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:
  • Pollen
  • Dust mites
  • Molds
  • Pet danders
  • Note that food allergies do not usually cause nasal symptoms
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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