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Hay fever

 


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Immune system
Causes
Hay fever is caused by the body's immune system reacting badly to pollen or spores. When air-borne pollen is inhaled by a person who suffers from hay fever, the sensitised immune system releases large amounts of antibodies to counteract the pollen. These antibodies bind to special cells called mast cells in the nasal passages and lungs, causing the release of a chemical called histamine. Histamine has the effect of widening the blood vessels in the nasal passages causing them to produce an excess of watery secretions and resulting in irritation, redness and sneezing. In the eyes, histamine has a similar effect, making the eyes red and water. In the lungs, histamine causes the airways to narrow, making breathing difficult.

In Britain, the main culprit is grass pollen, but pollen from trees and other plants can also cause hay fever. The peak season for hay fever is usually May to September but this can vary depending on the weather, the region of the country and to the type of pollen or spores in the air. Hay fever that develops in February to March is likely to be caused by pollen from birch trees. Hay fever that develops in May to July is likely to be caused by pollen from grasses and flowers, while hay fever that develops in the autumn is likely to be caused by spores from fungi. Climate change is affecting seasons, the crops that farmers cultivate and the time when plants produce flowers and pollen. Hay fever patterns will alter as these changes occur.
Symptoms
Hay fever can vary from being a mild, easily coped with irritation to being a severe condition that seriously affects day-to-day activities such as studying, working and driving. Hay fever usually affects the nose, eyes and the chest. Common symptoms of hay fever are sneezing and a blocked, itchy or runny nose. Eyes too can become itchy, as well as red, swollen and watery. Other symptoms include a headache, because of congestion and swelling of the sinuses, and tightness and wheeziness in the chest.
Treatment
Treatments for hay fever fall roughly into two main types - systemic treatments that are taken by mouth and which act on the whole body; local treatments that are applied directly to the affected area and which act just in the area where applied. The type of treatment chosen should depend on the severity and type of symptoms.

For example, if hay fever is mild and affects the eyes only, then eye drops containing drugs known as mast cell stabilisers, antihistamines or decongestants will help reduce redness and watering. The mass cell stabiliser sodium cromoglicate helps prevent the release of histamine from the mast cells during the allergic reaction. Antihistamines such as antazoline help block the action of histamine, while decongestants such as xylometazoline reverse histamine's effect on the blood vessels in the eye making them narrower, so soothing the eyes and making them appear less red.

Similarly, if the nose is blocked or runny, nose drops or nasal sprays containing antihistamines, mast cell stabilisers or decongestants may be applied to bring relief. There are also nasal sprays containing the topical steroids beclometasone, betamethasone, budesonide, flunisolide, fluticasone, mometasone and triamcinolone that help reduce the allergic response and which can be taken before an attack of hay fever begins to reduce the severity of the attack or to prevent it all together.

If hay fever symptoms are more widespread, for example, affecting nose, eyes and chest then antihistamines such as acrivastine, cetirizine, loratadine, chlorphenamine and promethazine can be taken by mouth in the form of tablets, capsules or syrups.

People who fail to respond to anti-allergy treatment may be given a course of grass and tree pollen extracts either in the form of an oral preparation (Grazax) or as a course of injections (Pollinex). This form of treatment is known as immunotherapy and works by reducing the person's sensitivity to pollen. Immunotherapy needs to be given before the start of the hay fever season in order to be effective.
When to see your pharmacist
Many of the anti-allergy preparations for the relief of hay fever are available from your local pharmacy without the need for a prescription. Talk to your pharmacist and he or she will recommend a product that is suitable for your symptoms. Always tell the pharmacist if you are taking any other medicines or if you have any other illnesses or may be pregnant. If asking the pharmacist's advice on behalf of a child, let the pharmacist know this as some anti-allergy preparations are not suitable for children.
When to see your doctor
If your symptoms are having a serious effect on your day-to-day activities, consult your doctor. Also if you are experiencing chesty symptoms such as wheeziness you should see your doctor to make sure that you do not have asthma or that your asthma is not getting worse.

If over-the-counter remedies do not help, see your doctor who may decide to put you on a course of corticosteroids or to prescribe medicines such as montelukast or omalizumab that interfere with the immune response to pollen. Alternatively, your doctor may decide to refer you to an allergy specialist who will be able to find out what is causing the allergy and may recommend a suitable course of immunotherapy.
Living with hay fever
If you suffer from hay fever, try not to let it rule your life. Some simple things will help put you in control and reduce the impact that the symptoms have on your life.

Avoiding or minimising contact with pollen is one of the best things to do to try to reduce the risk of hay fever. Try to discover what is causing your hay fever. Keep a record of where and when you suffered an attack of hay fever. You may find that your symptoms only occur at a particular time of year or in a particular part of the country. This will allow you to plan ahead, perhaps by taking avoiding action or by using medicines such as nasal steroids to reduce attacks.

In the summer months, newspapers and weather forecasts carry predictions of the pollen count. If the pollen forecast is high, staying in doors with the windows closed will help. Similarly, if in the car, keep the windows closed and, if fitted, use the air conditioner. Many modern cars now have a filter on the car's cooling system that helps trap pollen and spores in the air.

Wearing sun glasses helps reduce exposure of the eyes to pollen and reduces the glare of the sun that can add to any irritation of the eyes. Avoid walking in parks and fields, take holidays at the sea side where pollen counts are lower.

Try to reduce the urge to sneeze, blow your nose or rub your eyes. While this may not be as easy as it sounds, if you can resist the temptation it helps reduce the irritation and inflammation to these areas that can make your hay fever symptoms worse.

If you do need a treatment to control symptoms, select one that suits your life style. Many of the hay fever remedies contain the older anti-histamines such as chlorphenamine and promethazine that can make you feel drowsy, interfering with your ability to work or to study. If you find that this happens, change to a preparation containing one of the newer antihistamines such as acrivastine, cetirizine and loratadine that are much less likely to make you drowsy.

If you are not satisfied with a particular hay fever remedy because you still experience some symptoms, it is no longer as effective as it used to be, or it has side effects, try switching to a product that has a different type of active ingredient, or from one type of formulation to another. There are many types of products available, it's just a matter of finding which one suits you best.
Advice for carers and family members
Try to be patient with anyone that you look after or any members of your family that suffer from hay fever. Although it may be irritating to find that you are disturbed by the person's constant sneezing, try to put yourself in their shoes and think of the distress and annoyance it is causing them.

Take into account where and when the person suffers worse from hay fever so that you can plan your holidays or days out accordingly.

Provide help with the administration of medicines, particularly in helping putting drops in the eyes or reminding to use inhaled steroids in advance of any hay fever attacks.

During school examination times, help to reassure children who may be worried that their hay fever will affect their abilities. Talk to teachers to warn of the child's hay fever and ask if any special dispensation can be given.


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