Hay fever – The Pain and Perils of Pollen

One of our specialists shares their advice how to best prevent and minimise your symptoms.

by Dr. Sharryn Gardner

We might think hay fever is fairly benign and boring. It can be. It can also cause misery to around a quarter of us every Spring and Summer; affecting sleep, daytime performance and exams on top of the unpleasant symptoms. It can also cause life-threatening asthma in those who have both hay fever and asthma, particularly in thunderstorms (very small particles are in the air at our level and trigger it) and the additional risk of COVID in this mix means that we must be on guard for those with both conditions, whatever their age.

The numbers have trebled in the last 20 years. Around 25% of adults are said to suffer from hay fever and up to 15% of children. Often it can be overlooked in children, the symptoms mistaken for a cold. However, unlike with a cold, hay fever won’t cause a raised temperature and will last a lot longer – weeks or months rather than a few days. Sufferers tend to be affected at roughly the same time every year, and other rarer causes include certain medications or thyroid disease. It’s usually worth trying an antihistamine if you suspect hay fever which can then help with the diagnosis.

Skin prick tests can be helpful and IgE levels to specific pollens can help in diagnosis – a raised total IgE suggests allergy of some sort, while not specific.

We’re just heading into the start of the hay fever season 2021. Its proper name is Seasonal Allergic Rhinitis (swelling and inflammation in the nose caused by allergy) and it can affect the eyes, throat, ears and head. So there’s one overall cause encompassing a wide group of smaller causes – pollen and all its subtypes. Birch tree pollen is the most allergic (peaking in April) and grass the most common (peaking around June/July).

How does it start?

You generally inherit an allergic (atopic) tendency from a parent who is also affected, they may have eczema or asthma rather than hay fever. This makes you susceptible though you may never develop it. Pollen though is out there in the air – if you go outside between March and October you’ll be exposed. 

When you’re first exposed, nothing outwardly happens. The cells in your mouth, nose, throat and eyes are busy getting sensitised inside you. When they encounter the same pollen (allergen) again, special allergy cells called mast cells are activated, burst and leak all sorts of chemicals leading to the allergic response we see with the runny eyes and nose. The fastest and biggest volume of these is histamine, hence treatment with antihistamines. It’s only one of the chemicals and the others work slower affecting things like sleep and a reduced sense of smell for example.

So essentially if you’ve got it, you’re likely to keep getting it. You can’t completely avoid pollen, though you can massively minimise your exposure to it. It usually starts in childhood, peaks in the teens and can reduce as we go into adulthood. It may even disappear.

What can I do?

Weather forecasting, calendars and clocks are your friend. The Met Office produces predicted pollen calendars for each type of pollen – not just tree, grass, weeds or moulds (and they come in that order across the year), they show us the range for ash, birch and every other pollen. They can do this because pollens are released when the plants or trees are growing and these vary a bit year on year with changeable weather. You can roughly predict which you’re allergic to from when you’re most affected. If you’re worst in April, Ash and Birch are the likely suspects. The Met Office also provides a pollen count via the weather forecasts, which will generally be higher on hot and humid days. Thunderstorms cause pollen to break up into very small particles which can easily get deep into the lungs and are low down in the atmosphere and very concentrated.

Pollen counts vary greatly across the day. The pollen counts are highest from 7-9am as pollen is released from plants and trees and 5-7pm as the air cools and the pollen sinks down again. Try to stay inside at those times with windows closed. At least try and stay away from woodland, parks, grassed or rural areas. Bring washing inside before 5pm. Try and plan outdoor activities in the middle of the day when the pollen has risen up a bit.

Keep down pollen in your environment.

We know that pollen is in the air and constantly circulating and settling. Frequent hoovering and damp dusting help keep pollen low in the house. Keeping windows closed helps as does a pollen HEPA filter in the hoover or air filter. Pollen filters in the car and not circulating air from outside help. Wipe pets with a damp cloth as they can carry pollen on their fur.

Other environmental factors can make hay fever (and asthma) worse, such as smoking, exhaust fumes and air pollution. Bush fires in Australia hugely increase cases and their severity. Coastal breezes wash pollen inland so coast-dwellers tend to have fewer and less severe symptoms.

Minimise pollen on yourself.

The thing I’ve found most effective was close-fitting wraparound sunglasses. It is also effective to change outdoor clothes as soon as you get home (not leave them and their pollen lying around!) and shower and wash your hair, or at least wash your face. It is virtually indestructible on dry clothes, so water helps reduce the spread.

Another great tip is putting vaseline around the nostrils which traps a lot of pollen preventing it getting in. Salt water sprays can flush out pollens as well.

Prepare – treat BEFORE you get the symptoms.

As soon as you get symptoms the irritation is already well-established and it’s a challenge to get on top of it. Take antihistamines or steroid nasal inhalers at least two weeks before past experience leads you to expect symptoms. Antihistamines best treat the histamine symptoms (itching and runny noses) and milder cases, and are easily available cheaply over the counter.

Nasal steroid sprays can help relieve nasal congestion and sinus swelling. Combinations of antihistamines and steroid spray are becoming available. 

Eye drops (cromoglycate on prescription) can help runny eyes since constant rubbing can cause significant swelling of the white of the eyes.

Nasal decongestants should only be used for a few days at a time as they cause rebound congestion when stopped (you end up worse off than before). 

If you have asthma always carry your reliever – symptoms can become very serious very quickly. Take your preventer regularly, and treat hay fever symptoms aggressively as this can make serious asthma attacks more common. 

Colds, hay fever, COVID and weather can all combine to make asthmatics very sick very quickly. 

These aren’t working or it’s getting worse.

See your GP to look at your whole history and check for other causes or arrange testing.

If medications aren’t controlling it a specialist referral for medication optimisation or desensitisation treatment may help. Desensitisation is repeated injections of your pollen trigger under the skin in increasing doses to overcome the allergic response. Very new developments are looking at putting the allergy under the tongue rather than skin.

Unfortunately, some sufferers will become sensitised to more and more pollens or other allergens outside the hay fever season and then have a full year-round version resulting in perennial allergic rhinitis – no let up all year. 

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