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Hay fever

6th Oct, 2020

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Hay fever, also known as allergic rhinitis (AR), is the most common type of chronic rhinitis. It is characterized by respiratory symptoms and often associated with asthma and conjunctivitis. AR is a localized inflammatory response to inhaled allergens such as seasonal (e.g. pollen) or year-round (e.g. animal dander, dust mites) triggers. For affected individuals the exposure to these allergens causes inflammation of the nasal mucosa. Depending on the severity of the symptoms, this can significantly impair the quality of life, sleep, and performance.

The short term treatment goal for AR is symptom relief and avoidance of the specific allergens is recommended. Pharmaceutical management options include treatment with anti- histamines, steroids, decongestants and allergen immunotherapy.

Diagnosis of AR includes taking the history of signs and symptoms, physical examination and a diagnostic test to identify the specific allergen or trigger. One of the well-known tests is the skin-prick test which introduces several allergens to a patient’s skin on the fore-arm or back. The result for an allergen is seen as positive when a wheal-and-flare response appears on the site of exposure (redness of the skin).

Symptoms

Acute

Runny nose
(rhinorrhea)
Itchy nose
Sneezing
Nasal congestion
Asthma

Subsequent symptoms

Red, teary, and itchy eyes
(allergic conjunctivitis)
Sore throat and coughing
Puffy eye lids and dark circles under the eyes

Consequences

Poor quality sleep
Fatigue
Irritability
Reduced memory and
concentration

Causes

Seasonal allergens e.g. pollen, grasses, blooming plants
Permanent or year-round allergens e.g. animal dander, dust mites, mould

Aggravating factors

Direct exposure to allergen
Windy conditions
Mornings when pollen rise and evenings when they settle

Relieving factors

Seasonal triggers

Stay inside, if possible, especially mornings and evenings and keep windows closed
Use air conditioner or window screen filters
Wear mask and sunglasses, this might lighten
symptoms by providing a physical barrier against air-borne allergens
Potentially reduced symptom severity on rainy days

Permanent triggers

Avoid or restrict contact with animals and ensure adequate house cleaning
Wash bedding in hot water (60°C) and use a vacuum cleaner with a high efficiency particulate air filter
Use allergen-impermeable covers for bedding
Keep relative humidity in rooms below 50% to avoid mite growth

Treatment Options

Antihistamine treatment has been found successful in symptom relief if taken before allergen exposure or at time of maximal symptoms.
Nasal saline irrigation to help wash of inhaled allergens.
Decongestants to restrict blood flow to the nose and reduce mucus production.
Nasal corticosteroid sprays to reduce inflammation of nasal mucosa and is best used just before exposure to the allergen and taken regularly.
Allergen immunotherapy is a long term treatment and works to increase the immune system’s tolerance to the allergen.
Acupuncture treatment has shown promising results in symptom relief and is a safe and well tolerated option.

Long term holistic treatment aims

Support healthy immune system function
Provide mucosal membrane support for inflamed nasal inner lining

Nutritional and herbal recommendations
Vitamin D	Ensure adequate levels of vitamin D and supplement if needed
Vitamin C	Ensure a diet rich in vitamin C Foods high in vitamin C: broccoli, brussel sprouts, citrus fruit, peppers, pineapple, paw-paw and blackcurrant
Quercetin	A dietary flavonoid, might display antiallergic effects Foods high in quercetin: red wine, tea, onions, kale, tomatoes, broccoli, green beans, asparagus, apples and berries
Bromelain	An enzyme found in pineapple, has an anti-inflammatory effect and is used for hay fever
Albizia	Albizia is used in Ayurvedic medicine for its anti-allergic activity

Seek Medical Care

Treatment recommendations should be carried out concomitant to, and not replace medical treatment. Please consult your medical doctor for advice with compatibility of nutritional/herbal recommendation and any medicine you take.

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