Hay fever

Introduction

  • Hay fever, or allergic rhinitis, is an allergic reaction to airborne allergens such as pollen, dust mites, mold, or animal dander.
  • It is characterized by nasal congestion, sneezing, runny nose, and itchy eyes.
  • Symptoms can be seasonal (triggered by pollen during certain times of the year) or perennial (year-round).
  • Effective management includes avoiding allergens, using medications, and sometimes immunotherapy.

Causes of Hay Fever

  1. Airborne Allergens
    • Pollen: Grass, tree, and weed pollen are common triggers in seasonal hay fever.
    • Dust Mites: Found in bedding, carpets, and upholstered furniture.
    • Mold Spores: Indoors or outdoors, especially in damp conditions.
    • Animal Dander: Tiny skin flakes shed by pets.
  2. Immune System Response
    • Overreaction of the immune system to harmless substances, producing histamine and other chemicals that cause symptoms.
  3. Genetic Predisposition
    • Family history of allergies or asthma increases risk.

Symptoms of Hay Fever

  1. Nasal Symptoms
    • Sneezing, runny nose, nasal congestion.
    • Postnasal drip.
  2. Eye Symptoms
    • Red, itchy, watery eyes (allergic conjunctivitis).
  3. Throat and Ear Symptoms
    • Itchy throat, ears, and palate.
  4. Other Symptoms
    • Fatigue, irritability, or difficulty concentrating (often due to poor sleep).

Complications of Hay Fever

  • Sinusitis: Inflammation or infection of the sinuses.
  • Asthma Exacerbation: Hay fever may worsen asthma symptoms.
  • Sleep Disturbance: Nasal congestion can lead to poor-quality sleep.
  • Decreased Quality of Life: Impacts work, school, and daily activities.

Diagnosis of Hay Fever

  1. Medical History
    • Symptom patterns, triggers, and family history of allergies.
  2. Physical Examination
    • Nasal congestion, swollen nasal passages, or watery eyes.
  3. Allergy Testing
    • Skin Prick Test: Identifies specific allergen sensitivities.
    • Blood Test: Measures allergen-specific IgE antibodies.
  4. Differential Diagnosis
    • Exclude other causes of similar symptoms, such as non-allergic rhinitis or sinus infections.

Treatment Options for Hay Fever

1. Medications

Drug ClassExampleBrand NameManufacturerCost Range
Antihistamines (Oral)LoratadineClaritinBayer$10–$20 per pack
CetirizineZyrtecJohnson & Johnson$10–$20 per pack
Antihistamines (Nasal)AzelastineAstelinMylan$15–$30 per bottle
Nasal CorticosteroidsFluticasoneFlonaseGSK$15–$25 per bottle
MometasoneNasonexMerck$20–$30 per bottle
Decongestants (Oral)PseudoephedrineSudafedPfizer$5–$15 per pack
Leukotriene Receptor AntagonistsMontelukastSingulairMerck$15–$30 per pack

2. Lifestyle Modifications

  • Avoid Allergen Exposure
    • Stay indoors during high pollen counts (mid-morning and evening).
    • Use air purifiers and keep windows closed.
    • Wash hands and face after being outdoors.
  • Environmental Controls
    • Use dust-mite-proof bedding.
    • Reduce indoor humidity to discourage mold growth.
  • Personal Habits
    • Shower before bedtime to remove allergens.
    • Avoid drying clothes outside during high pollen seasons.

3. Immunotherapy

  • Allergy Shots (Subcutaneous Immunotherapy)
    • Gradual exposure to allergens to build tolerance.
  • Sublingual Immunotherapy (SLIT)
    • Allergen tablets or drops dissolved under the tongue.
Immunotherapy TypeExampleCost Range
Subcutaneous ShotsCustom Blends$1,000–$3,000/year
SLIT TabletsOralair, Grastek$100–$300/month

4. Alternative and Supportive Therapies

  • Saline Nasal Irrigation
    • Reduces nasal congestion and flushes out allergens.
  • Herbal Remedies
    • Butterbur and quercetin may help but should be used with caution.

Monitoring Parameters

  • Track frequency and severity of symptoms.
  • Evaluate response to medications or immunotherapy.
  • Monitor for side effects, especially with long-term corticosteroid use.

Patient Counseling Points

  • Explain the importance of avoiding known allergens and triggers.
  • Advise proper use of nasal sprays (e.g., tilt head slightly forward, spray away from the septum).
  • Stress the need for adherence to long-term treatments like immunotherapy.
  • Educate on reading pollen forecasts and planning outdoor activities accordingly.

Use in Children

  • Use child-friendly formulations of antihistamines or nasal sprays.
  • Monitor closely for side effects like drowsiness.

Use in Pregnancy

  • Safe options include loratadine or cetirizine; avoid decongestants in the first trimester.

Use in Elderly

  • Consider age-related changes in drug metabolism and potential interactions.

FAQs About Hay Fever

Q1: What causes hay fever?

  • Allergic reaction to airborne allergens like pollen, dust mites, or mold.

Q2: Can hay fever be cured?

  • There is no cure, but symptoms can be managed effectively with treatment.

Q3: What are common symptoms of hay fever?

  • Sneezing, runny nose, itchy eyes, and nasal congestion.

Q4: How is hay fever treated?

  • With antihistamines, nasal sprays, and lifestyle changes.

Q5: Can hay fever cause asthma?

  • Yes, hay fever can exacerbate asthma or increase the risk of developing it.

Q6: Are antihistamines safe for long-term use?

  • Yes, modern antihistamines are generally safe for prolonged use.

Q7: Can I prevent hay fever?

  • Avoid allergens and use preventive treatments like nasal sprays during allergy season.

Q8: Is hay fever hereditary?

  • Yes, a family history of allergies increases the likelihood.

Q9: What foods can worsen hay fever?

  • Certain foods may cross-react with pollen (oral allergy syndrome), such as apples or nuts.

Q10: Is hay fever more common in specific seasons?

  • Yes, it peaks in spring (tree pollen), summer (grass pollen), and autumn (weed pollen).

Q11: Can I exercise with hay fever?

  • Yes, but avoid outdoor activities during high pollen counts.

Q12: Does air conditioning help with hay fever?

  • Yes, it can filter allergens if fitted with a HEPA filter.

Q13: Can hay fever resolve on its own?

  • Symptoms may improve with age, but treatment is usually needed.

Q14: Are there natural remedies for hay fever?

  • Saline rinses and butterbur may help, but consult a doctor before use.

Q15: When should I see a doctor for hay fever?

  • If symptoms are severe, persistent, or affecting your quality of life despite treatment.