Hay fever is a pollen allergy from grass or trees that can cause symptoms in your eyes, nose, or throat. It can end up interfering with work, study, and sleep. In some, it can cause a whole-body response with a combination of symptoms, leaving you feeling pretty fed up and reluctant to embrace the great outdoors.
Pollen is dust-like particles carried on the wind to pollinate more plant growth. Proteins in pollen can trigger an inflammatory response where an immune-fighting substance called histamine is released from mast cells in the body. This helps protect you from certain irritants, but hay fever and other allergic reactions occur because your histamine release mechanism goes into overdrive. Hay fever is very common, affecting around 1 in every 10 people in the US, and it often starts as a child or teenager. It can run in families, and you are more likely to have hay fever if you also suffer from asthma or eczema.
Pollen is seasonal. You may be allergic to just one type of pollen, which means you are only susceptible to symptoms at certain times of the year, and therefore treatment can be limited to this time.
Treatment can be targeted at relieving each symptom or reducing inflammation. With lots of hay fever products on the market, it can be tricky to know which is right for you, so let's talk you through the options.
Eyes can feel itchy, gritty, and sensitive to light. You may get excessive streaming, making it difficult to see. You might get puffy eyelids, dark circles under the eyes, and redness on the eyes' whites and the conjunctivae's inner pockets.
Hay fever is medically termed allergic rhinitis, which refers to nose allergies but may be caused by allergens other than pollen, like house dust mites and pet dander. Constant sneezing is a classic hay fever symptom; the nasal passages can swell, making them feel blocked and congested. This can give your voice an odd tone and cause you to mouth-breathe.
Your throat can feel itchy and tingly. You may feel it constantly needs clearing, which may be in response to nasal congestion and the post-nasal drip, where secretions leak down from the back of the nose to the throat and irritate.
The post-nasal drip can also cause an irritating tickly cough. You might get a dry cough if histamine release directly affects the lungs and can trigger asthma if you are susceptible.
Skin can become itchy and blotchy, possibly with a rash. It can trigger eczema in those with this tendency.
Without treatment, nasal congestion can lead to sinusitis, where deep nasal passages are inflamed, causing discomfort and pain. Those who suffer from hay fever also tend to get asthma and eczema, and untreated hay fever can cause a flare-up of either of these conditions.
If your child suffers from hay fever over a long period, they may develop an allergic salute phenomenon. This is where they get a runny or itchy nose and use their palm to repeatedly swipe upwards, causing a little horizontal crease on the bridge of their nose and swelling at the base. This will go away with time once their symptoms are controlled.
Impact for highly sensitized people can be immediate, but for others, it can be more subtle. Symptoms can gather speed and worsen if you don't recognize them early and start treatment.
The hay fever season is typically from the end of March to July but varies depending on where you are in the country and whether your allergy is to grass pollen or tree pollen. Tree pollen tends to be active in the spring. Some start as early as mid-February (alder, hazel, and yew), most tree pollen is active in March or April (elm, willow, poplar, birch, and ash), and some trees shed in May (plane, oak, pine, and lime).
Grass pollen is most active for two months from the end of May, with yellow fields of oil seed rape pollen peaking in May and June and others (nettle, dock, and mugwort) from June to August.
It's worthwhile keeping a diary of your symptoms and the time of year you get them – you may notice a pattern that can indicate which pollen you are allergic to and start treatment a couple of weeks before this. You could also go for allergy testing, where skin prick testing is the most appropriate for pollen.
The first thing you can do is to keep an eye on the pollen count – the weather station pollen forecast is a reliable source of information.
If it's high in your area, you can take key steps to avoid it:
You may prefer to try drug-free options first, which are a good choice for pregnant women or who have suffered side effects from medicated hay fever products.
For nose symptoms, nasal lavage or saline sprays flush away allergens in the nose, preventing them from building up and provoking an immune response.
Topical nasal barriers aim to trap pollen before it enters the nasal passage and causes a reaction. Haymax Hay Fever Balm is one option, or apply Vaseline inside the nostrils.
Desensitization is a technique designed to reduce the histamine over-reaction that causes hay fever symptoms. One type is allergy immunotherapy, where a series of injections aims to gently introduce your body to the allergen – pollen – before the hay fever season starts so that you do not get the surge of histamine release.
Some people swear by eating honey produced in their area, as bees collect the nectar that has captured local pollen. While this may work for some as a solution and makes sense from the desensitization theory, the evidence is deemed too weak to say if it works for most sufferers.
People suffering from hay fever and allergies may suffer from the full spectrum of symptoms or with just one. A stepwise approach is usually the best course.
Oral antihistamines in tablet or liquid form will often be enough to bring down most symptoms, such as sneezing, a runny nose, and watery eyes. They are particularly useful if you suffer a combination of symptoms. They are available in tablet or liquid form can get to work fast, and can be used throughout the hay fever season. If you know your pollen season, it's a good idea to start antihistamines a couple of weeks beforehand to reduce or avoid symptoms when the pollen starts shedding.
Some antihistamines are classified as non-drowsy, such as cetirizine, fexofenadine, levocetirizine, or loratadine, and some older ones can cause drowsiness, like chlorpheniramine or diphenhydramine. This may be an advantage if symptoms keep you awake, and some people find one works better for them than another.
You should change the antihistamine class if using one continuously for more than three months, as you can build up a tolerance to its effects, and it may have stopped working.
Add-on treatments can help resolve any remaining symptoms, such as sinus congestion or red itchy eyes. They can be used alone if symptoms are mild or you wish to avoid antihistamine tablets.
Eye medications: Antihistamines, such as Alaway, Zaditor, and Pataday, are available over the counter for those aged 2-3 years and above.
Cromolyn sodium (Opticrom) is a mast cell stabilizer that reduces the hypersensitivity of mast cells in those with hay fever. This prevents the inflammatory response from becoming active and releasing lots of histamine, thereby stopping allergic symptoms in the eyes. It works differently from antihistamines and can be a helpful addition alongside oral antihistamines when necessary; however, this product is only available by prescription.
Nose medications: A steroid nasal spray reduces inflammation in the nose, suppressing histamine release and reducing the sensitivity to pollen or allergens. It's an excellent long-term option to help relieve congestion, sneezing, itching, and a runny nose, and you can start it a few weeks before you expect your hay fever to start. Allow five to seven days of daily application for it to get to work and continue throughout the allergy season.
Nasal decongestants provide short-term relief from a blocked nose, but they shouldn't be used in the long term, as they don't reduce the immune overdrive and can cause side effects.
A saline nasal spray or nasal lavage are good drug-free options.
Throat or cough medications, such as a throat spray, may be best to respond to coughs and throat symptoms. If you suspect pollen has caused a flare of your asthma symptoms, it's worth addressing this directly with inhalers and advice from your doctor.
For some people, there may be a few restrictions over the counter on what can be used, such as those who might be pregnant or who wear contact lenses. If you're pregnant, try the drug-free options, such as sea salt-based nasal sprays, and avoid taking any medication without speaking to a doctor or midwife first.
Not all eye drops are suitable for those wearing contact lenses, so it's worth checking the product information carefully when deciding what to use.
Drug-free options are safe and effective – this may be enough, but they are also useful to use alongside medicated products if needed. Preventative measures like balms to trap pollen in the nostrils, such as Haymax Balm, or nasal barrier sprays to prevent pollen from traveling higher up the nose, like AllerBlock.
Saline washes are also a safe option to flush out pollen from the nose. For the eyes, it's good practice to keep them clear of pollen with regular washing and some handy eye wipes.
This may not be enough, and as hay fever can impact your child's sleep and concentration at school, you may wish to progress to something medicated. Certain antihistamine formulations are known to be safe for children and babies, such as Zyrtec, containing the active ingredient cetirizine, and is suitable for children aged 2 years and over. Some oral solutions contain loratadine, a non-sedating antihistamine like cetirizine, as a safe alternative for children aged 2 and above.
You should consult your doctor if you have used pharmacy medications for 2 weeks with no relief or worsening symptoms or if symptoms have a significant impact. It's also worth a trip if you've been reliant on antihistamines for 3 months or more without your doctor's input.
The doctor will ask you about your medical history and current symptoms. Depending on your symptoms, they may examine and listen to your chest or look in your throat.
The doctor can prescribe different medications not available in the pharmacy, and in some instances, they may refer you to an allergy clinic. The clinic may do skin prick testing to determine specific allergies.
If you think your hay fever is worsening asthma or eczema symptoms, this is worth discussing with your doctor.
If over-the-counter remedies aren't helping your child or you're unsure of their diagnosis, do book an appointment with their doctor.
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