The kids have finished school and summer is officially here. Many of you are probably dreaming of long leisurely sunny days spent outside. Being honest looking outside today you wouldn't think summer has started and with all the sneezing , red eyes and runny noses in my waiting room one could be led to believe it was mid flu season. But no this stuffed up bunch is suffering from another seasonal problem; Hay fever, or allergic rhinitis as it is medically known. It is estimated that one in five people suffer from this irritating condition.
The symptoms of allergic rhinitis are a response to exposure to an irritant or allergen. The immune system responds by releasing histamine, a chemical which has a myriad of effects. The most common allergens for seasonal sufferers are grass and tree pollens with weeds, moulds and fungi also playing a role. Other irritants such as exposure to fumes and exhaust can often add to the problem and as a result many urban dwellers suffer more. Avoiding most of these substances is virtually impossible so for many people finding a way of controlling their symptoms becomes an annual crusade. When it comes to treatment I have good and bad news. The bad news is there is no medical cure for allergic rhinitis. The good news is it is possible to hit each symptom and so a combination of remedies often works best. Treatments are most effective if started before symptoms start. So here are the 4 steps to combat hay fever.
Step 1: Antihistamine tablets block the release of this hormone and can be very helpful. The older ones can be very sedating and must be taken several times a day so the newer less sedating once daily tablets are probably a better choice.
Step 2: The next weapon in the medical armoury is a steroid nasal spray. People often worry when they hear steroids being mentioned but these sprays act mainly locally in the nasal passage and systemic absorption is very limited. These take a few days to kick in and are designed to be taken daily through the season. There are other non steroid sprays available to decongest but most of these should only be used short term. If used too long when ceased a flare of symptoms often occurs.
Step 3: Eye drops. Itchy red eyes are often a very distressing symptom and the regular use of the correct anti-allergy drops can bring great relief.
Step 4: Lastly nasal rinses or sprays are now recommended to help reduce the presence of allergens in the nasal passages.
The above remedies don't work for everyone and occasionally doctors prescribe a short dose of steroid tablets to control a particularly severe case. Many patients looking for long term relief of symptoms will have heard of an injection called Kenalog. This is a high dose steroid and used to be administered to many at the start of the season. However this is a systemic treatment and is now known to put people at risk of all the complications of long term steroid use. It is no longer recommended.
There is a relatively new treatment that shows great promise for seasonal allergy sufferers. It is a type of immunotherapy that involves exposing oneself to small amounts of the allergen allowing the body to become desensitised. Grazax has minute amounts of grass pollen and has been shown in clinical trials to reduce symptoms of grass pollen allergy. It can only be prescribed by doctors trained in its use and should be started several months before seasonal symptoms begin it is then taken for several years.
Many people will have tried alternative remedies. Some of the common ones I came across include local honey, camomile, nettle, eyebright and turmeric but none of these have shown significant benefit in clinical trials. Evidence does suggest that keeping stress levels to a minimum, having a varied healthy diet, and exercising regularly can help reduce the severity of symptoms. Hay fever shouldn't be taken lightly a survey by Kleenex showed that 78% sufferers said their symptoms impact negatively on their quality of life. The search for answers is ongoing but hopefully in the meantime the correct combination of medication can help keep symptoms at bay and allow the summer to be enjoyed by all.