-feeding and have hayfever.
Steroid nasal sprays and drops
A usually works well to clear all the nasal symptoms (itch, sneezing, watering and
congestion). It works by reducing inflammation in the nose. A steroid nasal spray also tends to ease eye
symptoms. It is not clear how it helps the eye symptoms - but it often does! are also
It takes several days for a steroid spray to build up its full effect. Therefore, there is no immediate relief ofsymptoms when you first start it. In some people it can take up to three weeks or longer to be fully effective. Sodo persevere. (It is best to start taking it a few weeks before the hay fever season is likely to begin if you knowthat you have hay fever.)
A steroid nasal spray tends to be the most effective treatment when symptoms are more severe. It can also beused in addition to antihistamines if symptoms are not fully controlled by either alone.
You need to use the spray each day over the hay fever season to keep symptoms away. However, oncesymptoms have gone, the dose of a steroid spray can often be reduced to a low maintenance dose each day tokeep symptoms away. There are several brands which you can buy at pharmacies, or get on prescription. Side-effects or problems with steroid nasal sprays are rare (read the packet leaflet for details).
Other hay fever remedies / treatment options
If necessary, you can use eye drops in addition to other treatments:
work quickly, so you can use them as required to ease a flare-up of eyesymptoms. You can also use them regularly if needed. There are several brands.Mast cell stabilisers
are another type of eye drop. There are different brands. They are thought to workby stopping the release of histamine from certain cells (mast cells). You need to use them regularly toprevent symptoms.
Other nasal sprays
The following are sometimes used. They tend to be used if there are problems with any of the above treatments.
Sometimes one is used as an add-on treatment in addition to one or more of the above treatments if symptoms
are not fully controlled:
. Like steroid sprays, it takes a while to build up its effect and needsto be taken regularly. It is thought to work by stopping the release of histamine from certain cells. Onedisadvantage is that it needs to be taken 4-5 times a day (steroid sprays are taken 1-2 times a day).
This appears to be the safest drug to use for hay fever in the first three months of pregnancy.
may be worth a try if you have a lot of watery discharge. It has noeffect on sneezing or congestion.
that you can buy at pharmacies are not usually advised for more than afew days. They have an immediate effect to clear a blocked nose. However, if you use one for morethan 5-7 days, a rebound, more severe congestion of the nose often develops. One may be useful fora few days to clear a blocked nose when you first use a steroid nasal spray. The steroid can then getto the lining of the nose to work. Don't use decongestant nasal sprays for more than seven days.
Leukotriene receptor antagonists
These medicines block the effect of chemicals that trigger hay fever symptoms. They work well when taken with
antihistamine tablets, especially in people who also have asthma.
Nasal saline washouts
This is done by some people. The aim is to wash pollen out of the nostrils. This can sometimes help to reduce
the need for steroid nasal sprays. Washouts can be bought from a pharmacist and are comprised of a delivery
system such as a squeezable plastic bottle containing saline (salt water) connected to a tube inserted into the
nose. More sophisticated devices with pumps to control the pressure of the liquid are also available. For most
benefit, washouts should be on a daily basis.
Treatment for severe symptoms
Rarely, a short course of is prescribed for a week or so. For example, for students sitting
examinations, who have severe symptoms which are not eased by other treatments. Steroid tablets usually work
well to reduce inflammation. A short course is usually safe. However, you should not take steroid tablets for long
periods to treat hay fever, as serious side-effects may develop.
This treatment is sometimes used, mainly in cases where symptoms are severe and not helped by other
treatments. There are two methods:
Subcutaneous immunotherapy (SCIT). This is done using a series of injections of the allergen (in thiscase pollen) into the tissue just under the skin (the subcutaneous tissue). The idea is that yourimmune system will become desensitised to the pollen. This means that the allergic response thatyour body mounts when it is exposed to the pollen in the future is reduced, so improving yoursymptoms.
Sublingual immunotherapy (SLIT). This is similar to the above but the allergen (pollen) is placed underthe tongue (that is, sublingual). Typically, the dose is one tablet a day, starting four months before thestart of the pollen season and continued for up to three years.
Immunotherapy is normally supervised by a specialist after careful assessment. It is not suitable for everyone.
For example, people with certain diseases, pregnant women, and people taking certain medicines will not be ableto have this treatment. Your doctor will advise if this treatment is suitable for you. Note: immunotherapy is unlikelyto totally cure hay fever, but will often greatly reduce the severity of symptoms. The less severe symptoms willthen tend to be much easier to control with standard treatments such as antihistamines and nasal sprays. Also,immunotherapy has been shown to give long-lasting benefit for some years after stopping treatment.
If you develop asthma symptoms during the hay fever season you may be prescribed an inhaler. If you alreadyhave asthma, your asthma may become worse in the hay fever season. You may need an increase in the dose ofyour usual inhalers (or other treatment that you take for asthma) during the hay fever season.
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, British Society for Allergy and Clinical Immunology(January 2008), British Society for Allergy and Clinical Immunology (2011); Vandenplas O, D'Alpaos V, Van Brussel P; Rhinitis and its impact on work. CurrOpin Allergy Clin Immunol. 2008 Apr;8(2):145-9.
Antihistamines used in addition to topical nasal steroids for intermittent andCochrane Database Syst Rev. 2010 Jul 7;(7):CD006989.
; Efficacy of leukotriene antagonists as concomitant therapy in allergic rhinitis.
Laryngoscope. 2010 Sep;120(9):1718-23.
Nasal saline irrigation facilitates control of allergic rhinitis by topical ORL J Otorhinolaryngol RelatSpec. 2009;71(1):50-5. Epub 2008 Dec 1.
; Summary of Product Characteristics (SPC) GrazaxÂ®, ALK-AbelloLtd, electronic Medicines Compendium. Dated November 2010 Allergen injection immunotherapy for seasonal allergic rhinitis. CochraneDatabase Syst Rev. 2007 Jan 24;(1):CD001936.
NICE CKS, September 2012
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