Allergies and hay fever
If you sneeze a lot, if your nose is often runny or stuffy, or if your eyes, mouth, or nose often feel itchy, you may have hay fever (allergic rhinitis). Allergic rhinitis means inflammation inside your nose. Although hay fever symptoms mostly affect the nose, they also affect the eyes, skin, and roof of the mouth.
Although the name ‘hay’ fever is used, you don’t have to be exposed to hay to have hay fever symptoms. Also, contrary to what the name suggests, you don’t have to have a fever either. Essentially, hay fever is the common term for seasonal allergies. It’s a common condition that is estimated to affect around 20% of people.
Hay fever is typically triggered by environmental allergens (substances that cause an allergic reaction) such as pollen, pet hair, dust, or mould. The underlying mechanism involves immunoglobulin E (IgE) antibodies (produced by the immune system) attaching to the allergen and causing the release of inflammatory chemicals such as histamine from mast cells.
Types of allergic rhinitis
There are 2 types of allergic rhinitis:
(a) Seasonal: Symptoms of seasonal allergic rhinitis can occur in spring, summer and early autumn. They are usually caused by allergic sensitivity to airborne mould spores (tiny structures produced by moulds for reproduction purposes) or to pollens from grass, trees and weeds. Pollen is a very fine powder produced to fertilize other plants of the same species.
(b) Perennial: People with perennial allergic rhinitis experience symptoms all year-round. It is generally caused by dust mites, pet hair, pet dander (tiny skin flakes), cockroaches or mould.
Allergies, including hay fever, result when your immune system attacks a typically harmless substance that you come across in the environment. In the case of seasonal hay fever, these include grass, tree, and weed pollens as well as outdoor moulds.
The symptoms of hay fever occur when the immune system overreacts to a normally harmless substance, in this case pollen. When the body comes into contact with pollen, cells in the lining of the nose, mouth and eyes release histamine which triggers the symptoms of an allergic reaction.
Many people with asthma suffer from hay fever, whether seasonally or all year round. It’s not uncommon for uncontrolled hay fever to lead to an increase in asthma symptoms and as such, for someone with asthma, managing their hay fever is a key part of controlling their asthma.
Symptoms of hay fever
The symptoms of hay fever can include:
- Coughing and occasional wheeze
- Blocked or runny nose
- Loss of smell
- Sinus congestion with headaches, especially along the forehead
- Watery, itchy, red eyes (allergic conjunctivitis)
- Puffy eyes and lower eyelids
- Ears popping and occasional hearing impairment
- Diminished senses of taste and smell (severe hay-fever sufferers)
- Itch along roof of mouth and back of throat when eating certain foods
- Post-nasal drip
- Feeling fatigued and/or very lethargic – Fatigue is often reported due to poor quality sleep as a result of nasal obstruction.
It’s virtually impossible to completely avoid pollen or spores. However, by reducing your exposure to the substances that trigger your hay fever you should be able to reduce the severity of your symptoms. Below, are a number of tips to help you avoid being exposed to excessive amounts of pollen and spores.
- Avoid cutting grass and visiting areas of lush grassland. If you really have to cut grass, wear a face mask.
- Change your clothes and have a shower after being outdoors to remove the pollen on your body.
- Vacuum your home and car regularly,
- Keep the windows in your home and car closed during peak pollen hours. Consider buying a pollen filter for your car’s air vents.
- When outdoors, wear wrap-around sunglasses to reduce pollen grains irritating your eyes.
- Try to avoid being outdoors during late morning and late afternoon
- Don’t smoke and keep away from smokers. Other people’s cigarette smoke will irritate the lining of your nose, eyes, throat, and airways. This can make your symptoms worse.
- Put a little Vaseline inside each nostril to ease the soreness and to capture pollen entering the nasal passages.
- Don’t keep fresh flowers in your home.
- Don’t sleep with one of your bedroom window open.
- Don’t drive with a window open.
- Dust regularly with a damp cloth. This will collect dust and help prevent pollen from being spread around.
Medications and side effects
While it’s helpful to identify triggers and try to avoid them, this isn’t always possible. This being the case, it’s common to be prescribed antihistamines, nasal decongestants and steroid nasal sprays. These medications work by helping suppress the symptoms, but like all medications, they have side effects. For example, long-term use of nasal steroids raises the risk of developing cataracts and glaucoma in later life. A study reported in March 2015 in Journal of the American Medical Association (JAMA), Internal Medicine concluded that:
“An increased risk for dementia was seen in people with higher use of anticholinergics.”
The report also noted that:
“Medications with anticholinergic activity are used widely by older adults for diverse conditions, such as overactive bladder, seasonal allergies, and depression.” The report also highlights the fact that some anticholinergics are available as over the counter products.
Also, a 2010 study found a link between regular use of antihistamines and weight gain.
Over breathing and inhalation of environmental allergens
Many people breathe more air than they should when at rest. They breathe too much – this is called over breathing, or hyperventilation. An over-breather may be breathing twice as much air as someone who has a functional breathing pattern. If those two people are both standing in a field of airborne pollen, or sitting in a dusty room full of cat dander, then the over-breather will be inhaling up to twice the amount of pollen, dust or dander than the functional breather. This may be fine for a once off but if you are going about your daily life always over breathing then at some point the body becomes over-sensitised to this allergen burden. This over burdened situation results in an exaggerated response from the immune system as it feels under attack. The response may be hay fever, sneezing, itchy eyes, eczema, and dry inflamed skin.
Over-breathing results in hypocapnia, where the carbon dioxide (CO2) in the arterial blood is lower than it should be for optimum health. CO2 is an important gas that regulates the oxygenation of every cell in the body. Low CO2 causes degranulation of mast cells which results in increased histamine production. As noted earlier, it’s histamine that causes the allergic response we experience. Therefore, improving our breathing and ensuring we don’t over breathe, can reduce histamine production and reduce our allergic reaction.
Most people who complete a Buteyko breathing retraining programme, and adhere to its recommendations, experience significant relief of their allergic symptoms.