Hay fever - an underrated and chronic condition
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PROFESSIONAL Elizabeth Lang, MPSI
Hay fever –
an underrated
and chronic
condition
R
About 20% of the population of Ireland hinitis refers to
inflammation
suffers from seasonal allergic rhinitis (hay of the mucous
membrane
fever) and for many people the pharmacy of the nose.
Allergic rhinitis involves
is likely to be the first port of call. the production of allergen
specific protein IgE (after
exposure to an allergen),
which binds to mast cells.
Subsequent exposure causes
degranulation of these cells,
resulting in the release of
chemical mediators, such
as histamine, and the
production of leukotrienes
and prostaglandins, leading to
itching, runny nose, sneezing
and nasal congestion.
The main allergen of
hay fever is grass pollen.
Symptoms peak during June
and July. Symptoms in spring
are commonly due to tree
pollens, whereas symptoms
in late summer and autumn
may be due to weed pollens
and mould and fungus
spores. Trees, grass and plants
release pollen as part of their
reproductive process. These
tiny reproductive particles
trigger an allergic reaction
in susceptible individuals.
People with hay fever can
experience their symptoms
at different times of the year,
depending on which pollens
or spores they are allergic to.
IPUREVIEW APRIL 2019 29
Signs and Symptoms levels have been reached Antihistamine eye drops Leukotriene receptor
n Sneezing;
and cannot reverse H1 –
Most eye symptoms relating antagonists
receptor activation, so are
only effective if they are able to hay fever will be controlled Leukotrienes are another
n Itchy, blocked or
to block histamine release by oral antihistamines, but chemical released and
runny nose;
before it occurs. For maximum if symptoms are persistent together with histamine, they
n Red, itchy or effectiveness, antihistamines or particularly troublesome, cause inflammation in the
watery eyes; should be taken before eye drops containing nasal passages, throat and
symptoms are expected Sodium Cromoglicate are eyes. A leukotriene receptor
n Itchy throat, inner ear usually effective. Sodium
rather than wait till they have antagonist, montelukast,
or mouth; Cromoglicate is a mast cell
started. blocks the leukotriene
n Post nasal drip; stabiliser. It is used four receptors, thereby rendering
times daily and is suitable for the effects of leukotrienes
n Headaches; and
Corticosteroid nasal children. The addition of a useless. They are licensed for
n Loss of concentration sprays and drops topical decongestant can be use by asthmatic patients
and generally feeling useful to reduce redness and who also experience seasonal
Corticosteroids are used puffiness in the ocular orbit. rhinitis. It’s also important to
unwell.
to treat hay fever because note that leukotriene receptor
In an ideal world, the most of their potent anti- antagonists can be less
effective way to control inflammatory effect. When Corticosteroid tablets effective when taken with food.
hay fever would be to avoid pollen triggers an allergic
For rapid short-term relief
exposure to pollen. However, reaction, the inside of the nose
from severe symptoms, a
it’s very difficult to avoid becomes inflamed. Topical
short course of oral steroids Decongestants
pollen, particularly during application of corticosteroids
will usually suppress even Topical decongestant
the summer months when can reduce this inflammation
the most resistant symptoms nasal sprays containing
we all want to spend more and prevent the symptoms
giving antihistamines and Xylometazoline or
time outdoors. Luckily, this of hay fever. Corticosteroids
regular inhaled steroids a Oxymetazoline are effective in
miserable condition can be are more effective than
chance to work. reducing nasal blockage and
managed with some careful antihistamine tablets at
lifestyle adjustments and a preventing and relieving help penetration of topical
variety of OTC products. nasal symptoms, including steroid nose sprays. Rebound
Steroid injections congestion is always a
sneezing and congestion.
Beclomethasone and Long acting steroid injections problem if used continuously.
Oral antihistamines fluticasone are available as were commonly used for Oral decongestants,
aqueous non-aerosol sprays. treatment of hay fever in the often combined with an
Antihistamines are generally antihistamine, don’t cause
Absorption from the nasal past, but they are no longer
effective in controlling rebound symptoms. They
mucosa is low, and systemic recommended as routine
symptoms including sneezing, are stimulants, however, and
effects are highly unlikely at management due to the risk
nasal itching, rhinorrhoea can cause sleep disturbance.
recommended doses. Any local of serious side-effects, e.g.
and, to a lesser extent, allergic Their use is also limited in
reactions, such as stinging, osteoporosis, hypertension,
conjunctivitis, but they have hypertension and diabetes.
burning and aftertaste, are diabetes and muscle atrophy.
little or no effect on nasal Saline nasal spray/rinse:
congestion. The maximum mild and transient. Treatment
may need to be maintained Washing the nasal passages
effect of antihistamines is with saline may reduce
not achieved until several throughout the hay fever
season. symptoms and can offer
hours after peak serum relief in conjunction with
conventional treatment.
“It’s very difficult to avoid pollen, particularly
during the summer months when we all
want to spend more time outdoors. Luckily,
this miserable condition can be managed
with some careful lifestyle adjustments
and a variety of OTC products.”
30 IPUREVIEW APRIL 2019
Immunotherapy n Vacuuming regularly n Avoiding grassy areas It is best for parents to be
using a vacuum cleaner like parks and fields is prepared and have a plan in
Immunotherapy for pollen with a High Efficiency best but if unavoidable, place to treat the allergy if
and dust mite allergies is Particulate Air (HEPA) e.g. mowing the lawn, it is triggered. Informing the
now available in Ireland, filter and dusting with then wearing a dust school of the situation will
offered mostly through a damp cloth can help mask is advisable; also be beneficial so the child
private clinics. This involves remove pollen and is not sitting next to an open
giving gradually increasing n When exercising
spores from the air and window during an exam.
doses of the allergen, to outdoors, smearing
surfaces; Infections can be a
which the person is allergic. vaseline around the
complication of hay fever. The
This incremental increase n Furry pets should be inside of the nostrils
swelling of the nasal passages
causes the immune system kept outside during hay will trap pollen and
that occurs can prevent
to become less sensitive to fever season. If they do spores and prevent
mucus from draining out of
the allergen particle, possibly come indoors, there will them reaching the
the sinuses. The Eustachian
by production of an antibody, be residual pollen on lining of the nose.
tube can become blocked by
which reduces the symptoms their coat which can be
a build-up of mucus leading
of the allergy when the transferred to carpets
Complicating factors to a middle-ear infection. This
allergen is encountered in the and soft furnishings; and
is more common in children
future. Immunotherapy also n Avoiding going outside Hay fever does not pose a as their Eustachian tube is
reduces the inflammation that when pollen is very serious threat to health but smaller than an adult’s.
characterises rhinitis. high. Pollen trackers it can have a negative impact Though all of these
are available online at on quality of life. People with therapies and strategies are
www.asthma.ie. very severe hay fever often effective, it will often be
Additional advice find that it can disrupt their necessary for sufferers to use
It is sometimes possible to productivity at school or work. a combination of treatments
prevent the symptoms of hay When going outdoors: The Junior and Leaving to achieve symptom relief
fever by taking some basic Certificate examinations and prevent recurrence. A
n Wraparound sunglasses
precautions, such as: always coincide with the treatment plan offered by
will reduce pollen
height of the hay fever their pharmacist will often be
n Not drying clothes entering the eyes;
season. Children affected the best approach.
outdoors. They become n Keeping car windows by this condition should be
coated in pollen. Tumble closed when driving is advised to implement all of
drying is better in this advisable. Pollen filters the self care strategies listed, References
instance; can be fitted to the air as well as start prophylactic www.hse.ie
n Showering after an vents in cars; antihistamine treatment at www.asthma.ie
extended period outside least four weeks before the www.allergy-ireland.ie
will wash pollen out of pollen count starts to rise.
the hair and off skin;
n Keeping doors and
windows closed,
especially during late
afternoon and evening,
when the pollen count is
usually highest;
32 IPUREVIEW APRIL 2019
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