Hay fever

Symptoms Of Hay Fever 

Common symptoms of hay fever include:

• Runny nose and sniffing

• Blocked nose

• Sneezing

• Itching in the eyes, nose, roof of the mouth, and back of the throat

• Red, itchy, and watery eyes

• Headache

• Earache

• Loss of smell and taste

• Pain around your temples and forehead

• Mouth breathing

If you have asthma, you might also experience:

• Shortness of breath

• Wheeze and cough

• A tight feeling in your chest

Note: Hay fever will last for weeks or months, unlike a cold, which usually goes away after 1 to 2 weeks.

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Types of Hay Fever

Allergic rhinitis is caused frequently by exposure to perennial or seasonal allergens that exist in our indoor and outdoor environments. On the basis of causative factors, allergic rhinitis can be classified as:

1. Allergic rhinitis (also known as seasonal hay fever): Common allergens like pollens (grass, trees, and weeds) predominantly cause seasonal allergic rhinitis. 

2. Non-allergic rhinitis (also known as perennial hay fever): This type persists year-round and can result from allergens like dust mites, pet saliva or skin cells, and mold spores. 

Note: One can suffer from either seasonal or perennial allergic rhinitis or a combination of both.

Causes Of Hay fever

Allergic reactions can occur when allergens are inhaled, ingested, or in contact with the skin. Here's how hay fever occurs:

1. Exposure to allergens: When you come into contact with allergens, such as pollen from trees, grasses, weeds, dust mites, mold spores, pet dander, or certain foods, your body recognizes them as foreign invaders.

2. Immune system response: Your immune system perceives these allergens as threats. Immune responses can be mild, from coughing and a runny nose to a life-threatening reaction known as anaphylaxis.

3. Release of chemicals: When exposed to the same allergen again, your immune system releases chemicals, including histamines, as part of the immune response. Histamines cause various allergy symptoms.

4. Allergic reaction: The release of histamines and other chemicals leads to a range of symptoms, including sneezing, runny or stuffy nose, itchy or watery eyes, coughing, and sometimes skin reactions collectively known as hay fever or allergic rhinitis.

Risk Factors For Hay Fever

Several risk factors can increase the likelihood of developing hay fever. They include:

1. Host factors

• Heredity: Allergic conditions tend to run in families, indicating a strong genetic component. 
  
  
• Sex: Boys are more prone to hay fever, while girls show higher sensitivity to certain allergens, though these differences may change with age.
  
  
• Age: Hay fever can develop at any age, but it often starts in childhood or adolescence. Exposure to allergens over time can lead to the development of allergic reactions.
  Black individuals often experience more severe symptoms and higher allergy risk.
  
  
• Immune system factors: An overactive or hypersensitive immune system can increase the likelihood of developing allergies like hay fever.
  
  
• Medical conditions: The risk of hay fever increases in conditions like diabetes, heart disease, and respiratory disease. 

2. Environmental factors

• Passive smoking: Exposure to tobacco smoke can increase the risk of hay fever or other allergic diseases including rhinitis, asthma, and eczema.
  
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• Air pollution: Living in areas with high levels of air pollution such as particulate matter, ozone, and nitrogen dioxide may exacerbate hay fever symptoms and increase the risk of developing the condition.
  
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• Environmental exposure: Living in areas with high pollen counts, especially during peak pollen seasons, can increase the risk of developing hay fever.
  
  
• Dietary habits: Poor dietary choices, including low fruit and vegetable consumption, and high intake of packaged, processed and fast food, are associated with an increased risk of allergies, especially in children and adolescents.
  
  
• Infections: Respiratory infections, both viral and bacterial, can influence the development of allergic sensitization and asthma in childhood.
  
  
• Other allergic conditions: If you have other allergic conditions, such as asthma or eczema, you may be more prone to developing hay fever.

Diagnosis Of Hay Fever

The diagnosis of hay fever typically involves a combination of medical history, physical examination, and sometimes additional tests. Here is an overview of the diagnostic process for hay fever:

1. Medical history

A doctor will start by taking a detailed medical history. They will ask about your symptoms, their duration, and any triggers that worsen or alleviate your symptoms. Be prepared to discuss when your symptoms occur, such as during specific seasons or exposure to certain allergens.

2. Physical examination

A physical examination may be conducted to assess your nasal passages, throat, and eyes. Your doctor will look for signs of inflammation, such as redness and swelling, in these areas.

3. Allergy testing

Allergy testing is often performed to confirm the presence of hay fever to identify specific allergens responsible for your symptoms. There are three common types of allergy tests:

A. Skin prick test

• It is useful in diagnosing allergies to specific substances. 

• During this test, small amounts of common allergens are applied to your skin, usually on your forearm or back. The skin is then lightly pricked or scratched to allow the allergens to enter the skin. 

• If you are allergic to a specific substance, you will develop a small raised bump or redness at the site within 15-20 minutes.

B. Allergy blood test (IgE antibody testing)

• A blood test, such as a radioallergosorbent test (RAST), measures the levels of specific antibodies (IgE) in your blood. 

• It is done to confirm allergies to specific triggers, determine their severity, guide treatment decisions, and track progress in managing allergy symptoms.

C. Provocation test

• It involves exposing the nose or eye membranes to potential allergen extracts via spray or drops. If your nose swells, you sneeze, and your nose runs, it suggests allergic rhinitis.

Prevention Of Hay Fever

While it may not be possible to completely eliminate allergen exposure, these preventive measures can help reduce the severity and frequency of hay fever symptoms:

• Wash bedding and curtains regularly in hot water to remove dust mites and allergens.

• Use dust mite-resistant covers for mattresses, pillows, and quilt.

• Remove sheepskins and soft toys from the bedroom.

• Use air purifiers with HEPA filters in your home to reduce indoor allergens.

• Vacuum carpets weekly with a HEPA-equipped vacuum cleaner.

• Keep humidity levels low by using kitchen and bathroom exhaust fans

• Clean visible mold with bleach or mold reduction cleaners.

• Ensure proper ventilation and use extractor fans.

• Stay indoors as much as possible during peak pollen hours

• Keep your windows closed.

• Close external vents and use air conditioning, especially while driving.

• Avoid activities that expose you to heavy pollen, such as lawn mowing and leaf blowing.

• Shower or wash your hair before bedtime to remove pollen.

• Dry your clothes indoors to prevent them from gathering pollen.

• Keep pets outside.

• Bathe and groom pets regularly to reduce dander.

In order to prevent allergic attacks, it's better to get an allergy panel test. 
It comprises 31 tests that help to identify certain allergens that trigger your body. Know more about this test.

Doctor To Visit

Specialists who can help with diagnosis, treatment, and management of hay fever include:

• General physician
• Allergist
• Immunologist
• Pediatrician (for kids)
  

A general physician can help with hay fever by diagnosing the condition, providing allergy testing, and prescribing appropriate medications or treatments to manage symptoms.

An allergist is a medical practitioner specializing in the diagnosis and treatment of allergies.

An immunologist is a doctor who diagnoses, treats, and works to prevent immune system disorders. They can identify specific triggers and recommend advanced treatments like allergen immunotherapy for symptom relief.

When to see a doctor?

Seek medical attention if:

• Your symptoms persist for more than a week and are causing discomfort

• Over-the-counter allergy medications do not provide relief

• You have a coexisting condition, such as asthma, which exacerbates your hay fever symptoms

• Your hay fever symptoms occur throughout the year

• Your symptoms are particularly severe

• The allergy medications you are taking result in troublesome side effects.

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Treatment Of Hay Fever

The treatment of hay fever typically involves a combination of strategies to relieve symptoms and manage the underlying allergy. Treatment options include:

I. Conservative management

1. Steam inhalation: Inhale steam to help relieve nasal congestion. Adding a few drops of eucalyptus oil may also be soothing.

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2. Nasal irrigation: Using a saline nasal wash, either with a neti pot or spray, can effectively clear allergens and ease nasal congestion. 

3. Warm compresses: Applying a warm compress to your face, particularly over your sinuses, can help relieve sinus pressure and congestion.

4. Cold compress for eyes: Apply a cold compress or cool, damp washcloth to your eyes to relieve itching and reduce puffiness.

5. Stay hydrated: Drink plenty of fluids, such as water and clear soups, to stay hydrated and help keep nasal passages moist. It also helps to flush out allergens.

6. Use a humidifier: To add moisture to the air in your home, especially during dry seasons, to help ease nasal irritation.

II. Over-the- counter medications

1.  Antihistamines: Over-the-counter or prescription antihistamines can help relieve sneezing, itching, runny nose, and watery eyes. Examples include cetirizine, loratadine, and fexofenadine.

2. Nasal corticosteroids: Prescription or over-the-counter nasal corticosteroid sprays, like fluticasone or mometasone, can reduce nasal inflammation and congestion.

3. Decongestants: Over-the-counter decongestant nasal sprays such as oxymetazoline, can provide temporary relief from nasal congestion. However, they should not be used for more than a few days to avoid "rebound" congestion.

Note: Certain people should not use decongestants (such as those who are pregnant or have high blood pressure). Always consult your doctor before using these medications.

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III. Prescribed medications

1. Leukotriene modifiers: Prescription medications like montelukast can help control allergic rhinitis symptoms by blocking certain immune system chemicals.

2. Nasal antihistamine sprays: Prescription nasal sprays like azelastine can be effective in relieving symptoms.

3. Allergen-specific immunotherapy (also known as desensitization): In cases of severe or persistent hay fever that doesn't respond well to other treatments,regular injections of allergen extracts to build tolerance to specific allergens. This is called allergen immunotherapy.

4. Targeted therapy: Specialist treatments like dupilumab can target allergy triggers in hay fever, but they are mainly used for those with additional allergies like asthma.

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Home-care For Hay Fever

Homecare treatments for hay fever (allergic rhinitis) aim to alleviate symptoms and provide relief from allergen exposure. While these remedies may not provide a cure, they can significantly reduce the severity of symptoms. Here are some natural home remedies to soothe symptoms of hay fever:

1. Nettle tea: It is an herbal infusion made from the leaves and sometimes the roots of the stinging nettle plant. 

Some people find relief from hay fever symptoms by drinking nettle tea due to its natural antihistamine properties.

2. Chamomile: Chamomile tea contains flavonoids, acting as an antioxidant and anti-inflammatory. 

Steep a chamomile tea bag or dried chamomile flowers in hot water for about 5 minutes, then remove the tea bag or strain the flowers before drinking.

3. Honey (Shahad): Consuming local, raw honey may help your body gradually become accustomed to local pollen, potentially reducing hay fever symptoms.

4. Vitamin C: Include foods rich in vitamin C, such as tomatoes, broccoli, kiwi, berries, citrus fruits etc., in your diet. It acts as a natural antihistamine and antioxidant.

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6. Ginger (Adrak): It contains anti-inflammatory compounds that can help alleviate hay fever symptoms related to irritation and swelling in the nose, eyes, and throat.

Incorporate ginger into your diet through ginger tea, or by adding it to your meals like curry or stir-fry.

7. Garlic (Lehsun): It is known for its anti-inflammatory properties and is a natural source of quercetin, an antihistamine.

Consuming raw or crushed garlic a month or two before hay fever season may help reduce symptoms. 

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Complications Of Hay Fever

If allergy is left ignored or unnoticed, it may lead to certain complications or exacerbate pre-existing conditions. These include:

1. Exacerbation of asthma: 10-40% of people with hay fever may have concurrent asthma, especially in moderate to severe persistent rhinitis.

2. Sinusitis: Chronic hay fever can lead to sinusitis (sinus infections), causing symptoms like facial pain, congestion, and thick nasal discharge.

3. Otitis media (middle ear infections): Children with hay fever may experience increased episodes of middle ear infections due to congestion and sinus issues.

4. Chronic rhinosinusitis: It is a long-term condition characterized by inflammation of the tissues lining the nasal passages and sinuses. 

5. Adenoid hypertrophy: Allergen sensitization in hay fever can lead to adenoid hypertrophy (excessive tissue growth), affecting the back of the throat.

6. Eustachian tube dysfunction: Common in hay fever patients, presenting as ear fullness, otalgia (earache), and ear-popping.

7. Risk of allergen desensitization: Patients undergoing allergen desensitization (allergy shots) may experience acute exacerbation of rhinitis or asthma. In severe cases, progression to anaphylaxis is also possible.

8. Anaphylaxis: At times, the allergic reaction may be severe and may cause an episode of anaphylaxis, which can be fatal if not treated in time.

Alternative Therapies For Hay fever

The following therapies can act as an adjunct to managing the symptoms of hay fever. It is important to consult your doctor before starting any of them. 

1. Aromatherapy

Essential oils such as peppermint, lavender, or eucalyptus have anti-inflammatory and anti-microbial properties that help alleviate the symptoms of hay fever. It can be diffused into the air but should be diluted in a carrier oil if applied topically.

2. Acupuncture

It is suggested as a potential treatment for allergies like hay fever because it can help balance the immune system. This may benefit people with allergic rhinitis.

3. Homeopathy

Homeopathy works by correcting the immune responses of individuals rather than suppressing or modifying the immune system. It has proven to be beneficial for individuals with allergic reactions or allergic diseases.

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Living With Hay Fever

Managing hay fever is an ongoing challenge, as even minimal exposure to allergens like pollen or dust can trigger allergic reactions. Achieving a completely symptom-free life can be difficult, despite the use of treatments to alleviate hay fever symptoms.

1. Increase your immunity by eating right

Allergy symptoms can be reduced with a low-fat, high-complex-carb diet. Dietary advice to alleviate allergy symptoms includes:

Include:

• Dark green, leafy veggies
• Yellow and orange veggies
• Nettles
• Bamboo shoots
• Carrots
• Onions 
• Garlic
• Ginger
• Cayenne
• Horseradish

Limit/Eliminate:

• Alcohol 
• Caffeine 
• Dairy products
• Chocolate
• Food colorings
• Peanuts 
• Red meat 
• Sugar
• Wheat

Supplement with:

• Bioflavonoids
• Flaxseed oil
• Probiotics
• Vitamins A, C, E
• Zinc
  

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2. Tips to manage hay fever in kids 

• Identify allergen triggers

• Consult a pediatrician for medication

• Use saline nasal rinses

• Create an allergen-proof home

• Plan outdoor activities wisely

• Make sure they shower after outdoor play

• Protect eyes with sunglasses

• Monitor pollen forecasts

• Consider immunotherapy

• See an allergist for severe symptoms.

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