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Allergy and Hay Fever

1x1.trans Allergy and Hay Fever

What is allergy?

  • Foreign particles abound in our environment and many people are especially sensitive to them
  • When these particles cause an inflammatory reaction they are referred to as allergens
  • Allergens can evoke a chain of events at the cellular level which are responsible for the well-known symptoms of nasal allergy
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Hay fever symptoms

  • These symptoms may be seasonal or year-long and can occur at any age
  • Hay fever symptoms may include:
    • Blocked nose
    • Nasal congestion
    • Watery “runny nose”
    • Sneezing
    • Itchy eyes, nose or throat
    • Tearing
    • Puffy eyes or “allergic shiners”
    • Post nasal drip
  • It is also important to know that these symptoms may not always be caused by allergies
  • Other causes include rhinitis or pregnancy, the side effects of medications, mechanical irritation on the nasal mucosa, acute stress, and overuse of decongestant nasal spray

Hay fever causes?

  • Common causes of nasal allergy include:

Hay fever treatment

  • Non medical measures – hay fever remedies
  • The first line treatment of nasal allergy is avoidance therapy – minimising exposure to irritants to the nose is very important
    • Dust mites
      • Dust mites are the basis for dust allergies
      • These mites thrive in moist areas and feed off scales of human skin
    • Animal dander
      • Allergies to animal dander are a concern for pet owners and for those who work with animals
      • If animals cannot be removed, they should be restricted from the bed, bedroom, and if possible, common living areas
    • Pollen
      • Pollen is difficult to completely avoid but masks may help patients allergic to pollens during grass mowing and gardening
      • Appropriate filtration of air conditioning and heating systems can be helpful
        • It is important to change filters on air conditioners often
  • Molds
    • Molds are significant and are common in humid areas both indoors and outside
    • Indoor molds are found year-round especially in damp, warm environments which include old shoes, books, luggage, old newspapers, carpets, behind refrigerators, showers and bathroom surfaces
    • House plants and dried flowers are a major source of molds and should be kept out of bedrooms and major living areas
    • Molds are also commonly found outdoors in compost bins, grass and leaf piles, and in flower and vegetable gardens

Hay fever remedies

  • Further non medical measures to treat allergic rhinitis include:
    • A saline nasal spray should be used to clean the nose and sinuses
    • Minimizing exposure to non-specific irritants to the nasal mucosa
    • Avoidance of tobacco smoke and irritating fumes
    • Appropriate ambient humidity should be maintained indoors where air-conditioning or heating is used
    • Nasal dryness is detrimental to nasal function but humidity over 50% allows molds and dust mites to flourish

Hay fever treatment – Medications for allergic rhinitis

  • Antihistamines

    • Options include: Aerius, Azep, Claratyne, Fexal, Lorapaed, Loratadine, Telfast, Zyrtec
    • Block the release of histamine from cells and can prevent the classic allergic reaction and can be taken in tablet form or as nasal sprays
    • Antihistamines are most effective when taken prior to allergen exposure
    • They relieve the “wet” symptoms such as sneezing, itching and runny nose and watery eyes
    • They have little effect on congestion unless a decongestant is added
    • Prolonged use of one antihistamine may produce a tolerance necessitating a change to another type

  • Decongestants

    • Options include: Sudafed nasal, Drixine, Dimetapp nasal decongestant, Otrivin
    • Cause “vasoconstriction” or shrinkage of swollen tissues in the passages of the nose
    • Decongestant nasal sprays can cause an increase in congestion if used for longer than 3 days at a time – this is called rebound
    • Therefore it is recommended the use of these sprays be limited and only taken for severe episodes of nasal congestion

  • Intranasal mast cell stabilizers

    • Options include: Cromolyn, Intal, Rynacrom
    • These are effective therapy for allergic rhinitis in approximately 70-80% of patients
    • Cromolyn works by stabilizing cellular membranes and preventing the release of histamine
    • Because Cromolyn is expensive and requires dosing 4 to 5 times per day it is not widely used
    • It is best used prior to exposure to irritants and allergens to prevent symptoms and is not particularly helpful once symptoms commence
    • These products are now available over the counter

  • Leukotriene inhibitors

    • Eg. Montelukast (Singulair)
    • Other substances released during an allergic reaction are leukotrienes, which can aggravate allergic conditions and asthma
    • These drugs target leukotriene receptors to reduce allergic symptoms and are most useful in patients with both allergic rhinitis and asthma

  • Corticosteroid nasal sprays

    • Options include: Beconase, Flixonase, Flonase, Nasacort, Nasonex, Rhinocort
    • The most effective first-line drug treatments for allergic rhinitis include oral antihistamines or nasal steroids with or without oral antihistamines
    • Steroid nasal sprays do not prevent an allergic reaction but minimise symptoms
    • Steroid sprays may take 2 weeks to start working so they must be used regularly as directed – these sprays are best used 1 to 2 weeks prior to the typical allergy season – and can be stopped when the allergy season is over
    • Patients with year round allergies may also benefit from steroid sprays – however a 1 month “holiday” off the sprays ever 3 to 4 months is recommended to prevent nasal dryness

  • Immunotherapy

    • Immunotherapy may be more effective for seasonal than for allergic perennial rhinitis
    • Patients whose symptoms are not easily controlled with other medications, those who are sensitive to allergens not easily avoided, those with year-long symptoms or severe symptoms and those who are willing to cooperate with the program are candidates for immunotherapy

Hay fever treatment – Surgery for allergic rhinitis

  • Patient who have failure of medical management may be suitable for surgery which usually involves nasal septoplasty and turbinate reductions
  • This surgery opens the nasal passages to improve breathing through the nose
  • Nasal septoplasty and turbinate reduction surgery is safe and effective treatment for most patients with a blocked nose due to allergic rhinitis