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Rhinitis-Hay Fever

rhinitis What is hay fever?

Hay fever is caused by an allergy to pollen. Common hay fever symptoms include runny, itchy and/or blocked nose, sneezing and itchy eyes. Common treatments are anti-allergic medications(antihistamine) nasal spray or medicine, and/or a steroid nasal spray.

What is a pollen?

Pollen is a fine powder that is produced by plants, trees or flowers to fertilize other plants, trees or flowers of the same species.

How is Hay fever caused?

Hay fever is mostly caused by an allergy to grass or hay pollens. Most common cause include allergy to grass pollen, which tends to affect people every year in the season from about May to July (late spring to early summer). The term is also used in allergies, whichare caused by other pollens such as tree pollens, which 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 pollinate from early spring to early autumn. Hay fever is also called seasonal allergic rhinitis because symptoms tend to occur at the same time, or in the same season, each year.

Hay fever tends to run in families. If you already suffer from asthma or eczema you would be more likely to suffer from hay fever. The conditions asthma, eczema and hay fever are known together as atopic conditions or atopy. A tendency to atopy can run in families.

How does it present?

The common symptoms of hay fever can vary from person to person- 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. Other symptoms include loss of smell, face pain, sweats and headache. If the patient suffers from asthma, he may have symptoms like wheeze and breathlessness, which may get worse if you already have asthma. Some people have asthma symptoms only during the hay fever season.

How is it diagnosed?

Diagnosis of Hay fever is done from your typical symptoms that generally occur during the hay fever season. If there is also a history in your family,of hay fever, asthma or eczema, diagnosis is confirmed.

In suspected cases, symptomatic treatment is given, and if symptoms respond diagnosis is confirmed.In rare cases when the diagnosis is in doubt, blood tests or skin prick testing is done to confirm pollen allergy.

Avoiding exposure totally to pollen is impossible. However, symptoms tend to be less severe if you reduce your exposure to pollen. Lot of TV, radio, internet or newspaper weather forecast give forecast on pollen count, that is the number of pollen grains per cubic meter of air. A high pollen count is a count above 50.

When the pollen forecast is high, one can do the following:

  • Try staying indoors as much as possible and keep all windows and doors closed.
  • Avoid outdoor activities such as cutting grass, large grassy places, and camping.
  • Shower and wash your hair after being outdoors, especially after going to the countryside.
  • Wear protective 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 should be changed at every service.
What is the treatment of hay fever?

Treatment for hay fever includes antihistamine nasal sprays, antihistamine tablets, steroid nasal sprays, and eye drops. If your hay fever symptoms are not controlled on the medication that you are taking after 2-4 weeks, you should discuss this with your doctor.

Antihistamine nasal spray can rapidly ease itching, sneezing and watering (within 15 minutes or so). It works by blocking the action of histamine which is a chemical 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) are an alternative. They are also usually given to small children instead of a nasal spray. A dose usually works within an hour.If you are pregnant or breast-feeding, it is advised to try to avoid antihistamines, if possible. Treatment with a steroid nasal spray is usually tried first. Discuss with your doctor or pharmacist if you are pregnant or breast-feeding and have hay fever.

Steroid nasal sprays and dropsusually works well to clear all the nasal symptoms (itch, sneezing, watering and congestion), by reducing inflammation in the nose. A steroid nasal spray also tends to ease eye symptoms. It helps the eye symptoms.It takes several days for a steroid spray to build up its full effect. Therefore, there is no immediate relief of symptoms when you first start it. In some people it can take up to three weeks or longer to be fully effective. Steroid nasal spray is used to contain symptoms as well as could be used in addition to antihistaminics.

You need to use the spray each day over the hay fever season to keep symptoms away. However, once symptoms have gone, the dose of a steroid spray can often be reduced to a low maintenance dose each day to keep symptoms away.

Eye drops, are generally used to ease eye symptoms. You can also use them regularly if needed. They generally contain mast cell stabilizers, which work by stopping the release of histamine from certain cells (mast cells). You need to use them regularly to prevent symptoms.

Other nasal sprays

Sodium cromoglicate nasal spray. like steroid sprays, takes a while to build up its effect and needs to be taken regularly. It is thought to work by stopping the release of histamine from certain cells. One disadvantage 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.

Ipratropium bromide nasal spray may be worth a try if you have a lot of watery discharge. It has no effect on sneezing or congestion.

Decongestant nasal sprays that you can buy at pharmacies are not usually advised for more than a few days. They have an immediate effect to clear a blocked nose. However, if you use one for more than 5-7 days, a rebound, more severe congestion of the nose often develops. One may be useful for a few days to clear a blocked nose when you first use a steroid nasal spray. The steroid can then get to the lining of the nose to work. Don't use decongestant nasal sprays for more than seven days.

Leukotriene receptor antagonists, 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.

What are 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.

How do you treat severe symptoms?

Rarely, a short course of steroid tablets 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.

Immunotherapy (desensitisation)

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 this case pollen) into the tissue just under the skin (the subcutaneous tissue). The idea is that your immune system will become desensitised to the pollen. This means that the allergic response that your body mounts when it is exposed to the pollen in the future is reduced, so improving your symptoms.
  • Sublingual immunotherapy (SLIT). This is similar to the above but the allergen (pollen) is placed under the tongue (that is, sublingual). Typically, the dose is one tablet a day, starting four months before the start 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 able to have this treatment. Your doctor will advise if this treatment is suitable for you. Note: immunotherapy is unlikely to totally cure hay fever, but will often greatly reduce the severity of symptoms. The less severe symptoms will then 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.


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