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Hay fever (seasonal allergic rhinitis)

Hay fever is also known as seasonal allergic rhinitis. The symptoms of hay fever include sneezing, a runny nose and itchy eyes which are triggered by an allergic reaction to grass, tree and weed pollen as well as other particles in the air, usually in the spring and summer. Hay fever is common in Australia; about 3.2 million Australians reported they had hay fever as a long-term condition in 2004–05.

About hay fever 

If you have hay fever, you may be allergic to pollen from grasses, weeds or trees, and also possibly to moulds that are carried in the air, usually during the spring and summer months. Allergens produced by these plants and moulds, for example pollen, can cause an allergic reaction in susceptible people whose immune system mistakes the allergens for harmful invaders such as viruses.

Hay fever, asthma, food allergy and eczema are related allergic conditions and the tendency to develop them seems to run in families. This inherited predisposition is called atopy and it means your body produces a certain type of antibody in response to allergens which isn't produced in non-allergic people.

Symptoms of hay fever 

You may have one or more of these symptoms:

  • sneezing
  • a blocked or runny nose (rhinitis)
  • itchy eyes, nose and throat
  • headaches.

As a result of these symptoms, you may find it difficult to concentrate or sleep properly. In some people, hay fever allergens may also trigger asthma.

If you have hay fever-type symptoms all year round, you may also be allergic to house dust mites, pet hair and moulds. This is called perennial allergic rhinitis.

Causes of hay fever 

If you have hay fever, when you come into contact with pollen or the spores of moulds or fungi that you’re allergic to, your body produces an antibody called immunoglobulin E (IgE). Antibodies are usually only released to fight infection, but in this instance, your body believes the substance you’re allergic to is harmful.

When there’s a lot of the substance you’re allergic to in the air, the IgE antibodies will trigger the release of chemicals from certain cells in your nose, throat and eyes. One of these chemicals is histamine, and as a result of histamine in your system, you’ll experience the symptoms of hay fever.

Some possible causes of hay fever include:

  • grass pollen – including rye, Bermuda, couch , annual, Kentucky blue grass paspalum and prairie grass
  • tree pollen – including silver birch pollen, maple, olive, poplar ash and oak
  • weeds — such as plantain plus spores from fungi and moulds.

If you’re allergic to pollen, you may be allergic to one or more types – and this can determine when your symptoms are most severe.

Allergen Time of year when symptoms are worst
Grass pollen October - May
Tree pollen October – April
Weeds, spores September - April

Incidence of hay fever is highest in south-eastern Australia in areas such as Melbourne, due to the large areas of grasslands to the north and because of northerly spring winds. Residents of Canberra are also badly affected, due to the large amount of exotic plants in the city. In South Australia and Western Australia, the concentration of pollen can vary according to the prevailing winds.

Diagnosis of hay fever 

Your GP will usually be able to confirm whether you have hay fever by asking about your symptoms and when you get them. They may examine your nasal passages and throat to make sure you don't have any other conditions that could be causing your symptoms.

You probably won't need to have special tests, but very occasionally, your GP may advise you to have a skin-prick allergy test to help determine if you're allergic to specific substances. This involves putting certain allergens under the skin of the forearm, usually extracts from problem substances such as specific pollens and other irritants such as pet hair and house dust.

Then very small, fine scratches or pricks are made on the surface of the skin where the allergens have been applied. If redness and swelling develops around the scratch, the test is often positive for that allergen. This may be useful to help you identify and avoid the allergens you’re sensitive to.

Due to the risk of severe allergic reactions, particularly if you’ve had them in the past, these tests are generally carried out in hospitals or allergy clinics under strict medical supervision.

In some cases your doctor may do a RAST (radioallergosorbent test) to measure the level of IgE antibodies for a specific allergen in your blood. This may be if you have very severe symptoms that are difficult to control, if you can’t have a skin test due to a severe food allergy that puts you at risk of anaphylactic reaction or if you have extensive eczema or dermatitis.

Prevention and treatment of hay fever 

Understanding the pollen count

This is the average number of pollen grains in one cubic metre of air over 24 hours. Pollen counts are done daily for grass, tree and weed pollen. Pollen forecasts predict how high the pollen count will be. This can be useful in helping you decide when will be the best time to start and stop treatment. The weather can affect the pollen count and it’s generally higher on sunny days or windy days and lower on rainy days.

Self-help

If you have known allergies to pollens, you may be able to reduce your symptoms by:

  • staying indoors on days when the pollen count is high – this limits the contact you have with the allergens you’re sensitive to
  • keeping doors and windows closed when the pollen count is high. If your child is affected, expect the symptoms to be worse if they are playing outside during hay fever season
  • staying away from areas where there’s more pollen such as grassy parks, especially in the early morning and late afternoon and evening when the pollen count is highest
  • not mowing the grass and staying inside when it’s being mowed by someone else
  • wearing wrap-around sunglasses to keep pollen out of your eyes
  • taking a shower and washing your hair after going outside when the pollen count is high
  • removing house and garden plants that trigger your hay fever
  • not drying washing outside if counts are high – pollen may get trapped in the fibres of clothes and bed linen
  • putting Vaseline on the inside of your nostrils to prevent pollen from entering your nasal passages.

Other ways to help reduce your exposure to common allergens include:

  • avoid cigarette smoke
  • clean your house regularly to keep dust and mould counts low – wear a mask, dust with a clean, damp cloth and vacuum instead of sweeping
  • remove items that easily trap dust, such as stuffed animals, dried flowers and curtains
  • consider using low-allergy bedding products
  • repair plumbing leaks to prevent moisture that encourages growth of mould.

Medicines

There are a range of treatments available for hay fever. You can get some of these over-the-counter in pharmacies, while others require a prescription from your GP. Get advice from your pharmacist or GP before starting any medication, even if you don't need a prescription for it. Let them know if you’re taking any alternative or complementary treatments for hay fever or any condition as these can sometimes interact with other medications.

Some hay fever treatments are not suitable for women who are pregnant or breastfeeding. Ask your pharmacist for advice if you are pregnant or think there’s a possibility you may be pregnant.

Always follow the instructions on the accompanying consumer medicines information leaflet and if you have any questions, ask your doctor or pharmacist for advice.

Antihistamines

Antihistamines can quickly help reduce symptoms of sneezing and a runny nose. They are available as tablets or syrups.

It's important to be aware that some antihistamines can cause drowsiness, so if this is an issue, ask your GP or pharmacist for advice to help choose a non-drowsy antihistamine.

If you only get hay fever symptoms now and again, and they only affect your nose, you could try an antihistamine nasal spray or drops.

Corticosteroid nasal sprays

Part of an allergic reaction in hay fever involves inflammation of the lining of your nose. A steroid nasal spray can be helpful in reducing or preventing this inflammation. This can then help prevent further symptoms from occurring, especially a blocked nose, but it isn't very good at treating symptoms swiftly once they’ve started.

A nasal steroid works best if you take it before your symptoms start and then on a daily basis throughout the hay fever season. You can use it even if you have no symptoms while the pollen count remains high. If you don't feel it's controlling your symptoms well, don't take more than the recommended dose. Instead, ask your GP or pharmacist for advice.

You can buy corticosteroid nasal sprays over-the-counter from your local pharmacy. Your GP can also prescribe stronger nasal sprays.

Decongestants

Decongestant nasal sprays or nasal drops are an alternative that can give fast, temporary relief from a runny or blocked nose. However, it's only suitable for occasional use because using it regularly can lead to rebound congestion where the spray actually causes a blocked nose. Avoid using decongestant nasal spray or drops for more than five days in a row. If your symptoms haven’t improved after this time, talk to your GP or pharmacist.

Decongestants are also available as tablets and syrups, usually in combination with other medicines in products to treat cold and flu symptoms. They’re not suitable for some people with certain conditions or who are taking certain medications so talk to your GP or pharmacist for advice.

Eye drops

If you suffer from itchy or sore eyes, eye drops that contain antihistamines or sodium cromoglicate can help. Using a daily combination of eye drops and a nasal steroid is an option if you would rather not take oral medications.

Immunotherapy

If all other treatments have failed to relieve your hay fever symptoms, you may be advised by a specialist to try immunotherapy. This will involve being given doses of the allergy-causing pollen over a period of time – traditionally by injection.

There have been some cases of immunotherapy causing serious side-effects. However, recent studies have shown that these are rare with oral treatment. However, not all experts recommend it for routine use because of the cost and lack of clear evidence that oral immunotherapy works as well as alternatives.

Further information 

The Australasian Society of Clinical Immunology and Allergy
www.allergy.org.au

Raising Children Network
raisingchildren.net.au

Sources 

Australasian Society of Clinical Immunology and Allergy (ASCIA). Allergic rhinitis (hay fever) checklist. [online] Balgowlah, NSW: ASCIA. 2010 [accessed 4 Jul 2011] Available from:
http://www.allergy.org.au/images/stories/aer/infobulletins/2010pdf/ascia_allergic_rhinitis_checklist_2010.pdf (PDF 466Kb)

Australasian Society of Clinical Immunology and Allergy (ASCIA). Pollen allergy. [online] Balgowlah, NSW: ASCIA. [Last updated Jan 2010, accessed 4 Jul 2011] Available from:
http://www.allergy.org.au/content/

Australian Institute of Health and Welfare. Asthma, chronic obstructive pulmonary disease and other respiratory diseases in Australia. Canberra: AIHW. 2010; Cat. no. ACM 20.

Calderon MA Alves B Jacobson M et al. Allergen injection immunotherapy for seasonal allergic rhinitis. Cochrane Database of Systematic Reviews. 2007; Issue 1. Art. No.: CD001936. DOI: 10.1002

Durham SR. ABC of allergies. London: BMJ Books. 2000.

National Asthma Council Australia. Asthma and allergy. [online] South Melbourne, VIC: National Asthma Council. 2005 [Accessed 6 Jul 2011] Sourced from:
http://www.nationalasthma.org.au/

O'Connell EJ. The burden of atopy and asthma in children. Allergy. 2004; 59 Suppl(78):7-11. Simon C, Everitt H, Kendrick T. Oxford handbook of general practice. 2nd edition. Oxford: Oxford University Press, 2006

Health on the Net (HON). Australian pollen calendar. [online] Geneva, Switzerland: HON [Last updated 1 Jul 2002, accessed 4 Jul 2011] Available from:
http://www.hon.ch/Library/Theme/Allergy/Glossary/aus.html

Mallon D. Laboratory Testing in Allergic Disease. [online] Surry Hills, NSW: The Royal College of Pathologists of Australasia. May 2002 [Accessed 6 Jul 2011] Sourced from:
http://www.rcpa.edu.au/

Last published: 30 July 2011

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