Hay fever (also known as allergic rhinitis) is an umbrella term that covers a group of ailments that cause sneezing, a runny nose, and itchy, red eyes.
Hay fever affects millions of people in Australia. Ask your friends and colleagues about hay fever and chances are several will report having it. However, they will likely describe different triggers, symptoms, and seasons when it happens
Although it may seem more like a nuisance than anything else, uncontrolled hay fever can have economic and other health effects.
Nasal inflammation from allergies also has a worrying impact on an individual’s defenses against infection. The inflammation of hay fever and the need to breathe through the mouth have a direct effect impact on asthmaleading to poorer symptom control and a higher risk of a flare-up requiring unscheduled medical care.
To reduce these risks, a variety of treatments are available. However, before considering treatment, we must consider what is going wrong and why.
What is hay fever?
In addition to genetic factors, environmental exposures as airborne contaminants can dramatically predispose people to allergies.
The causes of hay fever fall into three main groups:
seasonal: pollens and plant materials that give symptoms at certain times of the year. Calendar charts of the various pollens are available.
perennial/year-round symptoms: No matter how clean your home is, it will be exposed to fungal spores and feces from dust mites that feed on dead skin cells. That sounds unsettling enough, but both can be potent allergens that can’t be effectively avoided.
intermittent: this is usually dead animal skin. It’s worth noting that the culprits are the molecules in your saliva, sweat, and urine, not your hair.
What treatments are best for hay fever?
Given these serious consequences, it is reassuring to know that there are effective treatments for hay fever. These range from common over-the-counter products to specialty medications.
Many people will immediately think of antihistamines for hay fever: in tablets, nasal spray, or eye drops. Histamine is a key chemical messenger in the allergy process, but it is not the only one. Therefore, antihistamines alone are usually only enough to fix minor problems.
There are a large number of antihistamines available with a range of effectiveness. Although many are available without a prescription, keep in mind that some are sedating and some are not safe during pregnancy or when you have certain heart conditions and may conflict with other medications.
Nasal sprays apply the treatment directly to the microscopic hairs in the nose, diffusing the medicine in a useful way. Many people take over-the-counter corticosteroid nasal sprays to reduce inflammation.
As a doctor, I’ve found that it’s common in the clinic for people to say that sprays “don’t work,” but usually this is because they don’t take them correctly. These deals it can take many days to take effect and must be taken regularly every day. The trick is: don’t sniff them (the medicine will end up in the back of your throat), or spray them into the sensitive middle part of your nose, which can bleed.
Saline nasal rinses can be very helpful in removing mucus, allergens, and inflammatory material (snot, you and me) before using other medications. Always use sterile fluids for this or nasty sinus infections can occur.
Decongestants may seem like a good idea when you can’t breathe, but they’re associated with worsening swelling when the effect wears off (this has the excellent name rhinitis medicinala).
As for many chemicals, if you take them long enough, the body cuts off its own supply (negative feedback), so when the drug is removed, the body is worse off. Think about how someone feels who hasn’t had coffee all day and usually drinks four or five cups. There is a rebound of blood vessel dilation and mucus production. Use them sparingly.
If your hay fever is more severe, your doctor might consider a course of higher-strength steroid nose drops, but these should not be used for more than a month as they can cause erosion of the nasal lining.
Sometimes it can be helpful to add a drug that acts on other key messengers of inflammation (leukotrienes), such as montelukast. These tablets are usually well tolerated, but they can have side effects, such as headache, that require discontinuation.
Validated scores that ask a standard set of questions about aspects of a person’s symptoms (such as “SNOT-22”) are useful in assessing who needs further prescription treatment for hay fever and their response.
For people with hay fever along with asthma or another allergic disease, there are now effective medications that block allergy messengers in a very specific way, such as monoclonal antibody Dupilumab, and more are coming soon. Although they are too expensive to prescribe for hay fever alone, they show that our understanding of the relevant mechanisms has improved.
Giving people a small regular dose of something they are sensitized to can make their immune system more tolerant. This is often known as immunotherapy, and it can be by injection or regular tablet.
This article does not constitute specific medical advice. Talk to your GP, specialist or pharmacist about the use of the medicines mentioned here. You can also review helpful information and videos from Asthma Australia