Hay fever is an allergy to pollen in the air, causing rhinitis (sneezing, runny nose), itching eyes, itching throat and sometimes wheezing. At its worst, it affects sleep, mood and exam performance, but with a few precautions you can still enjoy being outdoors!
Know your pollen!
If your symptoms occur in the spring , you are allergic to tree pollen, often birch, oak, or plane tree (common in many streets in London) .In the summer it’s grass and weeds (including nettles) and in the autumn it is moulds and ragweed (rare in the UK but common in central Europe and the USA)that cause problems.
Wind pollinated, non-flowering plants produce masses of pollen grains that cause hay fever and asthma, whilst flowering plants, pollinated by insects tend to produce smaller amounts of pollen. Grass pollen affects 95% of hay fever sufferers, and birch pollen about 20%.
Although 4% of hay fever sufferers have antibodies to oilseed rape pollen, and could therefore get hay fever symptoms from it, the plant is pollenated by insects, and the pollen is sticky, so there are not usually high pollen levels in the air. The main problem with oil-seed rape is not hay fever, but that the crops emit volatile organic compounds (VOCs) which can trigger a variety of non-allergic symptoms.
The Met Office provides a 5 day forecast of pollen counts localised to your area and including which trees and grasses are producing pollen, so with a bit of detective work, you can work out which might be causing your symptoms and look for places to go where those plants are less abundant.
Reduce your exposure to pollen
Pollen counts are highest in the early morning, and from late afternoon, so choose the middle of the day for your outdoor adventure. Pollen levels are highest in central and southern regions of the UK, so how about a walk on a westerly or northerly beach when there is an onshore wind blowing?
Putting a smear of Vaseline around your nostrils to trap pollen and wearing wraparound sunglasses may reduce the amount of pollen getting to sensitive tissues. Using a saline nasal spray may reduce symptoms; and avoiding alcohol, which can trigger histamine release, will also help.
You can reduce the amount of pollen brought into your home, by changing your outdoor clothes as soon as you get into the house, and wiping surfaces with a damp, rather than dry, cloth which removes more dust and pollen.
Start treatment early
Medication for hay fever is generally available in supermarkets and pharmacies. NHS England has advised doctors that these medications should not normally be prescribed. Pharmacists can help if you are unsure whether you have hay fever and give good advice about choice of hay fever preparations. If you have severe symptoms, your GP can help.
For mild intermittent symptoms, it is possible to take medication just when it is needed, but more severe symptoms are best controlled by regular medication which should be started a couple of weeks before the pollen count starts to rise. Regular medication is best taken in the early evening when the count is rising.
The most effective treatments for hay fever are antihistamines, and intranasal steroids. Some antihistamines cause drowsiness, so are best taken at night and avoided if you are driving or taking exams. Others such as cetirizine, do not cause drowsiness. Antihistamine tablets reduce sneezing and runny nose but are less effective for blocked nose and congestion. If your hay fever causes multiple symptoms – itchy eyes and throat, sneezing and sore eyes- antihistamine tablets are a good option.
If your symptoms are mostly sneezing and congestion, then nasal sprays can be effective either with antihistamine tablets or on their own. Nasal steroid sprays such as betamethasone are the most effective if used regularly, starting before the pollen count rises if possible. It is important to use the spray correctly, by removing the cap, holding the spray upright, bending the head forward and spraying each side of the inside of the nose twice without sniffing (to avoid the spray going down your throat and being ineffective). There are several You tube videos that demonstrate correct use of nasal sprays.
If your main problem is itchy, sore eyes, eye drops such sodium cromoglycate can be helpful. These are much more effective when used regularly and started a couple of weeks before hay fever symptoms are expected.
Most people can control their symptoms with a combination of antihistamine tablets, eye drops, and nasal sprays used regularly.
If you are experiencing wheezing and breathlessness, then it is worth seeing your doctor who can assess you for asthma and prescribe inhalers if necessary.
Teenagers can be particularly badly affected by hay fever, and one study showed a reduction in exam performance for hay fever sufferers, particularly those who took sedating antihistamines such as chlorphenamine. GPs can prescribe short courses of steroid tablets to take for a week or so during exam periods, but steroid tablets should not be used for prolonged periods because they can have serious long-term side-effects. Injections are not recommended because the risks outweigh the benefits.
If nothing is helping
People with very severe symptoms may be offered immunotherapy using grass or tree pollen vaccines, but these have the potential to cause life-threatening reactions (anaphylaxis)so must be prescribed by a specialist immunologist in hospital, with resuscitation facilities available, and treatment should start 4 months before the start of the hay fever season. (BNF, 2018)
Acupuncture has not been shown to be beneficial for hay fever. Some people have advocated eating locally produced honey, but there is no evidence to support this, because hay fever is triggered by air-born pollen rather than insect-pollinated plants.
- Record when you start experiencing symptoms to identify which pollens may be responsible.
- Watch the pollen forecast https://www.metoffice.gov.uk/public/weather/pollen-forecast.
- Choose late morning and early afternoon for your outdoor adventures.
- Avoid areas where trees (spring symptoms) or grasses (summer) are abundant.
- Reduce pollen by using a thin smear of Vaseline around your nose and changing outdoor clothes when you enter the house.
- Try antihistamine tablets, nasal spray and eye drops and start treatments early.
- Consult your GP if your symptoms are not responding to normal treatments.
Written by Doctor Hilary Fox