Could it be Hay Fever?

Hay fever is not just sniffles! It affects a vast majority of people every year during allergy season. Hay fever or seasonal allergic rhinitis (AR) has a major impact on the lives of sufferers.

What is Hay Fever or Allergic Rhinitis (AR) ?

Hay fever or AR is an allergic reaction which is seasonal as the name suggests and is generally induced by wind borne, grass, tree or weed pollen. However, it can sometimes be caused by fungal spores. Some examples of grass pollen include bermuda, johnson, orchard, timothy and sweet vernal. Tree pollen include that of alder birch, elm, juniper, oak, maple and wattle.

Several types of weed that have highly allergenic pollen include Echium plantagineum, pellitory weed ( asthma weed ) Ragweed and Parthenium weed. The type of pollen affecting you depends on your geographic location.

Some allergic sufferers have mild allergic symptoms but some have moderate to severe symptoms.

Signs and Symptoms

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Typical symptoms of hay fever are;

• Runny nose

• Nasal congestion

• Sneezing

• Itchy or watery eyes

• Itchy nose and throat

As the pollen season sets in, some people will have a quick onset of symptoms but some often have a gradual onset of symptoms. Eyes, nose, roof of mouth and throat start itching followed by watery eyes, sneezing, runny nose and nasal congestion. Depending on the severity, some sufferers may also get head aches, sleeplessness and irritability, coughing and wheezing. Nasal passages are swollen and eyes may be red due to itching. Asthmatics may notice their symptoms flareup.

Mild severity entails;

• Symptoms are easily manageable

• Sleep is not affected

• Daily activities and work performance not affected

Moderate or severe severity entails;

• Symptoms are troublesome ie, not easily managed

• Disturbed sleep

• Daily activities and work performance affected

Thunderstorm Asthma

science.org

Allergic rhinitis or hay fever is a risk factor for thunderstorm asthma. Thunderstorms can affect AR sufferers with or without asthma. It was found that on 21st November, 2016, Melbourne experienced the worlds largest epidemic thunderstorm asthma event which was unprecedented in severity and tragically 10 people died. Therefore it is extremely important to be aware of extreme weather changes bringing about thunderstorms especially on high pollen count days. Effective treatment of hay fever can reduce the chance of severe asthma attack. The symptoms of asthma attack coming on to be aware of are;

• chest tightness

• wheeze

• shortness of breath

• persistent cough

In light of the severity of attack due to thunderstorms AR sufferers should always carry bronchodilator or reliever medications at all times in case of emergency. ( see inhaler technique in a previous blog ). Speak to your doctor regarding an asthma action plan. In case of emergency if symptoms worsen do not hesitate to call 000.

Treatment Options of Hay Fever or AR

Treatment depends on the severity of symptoms which can have a significant impact on your life especially if you have a blocked nose every night. You can't have a good night sleep which makes you tired and grumpy the following day. This in turn reduces work productivity and children find it hard to concentrate on school work. Asthma flareup will also cause sleep deprivation. Thus, appropriate treatment is important to control symptoms of AR.

Avoidance

Avoiding pollen is easier said than done but you should minimise going outside during pollen season especially on high pollen count and thunderstorm days. Keep windows and doors closed until thunderstorm has passed. If possible avoid doing outside activities such as mowing the grass or gardening or wear an allergy mask. Wear wraparound sunglasses when outside to avoid pollen from getting into your eyes and rinse your eyes when you get inside. Have a shower and change clothes after being outside to wash off pollen. In the vehicle, turn AC on re-circulate to avoid outside air coming in.

Antihistamines

Non-sedating antihistamines are ok to use to reduce mild intermittent symptoms of sneezing, runny nose, itchy eyes, nose and throat. International guidelines do not recommend using sedating antihistamines for AR. The following antihistamines are non-sedating;

• loratadine (tablet and syrup form)

• desloratadine (tablet and syrup form)

• fexofenadine (tablet and syrup form)

• cetirizine (tablet, syrup and eye drops) can be a little sedating for some people

Antihistamines have similar efficacy but individual response may vary. If you find an antihistamine has stopped working, try a different one!

Antihistamine Nasal Sprays

Intranasal antihistamine sprays may be an option for people who can't swallow tablets. It also has a faster onset of action than oral ones. Some examples are;

• azelastine
  

• cetirizine

• levocabastine

Intranasal Corticosteroid Sprays (INCS)

The mainstay or first line of treatment of moderate to severe allergic rhinitis is corticosteroid nasal spray. INCS have an anti inflammatory action on the nasal passages thereby relieving blocked nose. It is important to understand that INCS are used as preventatives so can't be used on a when necessary basis. If used regularly it works well to prevent the symptoms of hayfever. Also important to understand that INCS usually start relieving symptoms within a few days not immediately and you have to give a minimum one month trial to see if its working properly. During the first few days an antihistamine can be taken together and as symptoms improve stop the antihistamine unless needed. Different medications have different dosage and effectiveness so read product information properly. Some INCS are as follows;

• beclomethasone

• budesonide

• fluticasone propionate

• mometasone

INCS failure is usually because you either haven't used it long enough or incorrect technique is used. The following are steps to use INCS spray correctly;

• shake gently

• take lid off

• prime the device by spraying a dose in air

• gently blow nose to remove any mucus

• gently place nozzle inside nostril and aim towards the outer edge as indicated below

• hold spray in left hand and spray in the opposite (right) nostril

• hold spray in right hand and spray in the opposite (left) nostril

• breathe in gently

The above technique shows that the spray should be used at an angle away from the septum of the nose which helps the medication work locally in the nostrils and not running down the back of the throat and swallowed therefore reducing taste in mouth and importantly reducing nose bleeds.

For the best effect of INCS you can also use saline nasal spray 15 minutes prior to using INCS to flush the pollen out and clean the nasal passage.

Some prescription nasal sprays have a combination of intranasal corticosteroid and an intranasal antihistamine to better manage symptoms.

Eye Drops

There are antihistamine eye drops for red itchy eyes which can be used in combination therapy with INCS if needed.

Some of these are as follows;

• azelastine

• levocabastine

Ketotifen, cromoglycate and olopatadine (on prescription only) can also be used as a preventative for ongoing eye relief.

Nasal Decongestants

According to the Australasian Society of Clinical Immunology and Allergy (ASCIA), decongestant nasal spray or drops are for quick relief but should not be used for more that 5 days to reduce excessive congestion. Continuous or long term use use of nasal decongestants can lead to rebound congestion and the nose does not have any chance of clearing, it is always blocked!

Allergen Immunotherapy

This is recommended for people with very severe allergy. It works by desensitisation which reduces severity of symptoms and the need for regular

medications. This technique involves introducing small amounts and gradually increasing the amount of allergen in your body via injections, tablets, sprays or drops. Speak to your doctor as this technique is only done by a clinical allergy specialist.

Finally, hayfever or AR is not to be taken lightly as it can have an impact on your daily life. It can manifest as mild to severe symptoms. If you only have mild, intermittent symptoms of sneezing, runny nose or itchy eyes it may be controlled by non sedating antihistamine otherwise intranasal corticosteroid sprays are first line of treatment. Use it daily as a preventative to control symptoms and it can be used in combination with antihistamines and saline sprays if needed.

Check the weather regularly to avoid high pollen count days and be prepared for thunderstorms. You can beat hay fever if you know what to do when symptoms arise!