Hay fever can be miserable and spoil what is for most people the best time of the year and despite the general thought that it is a summer only allergy, depending on the type hay fever can affect people across many months of the year.
Those who are allergic to trees tend to have hay fever symptoms in the spring from March through to the end of April. One of the major causes of tree allergy is the silver birch tree and the peak of the pollen season is usually in the middle of April. Grass pollen levels start to go up in May and peak towards the end of June and first half of July. Each year we see many patients at these times who are having horrible hay fever symptoms which are interfering with their studies, work and leisure activities.
Regardless of the type of hay fever, one of the most important things to realise is that getting good relief from symptoms needs to start before the onset of the pollen and hay fever season.
The two main types of hay fever treatment are steroid nasal sprays and antihistamines. The nasal spray contains a small dose of an anti-inflammatory steroid, which is harmless in the vast majority of people. Although nasal sprays and antihistamines combat hay fever symptoms in different ways, the nasal spray has the potential to offer more relief when you perform a head-to-head comparison with antihistamines.
Fortunately, you can of course take both!
Timing of the hay fever medication is crucial and I often recommend that my UK based patients with tree pollen hay fever start their nasal spray on St David’s day (1st March) and no later than the 1st May for grass pollen allergy.
Although it is sometimes tempting to forget the spray on days when pollen counts are low, e.g. during wet weather, it is important to try and take it daily. Once the symptoms start, antihistamines and eye drops if necessary should be added. During the “hell weeks” of the peak season the daily dosages of nasal spray and antihistamines may be doubled up provided this is done under the guidance of your allergy specialist.
Grass pollen counts tend to be highest in the evenings so staying indoors and keeping windows shut can be beneficial. Another way of ‘avoiding’ pollen is to place small filters inside the nose. These can be purchased online and there is some research evidence that they can help. Patients often ask if taking local honey can help. Perhaps this might have a soothing effect for an itchy throat but one clinical trial showed no benefit on hay fever symptoms when compared to honey-flavoured corn syrup. If all else fails and if the symptoms become totally unmanageable, it is occasionally necessary to prescribe oral steroids for a brief period of time.
When symptoms remain unbearable in spite of these measures, consideration should be given to a course of pollen desensitisation (sometimes referred to as immunotherapy). This needs to be started well before the next pollen season. Immunotherapy has been around for over 100 years and clinical trials show that it is highly effective. The traditional form of the treatment involves having injections of the pollen to desensitise the immune system although in recent years, immunotherapy vaccines have become available in oral form. In that case, the allergen is taken usually daily under the tongue as drops or dissolvable tablets. If a benefit is seen, treatment is carried on for 3 years. Research studies show that 3 years of treatment can continue to have sustained benefits even after the course of immunotherapy is finished. Immunotherapy is therefore the only treatment which actually has the potential to address the underlying cause of the problem and modify the immune response to the pollen which is at the root of the problem. The sublingual form of immunotherapy is usually very well tolerated. It may cause some itching in the mouth when the treatment is started but this usually subsides within a week or two. The great advantage of this over the older injections forms is that the treatment can be taken at home after the first dose.
If you are in need of hay fever advice, please contact Allergy London on 0203 758 9160.
