How to reduce effects of seasonal rhino-conjunctivitis (hay fever)

HAY fever can seem like a fairly trivial ailment at first and in some respects it is — certainly if one compares it to some of the more harmful conditions to which our bodies can succumb.

But in its own right a bad bout of hay fever can be debilitating and this year has been another bad one for it.

As I write, we’re in the second peak for grass pollen levels, which tend to rise in the first two weeks of June and July.

But what is hay fever, why is it worse some years more than others and what can we do about it?

Unlike many other medical issues with far-reaching histories, it seems as if hay fever is largely a modern phenomenon.

By that I mean it has only begun to rear its head in the last 200 years and in particular since the Sixties.

This follows a general upward trend in all allergy-related conditions which seems to fall in line with increasing industrialisation.

Hay fever, ironically, has nothing to do with hay, at least not directly.

The fact that its symptoms seem to flare around the same time as the hay is being gathered is probably why it was so named.

The real culprit is pollen from grass, trees and flowers, a link that was first made in the mid-1800s, supposedly when someone sneezed when close to a bouquet of flowers. At that time, although the link was made to pollen, it was wrongly assumed that the pollen was producing toxins to which people reacted. In reality, it’s the pollen itself to which our bodies react.

Pollen is the fine powder-like substance produced by plants that carry the male gametes (reproductive cells) to other plants. Each particle is on average smaller that the width of the average human hair.

Whereas a toxin actively attacks tissue, an allergen (a particle such as pollen to which the body produces an allergic response) causes issues with its presence alone — all because of our body’s immune system.

Exposure over time to a particular substance such as pollen can over-sensitise the body’s immune response to produce an overreaction to that allergen, resulting in inflammation.

Pollen has a nasty habit of floating around and getting into our eyes, nose and mouth so that when it causes a reaction, it gives rise to the classic symptoms of hay fever, a runny nose, sneezing, congestion and itchy eyes. If you’ve not experienced these, then you’re lucky.

The truth is, around one in four adults will have experienced these symptoms to some degree. It usually begins in childhood where it seems to be more common in males although it can develop at any age.

One in five sufferers develops hay fever for the first time as an adult at which point there is no prevailing gender discrepancy.

Allergic rhinitis is often used as a term to describe hay fever although technically it refers only to symptoms of runny nose and congestion (“rhin” is the Greek route word meaning nose). Allergic conjunctivitis can be used to describe the symptoms affecting eyes.

Of course, these descriptions can be used to refer to the effects of allergy to other substances such as house dust mite or any number of other non pollen-related allergens.

This means a more effective term to describe hay fever is seasonal rhino-conjunctivitis.

The season for hay fever spans a bigger period than many realise, from early January all the way through to November, taking in peaks of tree pollen up until about mid-May, followed by grass over late spring/summer before finally giving way to weed pollen for the latter part of the hay fever season.

This varies of course depending on both location and weather. There is a perception of high pollen counts linking to hot summer days. While this is to an extent true, above 28 degrees centigrade the pollen count actually goes down.

One might also think rain would dampen the counts but, again, heavy downpours can actually increase the pollen in the air.

Furthermore, wet weather can mean greater rates of growth in pollen producing species, so it is not always a simple picture.

On the whole though, average higher temperatures do seem to be contributing to the increase in prevalence of hay fever not just in the UK but globally too.

Because hay fever can rear its head early in the year when one might not necessarily expect it, there is a chance it can be mistaken for a cold. After all, its symptoms can indirectly lead to tiredness, headaches and irritability just as might a cold.

If certain types of pollen (birch for example) react with certain foods, including some vegetables or fruit like apples, a phenomenon known as oral allergy syndrome can occur in which cross reactivity can cause itchiness and even soreness at the back of the throat.

For many, a simple over the counter antihistamine will do the job of negating the symptoms of hay fever.

Histamines are chemicals produced by our immune system to increase the supply of fluid filled with other immune cells to areas of the body in which a foreign actor is identified. One of the ways in which they do this is by increasing blood flow to the area, in the case of hay fever to the mucosa in the nose, and by making barriers more permeable to fluids — something that gives rise to an increase in mucus production.

In essence, histamine is responsible for all the symptoms that make hay fever the nuisance that it is.

First discovered in the Thirties, antihistamines have become a mainstay and a first line against allergy-related conditions ever since.

For primary symptoms in the nose, nasal sprays, either with saline or with a steroid, both of which can be obtained from pharmacies, are the other big weapon we have against rhinitis.

Anti-itch eye drops are also available (such as sodium cromoglicate) if the eyes are an issue. For more severe and treatment resistant cases, a course of oral steroid can be used but this provides only transient relief. One does not want to be on continuous steroid treatment if at all possible.

More importantly, it is often the practical measures that can make the biggest difference and that probably are the biggest area overlooked by sufferers.

Pollen counts can be monitored by looking at forecasts from websites like the Met Office. If not already obvious, if counts are high, stay indoors as much as possible and certainly try to avoid going out for a walk in a big field full of flowers.

Likewise, avoid putting the washing out to dry on such days and keep windows closed that might otherwise let the pollen drift inside.

If you are outside in a high pollen environment, you could consider using vaseline in the nostrils to act as a barrier and wearing some form of eye protection such as wraparound sunglasses. If really prone, you could always consider a mask.

When you get back take a shower and wash your hair to get rid of any residual pollen.

If you have any pets, wipe them down as much as possible with a damp microfibre cloth to reduce as much as possible any contamination. (Interestingly, pets like cats and dogs can get hay fever too.)

If you drive a lot, you could even look into getting pollen filters for your car if you really suffer. It’s also worth mentioning that alcohol can make matters worse as it contains histamine.

Hay fever then has nothing to do with hay. Pollen fever would be a better name (if seasonal rhino-conjunctivitis is too much of a mouthful), although actually it doesn’t cause a fever either.

In any case, it can be a real nuisance. It can mimic and be confused with viral infections and in severe cases can cause huge upset.

Minimising symptoms through a combination of practical measures and pharmaceutical solutions is the best way forward. If you take that approach, hopefully it doesn’t spoil your spring and summer too much.