The Seasonal Nose – Hay-fever – Not Something to Sneeze At

If you are one of the estimated 3.1 million Australians suffering from hay fever, springtime is not your favourite season. According to Allergic Rhihitis (hay fever) in Australia—released in 2011 by the Australian Institute of Health and Welfare (AIHW), about 15 percent of the Australian population suffers from hay fever. Hay fever or allergic rhinitis is the most common chronic respiratory condition among Australians.

What causes hay fever?

The word rhinitis means “irritation of the nose”. The cold-like symptoms of hay fever are the result of an allergic reaction causing inflammation of the mucous layer of the nose. An allergic reaction requires exposure and sensitisation to an allergen.

The most common allergens that set off hay fever symptoms are inhaled ones. They include:

• House dust – House dust contains many possible allergens, including dust mites, hair, smoke, dirt, fibres, mould spores, pollen grains, insects, dander (skin scales or hair from pets), secretions (such as saliva) of pets, insects and mites, excreta including the faeces of pets, insects and dust mites.
• Pollutants – Natural pollutants such as dust storms and vegetation, and pollutants from activities of man, including industrial activities and vehicle emissions, can act as allergens. In addition to irritating the nasal passages, high levels of pollution in general can make allergies worse. Some pollutants directly irritate the nasal linings while others increase the risk of developing allergic rhinitis. Allergens that have been linked to allergic rhinitis and upper respiratory diseases like asthma include nitrogen dioxide (NO₂), carbon monoxide (CO), ozone (O₃), sulpher dioxide (SO₂), and small particles in the air.
• Exposure to various agents in the workplace – Substances encountered in the workplace can either cause allergic rhinitis or make it worse. Occupational irritants come in different forms, such as fumes, vapours, dust and gases. Natural rubber latex, bakery allergens (from mites growing in cereals) natural and supplementary enzymes and small mammals (rats and mice in research labs) may cause or make hay fever symptoms worse. Plants and flowers are the biggest source of common irritants for those working as gardeners, green house workers, florists and those engaged in making plant extracts. Other types of irritants include chlorine, ammonia, glutaraldehyde and wood dust.

Not everyone experiences hay fever in the same way

For some people, allergic rhinitis is mild. A mild attack will not cause trouble with sleep or daily activities such as work, school, leisure activities or sport.

Those who have moderate or severe allergic rhinitis will experience one or more of the following:

• Sleep impairment.
• Problems with attending to daily activities, including work, school or leisure pursuits.
• Troublesome symptoms such as itchy eyes and running nose.

Who is likely to suffer from hay fever?

Some people are genetically more susceptible to allergic rhinitis than others.

All age groups can be vulnerable, but in Australia hay fever most commonly occurs among people 25 to 44 years old. Those below 14 years of age or 65 and over are the least likely to suffer from hay fever. Exposure to tobacco smoke during early childhood can increase the risk of allergic rhinitis in children.

The ACT and Western Australia have the highest rates of hay fever in Australia. Queensland and New South Wales report the lowest incidence. The differences may be due to differences in exposure to different allergens.

Although there were differences between states, studies have not found significant differences between people living in major cities, inner regional and other areas. Hay fever is, however, more common among females than males.

Symptoms of hay fever

The most common symptoms include:

• A runny nose
• A blocked nose (nasal congestion)
• Frequent sneezing
• Tearing eyes, that turn itchy and red, medically known as allergic conjunctivitis
• An itchy throat, mouth, ears and nose

Some people may also experience the following:

• Lost sense of smell
• Pain in the face, usually due to blocked sinuses
• Coughing
• Sweating
• Headaches
• Puffy eyes and dark circles under the eyes
• Irritability and fatigue

Hay fever has also been associated with other conditions such as asthma.

Treatments

No cure has been found so far for hay fever, but there are many ways to effectively manage its symptoms. Medications, non-medicated means and immunotherapy can be employed to reduce hay fever symptoms. Avoiding allergens is the most obvious way to manage hay fever. It is also the most difficult.

Statistics show that as many as two thirds of Australians with hay fever do not see a doctor, opting instead for over-the-counter medications, often with the guidance of a pharmacist.

Although the rest seek medical advice, allergic rhinitis is not among the 30 most frequently treated conditions for which people see doctors in Australia.

Only a few sufferers from hay fever need hospitalisation.

Allergen avoidance

If you know what causes your allergic rhinitis, one of the best ways of managing your symptoms is to avoid that specific cause.

For example, house dust mites are a key component of dust allergens in a house. They can be found in mattresses, pillows, bed bases, upholstered furniture, curtains and carpets. Avoiding dust mite allergens can help control hay fever symptoms in some people. Use of substances that kill dust mites (acaricides) and extensive efforts to control dust in the bedrooms can reduce rhinitis symptoms. If you know that occupational agents cause your allergic rhinitis, you may want to consider a transfer to a different position, location or vocation to avoid exposure.

Although the Australian Society of Clinical Immunology and Allergy (ASCIA) recommends allergen avoidance as a strategy for managing allergic rhinitis, it is not always be possible or practical. What exactly you are allergic to can be determined with various tests.

The ASCIA website has an extensive pollen calendar that summarises distribution and seasonality of major pollen allergens found in Australia.

Medications

Medications used for treating hay fever include:

• Intranasal corticosteroids
• Oral antihistamines
• Immunotherapy

Corticosteroids taken through the nose and oral antihistamines are the medications commonly used for treating hay fever. How they should be used depends on the frequency of symptoms (intermittent or persistent) and their severity (mild, moderate or severe).

The AIHW report summarises treatment recommendations as follows:

• Mild intermittent allergic rhinitis is first treated with antihistamines. If that doesn’t control symptoms, use of intranasal corticosteroids is recommended.
• Persistent allergic rhinitis and moderate/severe intermittent allergic rhinitis are first treated with corticosteroids administered through the nose, as they cost less than oral antihistamines.
• If intranasal corticosteroids don’t help, oral antihistamines are recommended as the next step.
• Immunotherapy is also an option for those with moderate to severe persistent allergic rhinitis.

A variety of intranasal corticosteroids and oral antihistamine medications are available in Australia.

Immunotherapy

Allergen immunotherapy addresses the root cause of the disease, rather than merely treating the symptoms. The aim of immunotherapy is to ‘teach’ the immune system to react less violently by administering gradually increasing doses of allergens. This induces the body’s ability to tolerate exposure to these allergens over the long term.

Allergen immunotherapy requires long-term commitment. To bring down the chance of allergies eventually returning, immunotherapy must be administered for three to five years.  Improvement of symptoms typically comes within four to five months.

Immunotherapy has been in effective use in Europe for over 100 years.

Non-medicated treatments

Non-medicated methods of treating hay fever include using saline douching and sprays.

When should you see a doctor?

Statistics show that most Australians suffering from hay fever use over-the-counter medications to treat their symptoms. Many seek guidance and advice from a pharmacist.

Here’s when you need to see a doctor:

• When you are unable to control your hay fever symptoms with over-the-counter medications, it is time to see a doctor.
• You should also seek medical advice if you begin having troublesome side effects from over-the-counter medications you have taken.
• If you experience complications of allergic rhinitis—such as a worsening of asthma—on a recurring basis, see a doctor immediately.
• It is also best to see a doctor if you repeatedly experience episodes of sinusitis.
• If you have unusual symptom patterns of hay fever, see a doctor without delay. For example, you may only experience symptoms in the winter or while at work. If this is the case, your symptoms may be due to a substance other than pollen. There are medical tests that can help pinpoint the cause.

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