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Hay fever: How to ease the sneezing

Hay fever affects a quarter of the British population, yet few of us understand what causes it. Camilla Pemberton reports on the latest research, the best treatments – and the prospects for a cure

What causes it?

Hay fever, also called allergic rhinitis, is an allergic reaction to pollen, which affects one in five people in the UK. When airborne pollen particles enter the nose, throat and upper respiratory passages, they stimulate cells to produce histamines, which then produce the symptoms associated with hay fever such as itchy eyes and a running nose. Sufferers are most affected during the summermonths when the pollen count – the amount of pollen in the atmosphere – is highest, but the severity of symptoms varies from person to person. Lindsey McManus of Allergy UK says: “People tend to think of hay fever as a mild allergy, but when symptoms are severe, sufferers can feel very miserable for a large chunk of the year.”

When does it strike?

Different types of pollen peak throughout the year, from as early as January until as late as September. Grass pollen production typically starts inMay, while silver birch trees flower in March, nettles in August and fungal spores in late summer and autumn. The most common cause of hay fever is grass pollen, affecting approximately 90 per cent of sufferers – but 25 per cent of sufferers are sensitive to birch pollen, and other irritants include pollen from mugwort, oil seed rape and chrysanthemums.Sufferers may be allergic to more than one type of pollen.“ The time that your symptoms start is a good indication of which pollen you are allergic to,” saysMcManus. A low or moderate pollen count means mild or no symptoms for all but the most acute allergies, whereas a high pollen count means all sufferers are likely to experience a reaction. It is a useful guide for hay fever sufferers who want to plan their day accordingly, but it’s not just outside where symptoms are acute. Pollen particles can stay active in carpets for up to three months.

What are the symptoms?

Symptoms are caused by the inflammation of membranes that line the inside of the nose, throat and eyes. Symptoms vary depending on the severity of the allergy but include a blocked or running nose, red, itchy and watering eyes, an itchy throat, sneezing, coughing, wheezing and headaches. The symptoms can be very debilitating. Sufferer Louise Stanley,25, says: “From April to late August hay fever affects me before I’ve even woken up. I don’t sleep well and I’m disturbed by itchy eyes and a runny nose. When I wake up, my eyes are red and painfully itchy. When it’s really bad, my face gets swollen and I can’t wear make-up. My eyes itch all day and I’m constantly sneezing. But the worst thing is how tired and drained it makes me feel, all the time.” Many sufferers find their working lives are affected by the condition.

A recent study by the National Pollen and Aerobiology Research Unit, based at the University of Worcester, revealed hay fever might cost the UK economy as much as £7.1bn in lost productivity. Professor Jean Emberlin, director of the National Pollen and Aerobiology Research Unit, led the study. 1000 sufferers were surveyed, 600 of whom were in full-time employment. The study found that sufferers were working at only 63 per cent of their normal productivity.“ Hay fever tends to be trivialised, but, as this shows, it should be taken seriously. It can be a real problem.” said Professor Emberlin.

Who gets it?

Hay fever affects between 20 and 25 per cent of the UK population and around 38 per cent of teenagers, one of the highest rates in Europe. Professor Emberlin believes this could be due to the high levels of antibiotics that were prescribed by GPs until about 10 or 15 years ago. “The antibiotics reduced gut bacteria, which disrupts the immune system, which might account for why those children now have higher rates of allergies.” Symptoms begin to show at eight or nine years and peak in teenagers. Some sufferers find their symptoms decrease or disappear as they reach their twenties, but some adults develop the condition in their thirties or in middle age. Sufferers are genetically predisposed to the condition, but environmental factors can have a profound effect too.

Why is it on the rise?

Professor Emberlin says UK hay fever allergies rose most steeply between 1960 and 1995 but are still increasing at a rate of approximately one per cent every year. “It’s slowed down but numbers are still rising every year and will continue to do so,” she says. Predicted rising temperatures this summer could extend the pollen production season, and the symptoms of hay fever,says Professor Emberlin. Drier, warmer, less windy days allow pollen to build up, resulting in an overall higher pollen count. If this happens,allergies may be triggered in people who have not previously been affected. A theory, known as the “hygiene hypothesis”, is that the standard of living in developed countries is to blame for high levels of allergies. “Most affluent, developed countries have higher ratesof allergies than less well developed nations: our cleaner lifestyles mean we are less exposed to bacteria in early life, which can help build up our immune system,” says Professor Emberlin.

Symptoms can be more acute in rural areas, but urban life also has an inflammatory effect on hay fever. Pollen spores attach to particles from car exhausts, which then spread pollen in pollution. Retailers have reported increased sales of hay fever treatments, with some seeing sales rise by 37 per cent. Professor Steve Field, chairman of the Royal College of General Practitioners, has seen an increase in hay fever patients: “There have been more people coming to me in the last few years. I see at least a couple of hay fever patients every surgery.” A hay fever sufferer himself, Professor Field says the condition should not be underestimated: “It can have a really negative effect on people’s lives. Some can’t work or drive and the symptoms can be very difficult to manage in social situations.”

What are the best treatments?

Sufferers may respond differently to treatments, depending on the severity of their symptoms, but the most effective ways to treat hay fever,says Barry Kay, Professor Emeritus of Allergy and Clinical Immunology at Imperial College, London are: allergen avoidance, anti-allergy medicines (anti-histamine tablets and nasal steroid sprays) and immunotherapy.

Simple measures: Keep windowsclosed and avoid dryinglaundry outside. Use air conditioningin your car and invest in an air filter for your home. Wear wraparound sunglasses. Rub Vaseline underneath your nostrils to trap pollen before it can be inhaled. Eye drops, such as Opticrom, are effective treatments for itchy eyes. Professor Kay recommends a nasalguard (www.nasalairguard.com) for sufferers who cannot take medicines, such as pregnant women.

Pills: Antihistaminemedicines can significantly relieve symptoms.But Stephen Durham, a professor of allergy and respiratory medicine at Royal Brompton Hospital Londonand President of the British Society for Allergy and Clinical Immunology, says hay fever sufferers should be wary of using treatments containing the active ingredient chlorphenamine . “It causes heavy sedation in substantial amounts of patients and, in my professional opinion, should be banned as a hay fever treatment. ”Some of the most effective treatments, according to Professor Durham, are: those containing Loratadine, such as Clarityn, which he says is“very effective, and with the advantage of being nondrowsy”; those that contain Cetirizine, such as Zirtek, which is “consistently more effective than Clarityn, but tends to have a slight risk of drowsiness, affecting around five to 10 per cent of users”; and those with Acrivastine, such as Benadryl, “an effective, non-drowsy treatment”.

Nasal sprays: Steroid nasal sprays,such as Beconase or Flixonase, have proven to be more effective than antihistamines, says Professor Durham. Ideally, sufferers should begin treatment before the pollen season starts. “That way the spray won’ t exacerbate existing symptoms and, after three or four days, will become highly effective. Now is a good time to start taking them.”

The cost: Some sufferers spend as much as £50 a month on hay fever products. Professor Durham advises us to look at the active ingredients in medicines – generic versions are often available for just a fraction of the price of a named brand. And, more importantly, to visit our GPs if we’re buying medicines regularly.“ GPs can prescribe a month’s supply of most treatments, whereas over-the-counter remedies are usually sold in weekly supplies. ”High street chains, such as Boots and Asda,offer own-brand “hay fever hampers” that can offer significant savings.

What’s on the horizon?

Immunotherapy is a relatively new treatment, which could provide long-term relief for hay fever sufferers whose symptoms cannot be managed by medication. Unlike traditional hay fever medications,which simply treat the symptoms, immunotherapy is the only treatment available that aims to desensitise the body to the effects of allergens.“Immunotherapy works by administering doses of pollen to change the immune system, giving sufferers long term protection from hay fever symptoms,”says Professor Durham, who describes it as a “partial cure”. It comes in two forms: a series of injections and an oral vaccine called Grazax. The injections must be started two to four months before pollen production starts but if you have missed this year’s season it is still worth starting a course as the treatment, and potential benefits, are long-term. The treatment involves weekly injections for 12 weeks, followed by monthly injections for two to three years. Each injection must be administered in a specialised clinic. After a full course of injections sufferers could be protected for up to three years, but success rates do vary from person to person.

The orally administered option, Grazax, a pill placed under the tongue, must be taken once daily and only the first dose needs to be administered by a specialist. It must be started at least eight weeks (ideally four months) before the grass pollen season starts and is only effective for grass pollen allergies. Again, treatment should continue for about three years. Both forms are available on the NHS and must be prescribed by your GP or a specialist and, for those whose entire summer is blighted by hay fever misery, represent a real step forward in treatment.