Hay Fever

What is hay fever?

Pollen is the name given to the fine powder that is produced by plants, trees or flowers to fertilise other plants, trees or flowers of the same species. Strictly speaking, hay fever is caused by an allergy to grass or hay pollens. Grass pollen is the most common cause and tends to affect people every year in the grass pollen season from about May to July (late spring to early summer). However, the term is often used when allergies are caused by other pollens such as tree pollens. Tree pollens 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.

Symptoms are due to your immune system reacting to the pollen. Cells on the lining of the nose and eyes release histamine and other chemicals when they come in contact with pollen. This causes inflammation in the nose (rhinitis) and eyes (conjunctivitis). Sometimes the sinuses and throat can also be affected.

Hay fever is also called seasonal allergic rhinitis because symptoms tend to occur at the same time, or in the same season, each year.

Who gets hay fever?

Hay fever is very common. It affects 2 in 10 people in the United Kingdom. It often first develops in school age children and during the teenage years. Symptoms return for a season each year, but it eventually goes away or improves in many cases (often after having had symptoms each season for several years).

Hay fever tends to run in families. You are also more likely to develop hay fever if you already have asthma or eczema. Equally, if you have hay fever, you are more likely to develop eczema or asthma. The conditions asthma, eczema and hay fever are known together as 'atopic' conditions or 'atopy'. A tendency to atopy can run in families.

What are the symptoms of hay fever?

The symptoms of hay fever can vary from person to person. Some people only have mild symptoms that tend to come and go. Others can be severely affected with symptoms that are present every day during the pollen season.

• Common symptoms - These include a runny and itchy nose, a blocked nose, sneezing, itchy and watery red eyes, and an itchy throat. In some cases only nose symptoms occur, and in some cases only eye symptoms occur.
• Less common symptoms - These are loss of smell, face pain, sweats, and headache.
• Asthma symptoms - Symptoms such as wheeze and breathlessness may get worse if you already have asthma. Some people have asthma symptoms only during the hay fever season. If you have hay fever, you are more likely to develop asthma.

The symptoms may be so bad in some people that they can affect sleep, interfere with school and exams or interfere with work.

How is hay fever diagnosed?

You doctor or nurse can usually diagnose hay fever from your typical symptoms that can occur during the hay fever season. They may also ask if there is a history in your family of hay fever, asthma or eczema.

If hay fever is suspected, your doctor or nurse will usually suggest treatment for your symptoms (see below). If the symptoms respond to treatment, this can help to confirm the diagnosis. In rare cases when the diagnosis is in doubt, your doctor may suggest blood tests or skin prick testing to confirm your pollen allergy. See separate leaflet called 'Skin Prick Allergy Test' for further detail.

Will it help if I avoid pollen?

It is impossible to totally avoid pollen. However, symptoms tend to be less severe if you reduce your exposure to pollen. The pollen count is the number of pollen grains per cubic metre of air. The pollen count is often given with TV, radio, internet, or newspaper weather forecasts. A high pollen count is a count above 50. The following may help when the pollen count is high:

• Stay indoors as much as possible, and keep windows and doors shut.
• Avoid cutting grass, large grassy places, and camping.
• Shower and wash your hair after being outdoors, especially after going to the countryside.
• Wear 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 are the commonly used treatments?

The commonly used treatment options for hay fever are: antihistamine nose sprays, antihistamine tablets, steroid nose 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. You may need to try a different treatment or add in another treatment.

If you are taking hay fever medication regularly and your hay fever is well controlled on your current treatment, you should continue this treatment until the end of the pollen season.

Antihistamine nose spray

A dose from an antihistamine nose spray can rapidly ease itching, sneezing and watering (within 15 minutes or so). It may not be so good at easing congestion. Antihistamines work by blocking the action of histamine. This is one of the chemicals involved in allergy 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)

Antihistamines taken by mouth (tablets or liquids) are an alternative. They ease most of the symptoms but may not be so good at relieving nasal congestion (blocked nose). Antihistamines taken by mouth are good if you have eye symptoms as well as nose symptoms. They are also usually given to small children instead of a nasal spray. A dose usually works within an hour. Therefore, one can be taken 'as required' if symptoms are mild, or come and go. One can also be taken regularly if symptoms occur each day.

There are several brands of antihistamines that you can buy at pharmacies or get on prescription. Older brands such as chlorphenamine work well, but make some people drowsy, so they should not be taken if you are driving or operating machinery. There are several newer ones that cause less drowsiness. Ask your pharmacist for advice.

If you are pregnant or breastfeeding, it is advised to try to avoid antihistamines if possible. Treatment with a steroid nose spray is usually tried first (see below). An antihistamine may sometimes be used if your symptoms are not controlled. Discuss with your doctor or pharmacist if you are pregnant or breastfeeding and have hay fever.

Steroid nose sprays and drops

A steroid nose spray usually works well to clear all the nose symptoms (itch, sneezing, watering and congestion). It works by reducing inflammation in the nose. A steroid nose spray also tends to ease eye symptoms. It is not clear how it helps the eye symptoms - but it does! Steroid nose drops are also sometimes used.

It takes several days for a steroid spray to build up to its full effect. Therefore, you will not have an 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. So do persevere. (It is best to start taking it a few weeks before the hay fever season is likely to begin if you know that you have hay fever.)

A steroid nose spray tends to be the most effective treatment when symptoms are more severe. It can also be used in addition to antihistamines if symptoms are not fully controlled by either alone.

You need to take it 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. There are several brands which you can buy at pharmacies, or get on prescription. Side-effects or problems with steroid nose sprays are rare (read the packet leaflet for details).

Other treatment options

Eye drops

If necessary, you can use eye drops in addition to other treatments:

• Antihistamine eye drops work quickly, so you can use them 'as required' to ease a flare up of eye symptoms. You can also use them regularly if needed. There are several brands.
• 'Mast cell stabilisers' are another type of eye drop. There are different brands. They are thought to work by stopping the release of histamine from certain cells (mast cells). You need to use them regularly to prevent symptoms.

Other nose sprays

The following are sometimes used. They tend to be used if there are problems with any of the above treatments. Sometimes one is used as an 'add on' treatment in addition to one or more of the above treatments if symptoms are not fully controlled:

• Sodium cromoglicate nose spray. Like steroid sprays, it 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 3 months of pregnancy.
• Ipratropium bromide nose spray may be worth a try if you have a lot of watery discharge. It has no effect on sneezing or congestion.
• Decongestant nose 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 nose spray. The steroid can then get to the lining of the nose to work. Don't use decongestant nose sprays for more than seven days.

Treatment for severe symptoms

Rarely, a short course of steroid tablets is prescribed. For example, for students sitting exams, who have severe symptoms which are not eased by other treatments. Steroids 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. See separate leaflet called 'Steroid Tablets' for more detail.

Immunotherapy (desensitisation)

This treatment is sometimes used, mainly in cases where symptoms are severe and not helped by other treatments. It is done using a series of injections of the allergen (in this case pollen) in increasing quantities. 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. Another technique is being developed which involves placing the allergen under the tongue. However, this may not yet be widely available.

Asthma and hay fever

If you develop asthma symptoms during the hay fever season you may be prescribed an inhaler. If you already have asthma, your asthma may become worse in the hay fever season. You may need an increase in the dose of your usual inhalers (or other treatment that you take for asthma) during the hay fever season.

Further help and advice

Allergy UK

3 White Oak Square, London Road, Swanley, Kent BR8 7AG
Allergy Helpline: 01322 619898 Web: www.allergyuk.org
A charity for people with allergy, food intolerance and chemical sensitivity.