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Let's Win the Battle Against Hay Fever

Updated on July 2, 2020
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Doctor by profession, newly married, and living with her loving husband in England. She loves traveling and writing about Health Sciences.

You must read this article if you often suffer hay fever with nasal or other respiratory tract symptoms, and if you experience either persistent or never going allergic manifestations.

This article will discuss how allergy happens, how does it affect? How to fight against it? , and what happens if it is left untreated?

Hay fever, also known as Allergic rhinitis, is an allergic condition that is often undiagnosed or misinterpreted in other cases. If not treated on time, it severely disturbs the quality of life. Consequently, it then leads to asthma development, and if asthma is already present, untreated hay fever(allergic rhinitis) makes it worse.

Thanks to the advancement in healthcare sciences, allergic rhinitis is treatable if the patient stays away from triggering factors, and takes medicine on doctors' advice.

Around 40% of worlds population is allergic to something.

Hay Fever(Allergic Rhinitis)

It is an inflammatory condition that affects the internal lining of the nose called the mucosa. It occurs when re-exposure to a particular allergen arouses immune response and inflammation cascade.It causes sneezing, congestion, nose blockage, and runny nose. However, patients don't need to develop all the symptoms. Some have a runny nose; some develop a nasal block.

Hay fever(Allergic rhinitis) could be due to infection or allergy or neither of these

Common Allergens

(click column header to sort results)
Indoor  
Outdoor  
Occupational  
Medicine  
Dust mites
Pollen
Latex
Aspirin
Insects
Mould
 
 
Animal dander
Cigarette smoke
 
 
Plants
Vehicle exhaust
 
 
pollen
pollen | Source

Classification of Hay Fever( Allergic Rhinitis)

  • Exposure time and duration
  • Seasonal
  • Perennial
  • Occupational


Seasonal allergies mostly affect children, whereas Perennial allergies affect adults

Mechanism

It all begins when a specific type of allergen, causing allergy, enters the body. At first, the immune system perceives it and keeps it in its memory. Also, a specific anti-allergy-fighting IgE is made against the allergen for later to fight next time, and this is called Sensitization.
When the same allergin strikes the body again, previously build IgE comes in action and explode all its defensive mechanism through chemicals such as histamines, eosinophils, prostaglandins(inflammation provoking chemicals), etc. This re-exposure takes few hours to buildup the reaction against the offender, and it is term as Early-phase reaction.
The story doesn't end yet as another reaction begins parallel to the early one, and it is established within 10 hours. The immune system does not sit quietly, so it excites more immune, inflammation stimulating cells to ignite inflammation and mucous secretions. It is the Late-phase, and it is more dangerous and severe as it induces more inflammation and destruction inside the body.

Sign & Symptoms

This disease could manifest itself differently in different patients. Some develop a runny nose and sneezing signs, which are easy to identify, some with nasal blockage, which is tricky to diagnose. It disturbs the patient's sleep, and quality of life suffers a lot. Eventually, it results in daytime sleep, dizziness, less concentration on work, and tiredness all time, which is troublesome for employed ones and students.

Diagnostic criteria: at least 2 symptoms
Diagnostic criteria: at least 2 symptoms | Source

Hay fever(Allergic Rhinitis) also develops smell and taste disturbance, conjunctivitis, postnasal drip, ear infections. Besides, it has an association with certain diseases like atopic dermatitis, nasal polyp, and asthma.

Nose blockage with mouth breathing could be the only visible sign in infants and toddlers. They could have other diseases along with allergic rhinitis that often goes ignored or, misdiagnosed such as asthma, adenoids, sleep apnea, and ear infections.

Allergic rhinitis is more common in young boys

Asthma & Allergic Rhinitis

Studies have shown that asthmatic patients either suffer continuous or severe type of allergic rhinitis. Studies also show that about 75% of children who have asthma must have allergic rhinitis, and their asthma is usually not under control.

Bitter Truth

20% of people with allergic rhinitis develop asthma later in life

Possible Risk Factors

  • Firstborn child(according to UK research)
  • Genetics
  • Total IgE levels ↑100 IU/ml before age 6
  • Respiratory infections
  • Well socio-economic status
  • Pollution
  • Tobacco smoke
  • Farmer (exposed to moisture)

Diagnostic Tests

After a history of allergic symptoms

  • Nose examination(through nasal endoscopy&rhinoscopy)
  • Ear, throat and chest examination
  • Hypersensitivity skin test
  • RAST(blood test to evaluate allergen-specific IgE)
  • Nasal challenge test(for occupational allergies)

Allergen Skin Test
Allergen Skin Test | Source

Treatment Guidelines

It requires a definite diagnosis of hay fever(allergic rhinitis), avoiding the allergen and medicines to control symptoms.


Treatment for Hay Fever(Allergic Rhinitis)
Saline Spray
Anti-Histamines (preferably non sedating)
Intranasal Corticosteroids(for moderate&severe)
Anti-Lukotrienes
Decongestant
Best therapy is avoiding the allergen, medical treatments come after that

Avoiding allergens is the best approach before starting any therapy as 'prevention is better than cure'

Those who develop hay fever only in the pollen season, they can use Nasal filters to reduce pollen exposure.

Inhaled Corticosteroids(INC)

Healthcare practitioners consider corticosteroid therapy the best among all and prescribe it for both allergic rhinitis and asthma. But, the effect depends on the patient's acceptance, drug concentration, and formulation. Sometimes, unpleasant taste and odour reduce compliance or preservatives in the spray cause nose irritation.

Corticosteroids are more useful in relieving nasal obstructions and lowering the symptoms. Also, these are modern drugs, and they cause a minimum to no systemic side effects.
Research has shown that systemic effects are least in the nose and lesser in the lungs as compared to skin.
Corticosteroids work when administered successfully inside the nose. Therefore, a patient or a caregiver should learn the proper usage of a nasal spray.
However, still, regular monitoring is necessary, especially in children, as steroids retard or slow down bone growth in them.

Non-Sedating Anti-Histamines

It is used for mild to moderate allergic rhinitis. Anti histamines+ intranasal steroid combination is for severe conditions. Non-sedating 2nd-generation antihistamines are mostly preferred, as sedating ones cause dizziness, daytime sleep, headache, and slowing down the brain and physical activities.
A nasal spray of antihistamine is more convenient and potent as tablets take an hour to show the result as compared to 10-15 mints by spray.

Treatment for Hay Fever
Treatment for Hay Fever | Source

Immunotherapy

It was first used in 1911 to treat hay fever. It treats severe, persistent allergic rhinitis when no medicine works on it. In this, allergy provoking allergen is exposed to patients in a controlled manner. Re-exposure to the allergen, again and again, would at last resolve the symptoms.

They are of two types,

Local Nasal & Sublingual Immunotherapy is useful for grass pollen allergy. Sublingual therapy is safe for children.

Subcutaneous Immunotherapy halts the natural progression of allergic disease. A minimal dose up to 20μg is enough to bring positive results. Trained doctors or nurses perform this procedure, and they should wait and monitor it for at least 20mints to see the reaction and its outcome.

This therapy is for those,

  • who failed to respond to medicines
  • whose body has reacted to the snake venom, bee or spider sting
  • who has other diseases such as sinusitis and asthma
  • who can not avoid further exposure to the allergen, and it keeps creating a problem daily

Contraindications of Immunotherapy

  • Poorly controlled asthma
  • Pregnancy
  • Autoimmune diseases
  • Cancers
  • Heart and lung diseases
  • Patients on medications such as Beta-blockers

Saline Spray

Iso-tonic saline is well-tolerated, cheap, and easy to use. It relieves symptoms, and it augments the effect of the intra-nasal steroids.

Decongestants

It helps in constricting blood vessels(vasoconstriction)in the nose, which in turn keeps inflammation in control. Also, it eases the blockage by allowing drainage of secretions.

Surgery

It works for those who develop nasal allergy along with nasal growth or any deformity(such as nasal polyp and deviated nasal septum).

Exceptions for the Above Treatment

Pregnancy

Pregnancy is a condition in which allergy symptoms are either provoke or aggravated by the hormonal changes. Also, medicines cross the placenta barrier, and it could be dangerous for both mother and baby. Pregnant ladies should seek advice from their doctor before taking any medicine for allergy.

Aging

It is common to get allergy-like symptoms in 60+ age. However, they are less likely due to hay fever(allergic rhinitis). Symptoms can be due to underlying connective tissues and cellular changes in the nose or its vessels. Besides, drugs(such as ACE inhibitors in hypertension) which aged people use due to co-morbidities could manifest a runny nose.

Anti-allergy medicine itself could produce undesirable side effects in old age, for instance, the sedating effects of anti-allergy increase the chances of falls and trauma, and steroids increase the chances of fracture and bone pain in the elderly.

Nutshell

Hay fever(Allergic rhinitis) is a common condition that affects both young and adults. If signs and symptoms are picked and diagnose at the right time, it will cure the disease, and it will save many patients from late-onset complications (such as asthma). Also, on-time treatment would reduce frequent hospital admissions and its expenses.

This content is for informational purposes only and does not substitute for formal and individualized diagnosis, prognosis, treatment, prescription, and/or dietary advice from a licensed medical professional. Do not stop or alter your current course of treatment. If pregnant or nursing, consult with a qualified provider on an individual basis. Seek immediate help if you are experiencing a medical emergency.

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