Hay fever: Causes, prevention and treatment

Hay fever, also known as allergic rhinitis, is a very common affliction that can prove very annoying and painful if left untreated. In his latest online article, renowned consultant ENT surgeon Mr Kiran Varad explains in detail the steps you can take to relieve your symptoms.

What are the most common forms of hay fever treatment?

Allergic rhinitis causes inflammation of the nasal passages and eyes. It is often referred to as hay fever, but can be caused by an allergy to many things outside of grass and tree pollen. Treatment of hay fever usually entails allergen avoidance and medications. Surgery is occasionally used if the symptoms are severe.

An allergy test can help determine what a patient is allergic to. This can be in the form of a skin prick test (the skin is pricked with various allergens in the air to see if there is a response) or a blood test that measures sensitivity to various allergens.

The stepwise treatment of hay fever is as follows:

• Allergen avoidance: trying to avoid substances (e.g., dust or tree pollen) that the patient is allergic to.
• Saline nasal sprays
• Steroid nasal sprays
• Antihistamine tablets
• Immunotherapy: this allows the body to be desensitised a given substance a patient is allergic to
• Surgery: mainly to reducing the swelling of the lining of the nose.

Medical treatments include:

• Saline nasal sprays: This can provide relief to some of the symptoms of hay fever with minimal side effects.
• Intranasal corticosteroids: Steroid nasal sprays help reduce inflammation in the nasal passages, relieving congestion, sneezing, itching, and runny nose. They are usually the most effective medications for controlling hay fever symptoms and may require regular use over time to achieve maximum benefit. Some intranasal corticosteroids are available over the counter, while others require a prescription.
• Antihistamines: These medications block the effects of histamine, a chemical released during an allergic reaction. They can help relieve sneezing, itching, runny nose, and watery eyes. Antihistamines are available in both over-the-counter and prescription forms.
• Decongestants: Oral or nasal decongestants can provide temporary relief from nasal congestion. They work by shrinking blood vessels in the nasal passages, reducing swelling and congestion. However, decongestants should be used for short periods due to potential side effects and should be avoided in individuals with certain medical conditions.
• Leukotriene receptor antagonists: These medications block the action of leukotrienes, which are chemicals involved in the allergic response. They can help alleviate hay fever symptoms, particularly when combined with other treatments. Leukotriene receptor antagonists are available by prescription.

Why is hay fever treatment sometimes ineffective?

Hay fever treatments usually work well but there are certain scenarios where it may not be as effective:

• Incorrect use of steroid sprays: the steroid spray nozzle should be directed backwards and slightly towards the side of the nose to work effectively. If patients find they are tasting/swallowing a lot of the spray then the spray is probably not being administered correctly.
• Incorrect diagnosis: Many patients have rhinitis in the absence of any allergies and in these cases, hay fever treatments may not work.
• Medication suitability: Unfortunately, not all patients with hay fever respond to medications. Some patients may need desensitisation immunotherapy or surgery to help the symptoms when medications have failed.

Are some people more likely to be affected by treatment-resistant hay fever than others?

• Allergen sensitivity: People with higher sensitivity to allergens might find it more challenging to control their hay fever symptoms with standard treatments.
• Genetic predisposition: Genetics can play a role in how the immune system responds to allergens and how individuals process medications. Some people might have genetic factors that make them more prone to treatment resistance.
• Coexisting conditions: Individuals with other health conditions, such as asthma or chronic sinusitis or nasal polyps, might have more complex symptoms that are harder to manage effectively.
• Environmental exposures: Those living in areas with high pollen counts or increased pollution might experience more severe symptoms that are less responsive to treatment.
• Immune system variability: Immune responses vary widely between individuals. Some people's immune systems might not respond well to certain treatments.
• Medication tolerance: Some individuals might develop a tolerance to certain medications over time, making them less effective.
• Lifestyle factors: Lifestyle choices such as smoking or exposure to irritants can exacerbate symptoms and make treatment less effective.
• Age: Children might experience different challenges in managing hay fever symptoms and might be more prone to treatment resistance. Children can also have large adenoids which can make the hay fever symptoms worse.

What forms of treatment can help in the most severe cases?

In severe cases patients not responding to standard medical treatment, immunotherapy or surgery may be options.

Immunotherapy: Allergen immunotherapy can be given in tablet or injection form. The tablet/injection contains a dose of a specific allergen that the individual is allergic to. A regular dose is given in slowly increasing doses over a few years. Over time the body gets desensitised to the substance, reducing the severity of hay fever symptoms and potentially provide long-lasting relief.

Surgery is only considered when medical treatment fails to improve symptoms:

• Turbinate reduction surgery is useful in cases where nasal blockage does not improve with medical treatment. It involves using heat/energy or removing part of the turbinate tissue to reduce the size of the turbinates.
• Septoplasty: This involves straightening a bent nasal septum to improve airflow in the blocked nostril.
• Intranasal cryotherapy: This can be useful in cases of a persistent runny nose despite medical treatment. The cryotherapy freezes the nerve that controls a runny nose reducing the severity of this.
• Vidian neurectomy: This is a surgical procedure performed to address chronic nasal blockage and excessively runny nose. It involves cutting or removing the vidian nerve, which contributes to these symptoms, with the goal of reducing a runny/blocked nose. The surgery is rarely required and done under general anaesthesia.

What are the do’s and don’ts of managing hay fever symptoms? Can lifestyle changes help?

Do's:

1. Consult a healthcare professional: If you suspect hay fever, consult a doctor for proper diagnosis and treatment recommendations.
2. Follow treatment plans: Adhere to prescribed medications, including antihistamines, and nasal steroid sprays as directed by your doctor.
3. Identify allergens: Determine the specific allergens triggering your symptoms, which can help you avoid exposure.
4. Stay informed: Keep track of local pollen counts and plan outdoor activities accordingly.
5. Use air filters: Consider using air purifiers with HEPA filters in your home to reduce indoor allergen exposure.
6. Keep windows closed: Keep windows closed during peak pollen seasons to prevent allergens from entering your home.
7. Shower and change: After spending time outdoors, shower and change clothes to remove pollen from your skin and hair.

Don'ts:

1. Avoid self-diagnosis: Don't assume you have hay fever without consulting a healthcare professional to rule out other conditions.
2. Overuse decongestant nasal sprays: Prolonged use of decongestant nasal sprays can lead to "rebound" congestion. Limit usage as directed by your doctor.
3. Neglect allergen avoidance: Don't underestimate the impact of allergen avoidance. Minimizing exposure is essential.
4. Ignore symptoms: Ignoring symptoms can lead to complications. Address symptoms promptly to prevent worsening.
5. Skip medications: Even if symptoms improve, continue taking prescribed medications throughout the allergy season.

Lifestyle changes are essential to help with hay fever. These include:

1. Allergen avoidance: Minimise exposure to pollen by staying indoors during peak pollen times and keeping windows closed.
2. Nasal irrigation: Use saline nasal irrigation to clear nasal passages of allergens and reduce congestion.
3. Dietary changes: Some studies suggest that certain foods, like fruits and vegetables rich in antioxidants, might help alleviate allergy symptoms. However, individual responses vary.
4. Hydration: Staying hydrated can help thin mucus and reduce congestion.
5. Healthy diet: A balanced diet rich in nutrients supports your immune system, which can impact your body's response to allergens.
6. Regular exercise: Regular physical activity can boost your immune system and overall well-being.
7. Reduce stress: Chronic stress can exacerbate hay fever symptoms. Engage in stress-reduction techniques like meditation, yoga, or deep breathing.
8. Maintain cleanliness: Keep your living spaces clean and free of dust and pet dander.
9. Wear sunglasses: Wearing sunglasses when outdoors can help protect your eyes from pollen.
10. Travel wisely: If you're traveling during allergy season, research pollen levels at your destination and plan accordingly.

Allergen avoidance depends upon what a person is allergic to:

• Pollen avoidance:
  • Staying indoors during peak pollen times (typically early morning/ late afternoon).
  • Keeping windows closed and using a high-efficiency particulate air (HEPA) filter in your home.
  • Shower and change clothes after spending time outdoors to remove pollen from your body and clothes.
• House dust mite avoidance:
  • Use allergen-proof covers on mattresses, pillows, and bedding.
  • Wash bedding regularly in hot water.
  • Minimise the use of carpets, curtains, and upholstered furniture.
  • Vacuum with a HEPA filter or damp cloth to reduce dust dispersal.
  • Regularly clean and dust your home, using a damp cloth or microfiber cloth.
  • Keep humidity levels low (around 30-50%) to inhibit dust mite growth.
• Pet dander avoidance:
  • Keep pets out of bedrooms and other areas where you spend a lot of time.
  • Regularly bathe and groom pets to reduce dander.
  • Use high-efficiency air purifiers or filters to trap pet allergens.
• Mould avoidance:
  • Reduce indoor humidity levels to discourage mould growth.
  • Repair any leaks or water damage promptly.
  • Use a dehumidifier in damp areas like basements or bathrooms.
  • Avoid activities that increase mould exposure, such as raking leaves or working with compost.

If you would like to request a consultation with Mr Kiran Varad, you can do so today via his Top Doctors profile.