Around one in five people in the UK have an allergy such as hay fever.
Hay fever (seasonal allergic rhinitis) is caused by an allergic reaction to pollen. It can trigger sneezing, a blocked or runny nose and itchy eyes at around the same time each year.
What is hay fever?
If you have hay fever, your immune system reacts to pollen from grass, trees or weeds. Pollen is a type of allergen – a harmless substance that can trigger an allergic reaction in certain people.
Hay fever symptoms include a blocked or runny nose, sore or itchy eyes and sneezing. You’ll notice these symptoms at certain times of the year when pollen is carried in the air. This is usually during the spring, summer and sometimes autumn months, and occasionally for some people, the winter.
Allergic rhinitis is becoming more common. Many people with hay fever also have asthma and eczema. These are called atopic conditions or atopy. You’re more likely to have atopic conditions if they run in your family.
Causes of hay fever
If you have hay fever, your body produces a type of antibody called immunoglobulin E (IgE) when you come into contact with pollen, which is a harmless substance. But with hay fever, your body mistakenly believes that the harmless pollen is actually harmful and a threat. IgE triggers the release of certain substances from cells in your nose, throat and eyes. One of these substances is histamine, which triggers the symptoms of hay fever.
You may be allergic to one or more types of pollen. The pollen you’re most allergic to will influence when your symptoms are at their worst. Some possible causes of hay fever include:
- grass pollen
- tree pollen
- weeds, such as nettles, dock and mugwort
- fungal spores
More than nine out of 10 people in the UK who have hay fever are allergic to grass pollen. Different trees produce pollen at different times of the year. One in four people in the UK with hay fever are allergic to birch tree pollen.
The hay fever season
You may notice that your hay fever symptoms change over the spring and summer months, getting worse on some days and better on others. This will depend partly on what you’re allergic to. But the hay fever season, also called the pollen season, varies from year to year. Its timing and length can be different depending on where you live. If you live in southern and central parts of the UK, you may notice the hay fever season starts earlier in the year and lasts longer.
Allergen: Tree pollen
Time of the year when symptoms are worst: Spring
Allergen: Grass pollen
Time of the year when symptoms are worst: End of spring and beginning of summer
Time of the year when symptoms are worst: Early spring to late autumn
The pollen count
Everyone reacts differently to pollen. Some people react to very low levels of pollen but others don’t notice any hay fever symptoms until the pollen count is very high. The pollen count is the average number of pollen grains in one cubic metre of air over 24 hours. The pollen count can be affected by the weather – it’s generally higher on dry, sunny days. It’s lower on rainy days because the rain gets rid of the pollen in the air, though it does make the grass grow which can then make hay fever worse on following days that are dry and warm.
The pollen count is classed as low, moderate, high or very high. Keeping an eye on the pollen count can help you manage your hay fever symptoms. You can check pollen counts for grass, tree and weed pollen and fungal spores on the National Pollen and Aerobiology Research Unit (NPARU) website. Daily forecasts are available from mid-March to mid-September. The Met Office also has pollen forecasts on its website during the spring and summer months. Daily forecasts often appear in newspapers and during radio and TV weather reports as well. You can also get forecasts on various apps.
If you know the pollen count is going to be high, you can take medicines and try self-help measures.
Symptoms of hay fever
Hay fever symptoms aren’t usually serious, but if your symptoms are bad they can negatively impact on your work, home and social life. Symptoms may come and go or last for the whole of the hay fever season, depending on what you’re allergic to.
The most common hay fever symptoms include:
- a blocked or runny nose (rhinorrhoea)
- itchy eyes, nose, throat and roof of your mouth (palate)
- red or watery eyes
- postnasal drip (mucus dripping down your throat from the back of your nose) – this may make you cough
- headache, caused by a stuffy nose (the air spaces filled around your nose
A blocked nose is usually the most troublesome hay fever symptom. Red, watery or itchy eyes are also called allergic conjunctivitis. Some people with hay fever only have the eye symptoms.
Hay fever can make you feel very tired and irritable and stop you sleeping well. Some people find their hay fever makes them struggle to concentrate at work or at school and affects their usual daily activities.
In some people, pollen may also trigger asthma or make existing asthma worse. Hay fever can also cause sinusitis. Sinusitis can give you headaches, toothache or pain in your face.
Some people get hay fever-like symptoms all year round. This is called perennial allergic rhinitis, in which the allergens are usually caused by dust mites, pet hair or moulds.
Diagnosis of hay fever
If you have hay fever, you’ll probably be familiar with your symptoms and won’t need to see your GP. You can try to ease your hay fever symptoms with help from your local pharmacist. But if your symptoms don’t get better with over-the-counter treatments, there are other options available.
Self-help and prevention for hay fever
If you have hay fever, the best way to prevent your symptoms is to avoid whatever’s causing them. But this isn’t always easy when you’re allergic to a substance like pollen, which is found in the air.
Here are some ways to help reduce your symptoms.
- Keep an eye on the daily pollen count. You can check this on the Met Office website. If you know the pollen count is going to be high, you can take action before your symptoms get too bad or even start.
- Stay indoors, and keep your doors and windows closed.
- Keep your car windows closed when you’re driving.
- Fit a car pollen filter and change it every time you get the car serviced.
- Stay away from grassy areas, especially during the early morning and evening when the pollen count is highest.
- Wear wrap-around sunglasses to keep pollen out of your eyes.
- Take a shower and wash your hair after going outside. Change your clothes too.
- Don’t dry your washing outside. Pollen can get trapped in the fibres of your clothes and bed linen.
- Apply a barrier balm around the inside of your nostrils to reduce how much pollen gets into your nose – petroleum jelly works for some people.
- Use a saline (salt water) nasal spray or rinse inside your nose or use steam inhalation to wash out the pollen.
- If your eyes are sore or itchy, use a cold compress on them, or wash them with water.
If it’s been raining, or is raining, the pollen count should be lower, so your symptoms will probably be better on these days. The pollen count is usually higher on warmer, dry days.
Medicines for hay fever
Hay fever can often be treated with over-the-counter medicines from a pharmacy, with tablets, nasal sprays or eye drops. You can also buy some of these medicines from a supermarket. There are lots of different medicines available for hay fever. Your local pharmacist can help you work out the best treatment for you, and check you’re using the medicines in the right way. If the first medicine you try doesn’t help, you may be able to try something else. You may need to use several different hay fever medicines together to keep your symptoms under control.
For some types of hay fever treatment, such as nasal sprays, you should ideally start using them two or three weeks before the hay fever season begins. You usually need to take hay fever medicines every day. You may need to keep using the treatments for several months, depending on what you’re allergic to and when your symptoms appear. See the section below on The hay fever season.
If over-the-counter medicines don’t help help, there other treatment options available on prescription. Be sure to read the patient information leaflet that comes with your medicine.
Alternative medicine such as essential oils.
If your hay fever is mild, you may find that antihistamine tablets are all you need to ease your symptoms. Antihistamines usually reduce sneezing and a runny nose, but may not help so much with a blocked nose. Don’t drink alcohol while you’re taking antihistamines. Always read the patient information leaflet that comes with your medicine. If you’re unsure about anything, ask your pharmacist.
Choose the newer types of antihistamine such as cetirizine, acrivastine and loratadine, as these are less likely to make you feel drowsy. You usually only need to take these tablets once or twice a day. Even these antihistamines can make some people feel tired though, so don’t drive, cycle or use heavy machinery if you notice this side-effect. Older antihistamines, such as chlorphenamine, can make you feel drowsy and aren’t recommended for hay fever.
If your hay fever is mild, you could try an antihistamine nasal spray, such as azelastine. These sprays usually work quickly (within 15 minutes), so are useful if your nose symptoms suddenly get worse. They can help to ease a runny nose, but don’t help eye symptoms.
If your nose is very blocked, you can use a decongestant nose spray such as xylometazoline for a few days. You may find this useful before you use an antihistamine nose spray or a corticosteroid nose spray, as it will help to clear your nose. But don’t use a decongestant spray for more than seven days as using it for too long can make your blocked nose worse.
If you have a very blocked nose, a corticosteroid nasal spray, such as beclometasone or fluticasone, may be a good option for you. You can buy some of these nasal sprays over the counter from pharmacies – others are available only on prescription. I can prescribe a spray that contains both a corticosteroid and an antihistamine if your symptoms are very bad.
Corticosteroid nasal sprays can usually treat all hay fever symptoms, including allergic conjunctivitis (eye symptoms). But it can take a while for a corticosteroid spray to work. Use the spray at least two weeks before your symptoms usually start. Make sure you take the lowest dose that works for you. You may have some mild side-effects, such as irritation in your nose or nosebleeds. If so, you may need to try a different corticosteroid nose spray.
If you have itchy or sore eyes (allergic conjunctivitis), you can use eye drops. Sodium cromoglicate drops usually work well and are available without a prescription from your local pharmacy. You’ll need to use these drops four times a day. Your pharmacist can show you how to put them in your eyes. Lodoxamide, nedocromil and antihistamine drops are other options if sodium cromoglicate doesn’t help.
Steroid tablets are rarely prescribed for hay fever, unless you have very severe symptoms. If you’re prescribed them, it will only be a short course of treatment.
The Kenalog hay fever injection
INTRA-ARTICULAR / INTRAMUSCULAR INJECTION 40 mg/ml
Steroid treatments are available in tablet form, or in the form of an injection known as the Kenalog injection. The injection effectively contains the same medication as steroid tablets, but the route of administration is different.
- When the steroids are injected instead of ingested they are deposited directly into the muscle. There, they leak into the bloodstream in a low dose over the course of around three weeks.
- Hay fever sufferers generally only require one injection to reduce symptoms for the entire hay fever season. Compared to taking tablets every day, that’s very convenient.
- The Kenalog injection contains 40mg of the steroid triamcinolone. Each injection is roughly equal to the steroid dose from taking a 5mg tablet of prednisolone every day for around three weeks.
- One of the benefits of the injection is that it does not have to go through the liver or the digestive system, so you can administer a slightly lower dose than the tablet form.
- Kenalog injections have helped many people to control hay fever symptoms. For severe sufferers, life can be seriously disrupted by hay fever.
- Untreated, hay fever has been shown to reduce exam results by between 5-10 per cent. Patients report feeling unwell or exhausted for several months at a time.
- The general public have been given a lot of information about steroids in recent years, not all of it positive. To be clear, many of the more severe side effects of steroids come from the use of very high doses over a long period of time. The hay fever injection contains a relatively low dose and carries a much lower risk of adverse side effects.
Treatment costs £80
For more information here is the patients information leaflet.
For a consultation to see if you are eligible book a consultation with me to discuss.