Hay fever & allergic rhinitis
Hayfever was first described several hundred years ago and results from seasonal allergic symptoms due to grass pollen allergy. It is one form of allergic rhinitis which means allergic inflammation of the nasal lining. This has been classified in recent treatment guidelines by the World Health Organization.
Nasal symptoms: classically nasal allergy can cause itching, sneezing running or nasal blockage. It is frequently associated with asthma and/or allergic conjunctivitis (itchy, watery, inflamed eyes).
When symptoms occur may give a clue about the allergen responsible:
The ARIA guidelines subdivide rhinitis into persistent (everyday) or intermittent and severe (interferes with daily life) or mild/moderate (symptoms are a nuisance but do not prevent daily life). Severe rhinitis has considerable impact on quality of life: for example students with severe hayfever have been shown to drop a grade in summer time exams.
Investigation of rhinitis
History should describe symptoms, severity and frequency, as well as associations with work, medication and the presence of asthma or allergic eye disease. The seasonal link will guide which allergen is responsible.
Skin Prick tests will then confirm which allergens may be playing a role in symptoms. This is important as allergen avoidance and/or allergen specific therapy may be appropriate.
ENT examination: if there are any unusual features an expert ENT opinion should be sought.
Treatment of hayfever and allergic rhinitis
There is no trial data but general advice is to avoid pollen exposure by keeping house and car windows shut. Avoiding being outdoors in the evening (when pollen counts are high). Using dark glasses and showering and changing clothes after work to avoid pollen contamination. Pets may act as pollen reservoirs as may washing hung outside to dry.
There are no reported trials on house dust mite avoidance measures for rhinitis.
If cats or dogs are responsible for symptoms exposure should be avoided where possible: certainly avoid letting the pet sleep in your bed.
These drugs block H1 histamine receptors so prevent many allergic symptoms particularly sneeze and itch. Modern anti-histamines (loratidine, cetrizine, ebastine etc) are less likely to have sedating side effects than older drugs such as chlorpheniramine. In mild disease intermittent use of tablets or even topical antihistamine eye drops or nose sprays may be helpful. For persistent symptoms (which can be through the pollen season) once a day regular tablets are suggested: if possible started before the season..
To damp down the allergic reaction nasal steroid sprays taken on a regular basis are helpful. Make sure you know how and when to take these. It is best to put your head down after using the spray as the drug should get into the sinuses. They should be used daily even in the absence of symptoms (this means they are working).
If the nose is blocked you may be given a short course of steroid drops to initiate treatment.
Are nasal steroids safe?
As for asthma inhalers, many patients worry about taking regular nasal steroids. However there is no evidence of long term effects either on other systems such as bones or in the nose.
There is some evidence that these tablets may add benefit if antihistamines alone do not control disease but most would add a nasal steroid spray.