Hay Fever OverviewMost likely you or someone you know has allergies. The telltale itchy, puffy, watery eyes and red, stuffy nose signal changes in the seasons in homes and workplaces across the country. What these people suffer from is allergic rhinitis, or hay fever. The medical name for this condition refers to stuffy and itchy nose ("rhin-"), the most common symptom.
Hay fever is an allergic reaction. It is your immune system's response to foreign material in the air you breathe. Hay fever usually refers to allergies to outdoor, airborne materials such as pollens and molds.
Hay Fever Causes
Hay fever, like all allergic reactions, is caused by allergens, foreign "invaders" that enter your body by inhalation, by swallowing, or through your skin.
- In hay fever, the allergens are airborne substances that enter your airways (mouth, nose, throat, and lungs) via your breathing and the linings of your eyes and sometimes ears via direct contact.
- Most of the time it is difficult to identify a specific allergen.
- Once these allergens come in contact with your airway, the white blood cells of your immune system produce antibodies to the offending substance. This overreaction to a harmless substance is often called a hypersensitivity reaction.
- The antibody, called immunoglobulin E, or IgE, is stored on special cells called mast cells.
- When the antibody comes in contact with the corresponding antigen, they promote release of chemicals and hormones called "mediators." Histamine is an example of a mediator.
- It is the effects of these mediators on organs and other cells that cause the symptoms of the allergic reaction, in this case hay fever.
What are the symptoms of hay fever ?
Symptoms of hay fever may start at different times of year, it depends on what substance the patient is allergic to. If a person is allergic to a common pollen, then when the pollen count is higher his symptoms will be more severe.
Common Symptoms Include:
- Watery eyes
- Itchy throat
- Itchy nose
- Blocked/runny nose
Severe Symptoms May Include:
- Loss of smell and taste
- Facial pain caused by blocked sinuses
- Itchiness spreads from the throat, to the nose and ears
Sometimes hay fever symptoms can lead to:
- Tiredness (fatigue)
What Are The Causes Of Hay Fever ?
Hay fever occurs when the immune system mistakes a harmless airborne substance as a threat. As your body thinks the substance is harmful it produces an antibody called immunoglobulin E to attack it. It then releases the chemical histamine which causes the symptoms.
There are seasonal hay fever triggers which include pollen and spores that will only cause symptoms during certain months of the year.
The following are some examples of hay fever triggers:
- Tree pollen - These tend to affect people in the spring.
- Grass pollen - These tend to affect people later on in the spring and also in the summer.
- Weed pollen - These are more common during autumn (fall).
- Fungi and mold spores - These are more common when the weather is warm.
What Are The Risk Factors For Hay Fever?
A risk factor is something that increases a person's chances of developing a disease or condition. Below are some risk factors for hay fever:
- Family history (inheritance, genetics) - if you have a close family member who has/had hay fever, your risk of developing it yourself is higher. There is also a slightly higher risk if a close family member has any type of allergy.
- Other allergies - people with other allergies are more likely to suffer from hay fever as well.
- Asthma - a significant number of people with asthma also have hay fever.
- Gender and age - hay fever affects more young males than young females. Before adolescence, twice as many boys as girls have hay fever. However, after adolescence many boys outgrow it and slightly more girls than boys are affected.
- Birth date - people born during the high pollen season have a slightly higher risk of developing hay fever than other people.
- Second-hand smoke - infants and babies who are regularly exposed to cigarette smoke during their first years of life are more likely to develop hay fever than babies who aren't.
- Being the first child - a higher percentage of firstborn children eventually develop hay fever, compared to other people.
- Babies from smaller families - a higher proportion of babies with no siblings, or just one sibling develop hay fever later on compared to babies born to larger families.
- Babies born to high income families - babies born to families with a high standard of living have a higher risk of developing hay fever later on, compared to other babies.
Experts believe that the last three risk factors are linked to childhood infections. If a baby and/or small child has had fewer infections, there is a greater risk of autoimmune problems.
How Is Hay Fever Diagnosed ?
Generally, doctors can make a diagnosis based on the symptoms, which are usually fairly obvious. The doctor will also ask questions about the patient's personal and family medical history, and how signs and symptoms have been dealt with so far.
A blood or skin test can be followed up to identify which substance(s) the patient is allergic to.
- Skin test - the skin is pricked with a minute amount of a known allergen (substance that some people are allergic to). The amount of IgE antibodies (immunoglobulin E) is measured. IgE antibodies are produced in high amounts if a person has an allergy to something.
- Blood test - the test simply measures the level of IgE antibody in the blood. If it is zero there is no sensitivity, whereas 6 indicates very high sensitivity.
What Are The Treatment Options For Hay Fever ?
There is a vast array of OTC (over-the-counter) and prescription medications for treating hay fever symptoms. Some patients may find that a combination of two or three medications works much better than just one.
It is important for parents to remember that some hay fever medications are just for adults. If you are not sure, talk to a qualified pharmacist, or ask your doctor.
- Antihistamine sprays or tablets - these are commonly available over the counter. The medication stops the release of the chemical histamine. They usually effectively relieve symptoms of runny nose, itching and sneezing. However, if your nose is blocked they don't work.
Newer antihistamines are less likely to cause drowsiness than older ones - but older ones are just as effective. Examples of OTC antihistamines include loratadine (Claritin, Alavert) and cetirizine (Zyrtec). Examples of prescription antihistamines include Fexofenadine (Allegra) and the nasal spray azelastine (Astelin). Azelastine starts working very rapidly and can be used up to 8 times a day - however, it can cause drowsiness and leave a bad taste in the mouth after use.
- Eye Drops - these reduce itching and swelling in the eyes and are usually used alongside other medications. Eye drops containing cromoglycate are commonly used.
- Nasal Corticosteroids - These sprays treat the inflammation caused by hay fever, and are a safe and very effective long-term treatment. Examples include fluticasone (Flonase), fluticasone (Veramyst), mometasone (Nasonex) and beclomethasone (Beconase). Most patients may have to wait about a week before experiencing any significant benefits. Some patients may notice an unpleasant smell or taste, and have nose irritation.
- Oral corticosteroids - for very severe hay fever symptoms the doctor may prescribe prednisone in pill form. They should be prescribed only for short-term use, because of their long-term link to cataracts, muscle weakness and osteoporosis.
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