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Hay Fever and Allergies

Achoo! Mystery sneezing, a runny nose, itchy, watery eyes, and general itching and discomfort… Does this sound familiar? Allergies can be annoying and manifest in many ways, but they are possible to manage.

While hay fever and allergies are common problems, they are often underdiagnosed, and we still have many misconceptions about them. Some people believe that allergies—especially ‘mild’ seasonal allergies—are not serious enough to make a fuss about, but the truth is that any allergic reaction takes a toll on your body and should be treated accordingly.


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What is an allergy?

Just about any substance, no matter how harmless, can cause an allergic reaction if the body develops a sensitivity to it. When this happens, your body perceives an otherwise benign substance as a threat and activates its powerful immune response in defence. An estimated 20 % of people experience allergies at some point in their lifetime, and you never know when it might strike!

When you encounter an allergen that your immune system identifies as a threat, your body responds by releasing histamines and other inflammatory mediators to counteract the threat. It is this immune response that causes the characteristic symptoms of an allergic reaction.

Common allergens include:

  • pollen
  • dust mites
  • pet dander
  • certain foods, such as peanuts, shellfish, or eggs
  • insect venom, such as bee stings or mosquito bites
  • certain medications, such as penicillin or aspirin 
  • various substances commonly found in living spaces, such as mould spores

Allergies can affect various parts of the body causing, for example, allergic rhinitis in the respiratory system, hives or eczema in the skin, or gastrointestinal symptoms in the digestive tract. Symptoms will vary depending on the allergen and the individual's sensitivity. Mild to moderate allergic reactions include sneezing, a runny or stuffy nose, and coughing or wheezing, itchy and watery eyes, itchy skin and rashes, nausea and vomiting, and diarrhoea.

A severe allergic reaction can lead to anaphylaxis, which is life-threatening and requires immediate medical attention. Symptoms include swelling of the throat or tongue, difficulty breathing, rapid pulse, dizziness, and loss of consciousness. Primary treatment is an injection of the hormone epinephrine. Many people who are prone to allergies carry an autoinjector for epinephrine—an epipen—in case of emergency. Even so, further assessment and treatment with IV fluids and also potentially antihistamines or steroids is strongly recommended. Up to 2% of people will have at least one such episode in their lifetime, but most survive given they receive treatment very quickly.

What is hay fever?

Hay fever, also known as allergic rhinitis, is a common condition that affects the nasal passages, or sinuses. This is characterized by irritation and inflammation of the mucous membranes in the nose and eyes causing sneezing, a runny or stuffy nose, and itchy, watery eyes.

Hay fever is typically triggered by exposure to tree or grass pollen, or other small airborne particles in the environment.

Is hay fever an allergy?

Yes, hay fever is a type of allergy that specifically affects the nose and eyes. Symptoms can vary in severity and may be seasonal or perennial, depending on individual sensitivity and the allergen in question. Hay fever tends to be mild yet persistent, with symptoms that are annoying rather than life threatening, much like the symptoms of the common cold. People with respiratory conditions such as asthma are especially susceptible to hay fever.

Which allergens cause hay fever?

Hay fever is typically triggered by exposure to small airborne particles in the environment.

Pollen from trees and grasses is the most common trigger for seasonal hay fever, giving the condition its name. Different types of pollen are present at different times of the year. For example, trees release their pollen in the spring, various grasses—which are cut and dried to make hay—release their pollen in the summer, and ragweed is the main culprit for pollen allergies that appear in the fall.

Some of the most common allergens that can cause persistent, year-round hay fever include:

Microscopic dust mites that live in bedding, upholstery, carpeting and other parts of our living spaces. Their droppings and body parts can trigger allergies in some individuals.

Mould spores can be present both indoors and outdoors, particularly in damp and humid environments.

Pet dander, tiny flakes of skin and hair from cats and dogs, and other animals together with proteins from their saliva and other fluids can trigger an allergic reaction. Parrots are highly allergenic animals.

Hay fever can also be caused by various other allergens not listed here.


If you suspect you have hay fever or some other allergy, consult a healthcare professional for testing and diagnosis so you can quickly receive the most appropriate treatment.

The (Excessive) Hygiene Hypothesis

There is an idea in the medical community that early childhood exposure to dirt and germs, microorganisms and parasites, “trains” the immune system and so protects us against allergies. The rates of allergies and autoimmune diseases have skyrocketed in the past hundred years and are much higher in the industrial world than elsewhere. While this idea is not universally accepted, and there are competing theories about the mechanisms at work, there is quite a lot of evidence that personal hygiene is important for our health, but an overly sterile environment can be detrimental.


How to get rid of hay fever?

Sadly, there is currently no known cure for hay fever. The simplest way to prevent hay fever would be to avoid the trigger. Unfortunately, unlike food allergies that can be clearly identified and eliminated from your diet, avoiding all environmental triggers is nearly impossible. However, there are various steps you can take to reduce your symptoms and improve your quality of life.

Even though complete avoidance may be unrealistic, minimizing exposure to allergens can help reduce hay fever symptoms.

For people with pollen sensitivity, this might mean staying indoors as much as possible during peak pollen times, typically in the mornings and on windy days when your pollen triggers are in season. Some weather reports include pollen level predictions for those of us with allergies. Keep your windows closed and use a HEPA (high-efficiency particulate air) filter in your air conditioner or humidifier to reduce allergens indoors. People with dust mite allergies can minimize their exposure by regularly cleaning the bedding, vacuuming carpets and furniture cushions, and otherwise limiting the accumulation of dust and dander in the home. Consider investing in high-quality air filters or a vacuum with a HEPA filter. Remember, strong cleaning solutions, scented products, and dry air can also exacerbate symptoms for people prone to allergies.

Allergy Medications

For some people, medications can be an effective way to treat the symptoms of allergy. Access and preferred treatments tend to differ in different parts of the world. The most common medications for allergic symptoms include:

Antihistamines

Antihistamines are commonly used to quickly relieve symptoms such as sneezing, itching, runny nose, and itchy eyes. Among other functions, the hormone histamine is involved in the body’s immune response; it makes capillary walls easier for white blood cells to pass through, so they can attack and eliminate pathogens. This same mechanism also allows fluid to leak from the capillaries causing classic allergy symptoms of runny nose and watery eyes.

First-generation antihistamines such as diphenhydramine (Benadryl), chlorpheniramine (Chlor-Trimeton), and hydroxyzine (Atarax) are effective in relieving allergy symptoms but are often avoided during the daytime due to their sedating effects. These drugs can cross the blood-brain barrier to influence histamine in its role as a neurotransmitter where it helps regulate the sleep-wake cycle. This is why Benadryl makes you drowsy.

The newer, second-generation antihistamines such as cetirizine (Zyrtec), loratadine (Claritin), fexofenadine (Allegra), and desloratadine (Clarinex) don’t cross into the brain, so they are preferred for daytime use as they don’t usually cause drowsiness.

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Nasal corticosteroids

Nasal corticosteroids are anti-inflammatory nasal sprays that help reduce inflammation in the nasal passages and relieve symptoms such as nasal congestion, runny nose, and sneezing when used regularly. They are available by prescription and can be very effective in managing hay fever symptoms. Some brands may also be available over the counter in your country.

Unlike antihistamines and decongestants, nasal corticosteroids take hours to days before their effects are felt, and full effectiveness can come after weeks of use. If you suffer from seasonal hay fever, it’s best to start using them 1 to 2 weeks before your trigger pollen becomes abundant.

Because the effects are delayed, there is a greater risk of overuse by impatient allergy sufferers. Side effects of this type of medication include mild nasal irritation, sneezing, throat irritation, headaches, and nosebleed.

The most dangerous side effect of excessive use of nasal corticosteroids is perforation of the septum, so the medication should be discontinued if any bleeding occurs before serious damage is done. Nasal corticosteroids can be very effective, but because there are more contraindications for this medicine, it’s best to consult with your doctor before you begin to use it.

Decongestants

Oral or nasal decongestants provide rapid, temporary relief from nasal congestion and pain and pressure in the ears by shrinking blood vessels and swollen tissues. Most people can use them safely, but they should be used in the recommended dosage and for no more than a few days at a time, as prolonged use can lead to rebound congestion where your mucous membranes swell up more than before.

Decongestants come in many different forms using a variety of active ingredients, for example oxymetazoline, phenylephrine, or pseudoephedrine. Many decongestants are sold over the counter, but some require a prescription. They should not be given to young children and be sure to consult with your doctor before using any medication if you are pregnant.

Other Treatments for Allergies and Hay Fever

There are many cases in which people may want to use alternative treatments to manage their allergies.

Immunotherapy

In cases of severe hay fever that does not respond well to other treatments, allergen immunotherapy (allergy shots) may be considered. This involves receiving regular injections of small amounts of the allergen over a period of time, gradually desensitizing the immune system to the allergen and reducing symptoms. Allergy shots are typically prescribed and administered by an allergist. This solution takes some time but has to the potential to provide permanent relief.

Probiotics

There is a lot of talk about probiotics these days. Many different microorganisms live all around us, on plants and animals, in the foods we eat, and in our intestines, where they live in symbiosis with our own bodies, playing a vital role in our immune response. Each person has their own unique gut microbiome with many different microorganisms. Some strains are beneficial, while others can cause dysbiosis—an imbalance of microorganisms in the digestive system.

Some studies now show that certain strains of bacteria, such as the Lactobacillus and Bifidobacterium commonly found in yoghurts and kombucha, can reduce inflammation and a calm a hyperactive immune response to certain types of allergens, including those that cause rhinitis. As each of us is unique there is no single formula that will work for all people, but this may be an avenue worth exploring.

It is important to consult with a healthcare professional or allergist to evaluate your symptoms and conduct any necessary allergy testing. Once you have a proper diagnosis, the allergist can recommend the most effective approach to managing your hay fever.

Can you develop hay fever as an adult?

Although it comonly begins in childhood or adolescence, it is possible to develop hay fever later in life. Late-onset hay fever is believed to be caused by one or several of the following factors:

  • compromised immune response coupled with increased sensitivities
  • environmental changes
  • occupational exposure
  • hormonal changes

Prolonged exposure to common allergens such as dust, mould, pollen, and other small particles can cause hay fever in otherwise healthy individuals.

Is this hay fever or a cold?

While the symptoms of hay fever overlap with many cold symptoms, hay fever is caused by allergens, whereas a cold is a viral infection. This distinction is important because the treatments for these conditions are very different. The three main ways to tell the difference between a cold and hay fever are onset, progression, and the presence of a differentiating symptom.

Onset. A cold develops gradually after exposure to a virus, while hay fever starts soon after encountering the allergen. Progression. Cold symptoms usually resolve within 10 days, while hay fever remains as long as there are triggers in the environment. Differentiating symptoms. Fever is a common cold symptom that does not typically occur with hay fever, while itching is a common symptom of hay fever that is not typically present with colds.

You deserve to be free from hay fever, as much as possible

While hay fever is typically not life-threatening, it can significantly impact a person’s quality of life. The symptoms can be bothersome and interfere with daily activities, including sleep, work, and studying. Having to contend with allergic symptoms wears you down over time. Persistent allergies also increase the risk of experiencing an asthma attack or developing some other more serious respiratory condition.

If you are suffering from allergies or hay fever, it’s better not to be stoic and tough it out. Figure out what your triggers are and do what needs to be done to sooth your symptoms and make yourself more comfortable. You’ll be glad you did.

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https://www.nhsinform.scot/illnesses-and-conditions/immune-system/hay-fever
https://erj.ersjournals.com/content/60/3/2102865.abstract
https://www.nhs.uk/conditions/hay-fever/
https://www.mayoclinic.org/diseases-conditions/hay-fever/symptoms-causes/syc-20373039
https://acaai.org/allergies/allergic-conditions/hay-fever/
https://my.clevelandclinic.org/health/diseases/8622-allergic-rhinitis-hay-fever
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