Hay fever, which is also called allergic rhinitis, is a common allergic condition. A main feature of the condition is an inflammation of the nasal passages, or rhinitis, caused by an allergic reaction to pollen. Hay fever usually occurs when airborne plant pollens are at their highest levels in the spring, summer, and early fall.
Hay fever is one of the most common chronic diseases in the United States. It is estimated that about 35 million people in the United States are affected. Hay fever can develop at any age, but it shows up most often in childhood through the early 20s. The term “hay fever” is not quite accurate, since the pollen of hay grasses is only one of the many possible allergens involved, and there is no fever. Although an allergy to pollen does not appear to be inherited, the tendency to allergic sensitivity in general may run in families.
Causes & symptoms
Of all the causes of allergies, pollen is one of the most widespread. Trees, weeds, and grasses produce pollen in large amounts for seed production. These pollens are dispersed by the wind, and many never reach the intended targets. Instead, they are inhaled through the nose and throat. Different plants release their pollen at different times of the year, so the timing of hay fever symptoms varies from person to person, depending on which plants provoke a response.
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For people with hay fever, inhaled pollen grains are identified by the body as foreign invaders. This is probably due to a dysfunction in the immune system. The mast cells of the immune system act as storage containers for highly reactive chemical granules, including histamine.
Allergens trigger a release of these granules, and the mast cells spill their chemicals into neighboring blood vessels and nerve cells. Histamine dilates the blood vessels, causing fluids to escape into surrounding tissues. This results in swelling, pooling of fluid in the tissues, and redness of the nose and eyes. Histamine also stimulates pain receptors, and causes the itchiness and discomfort of the nose, eyes, and throat that are common hay fever symptoms.
Inflammation of the nose, or rhinitis, is the major symptom of hay fever. Inflammation causes itching, sneezing, runny nose, redness, and tenderness. Swelling of the sinuses can constrict the eustachian tube that connects the inner ear to the throat, causing a feeling of congestion and popping in the ears. Mucus from the sinuses may run down the back of the throat, leading to throat irritation and redness.
Seasonal fatigue and sinus headaches may also be indications of hay fever, as well as respiratory congestion and a decreased sense of smell. Severe allergies can lead to dark circles under the eyes, puffy eyelids, and creases under the eyes. Characteristically, children with hay fever may push their noses upward with the palm of their hand or twitch their noses to clear the congestion.
Virtually any type of tree or grass may cause hay fever, although plants with showy flowers usually produce a sticky pollen that is much less likely to become airborne. Among North American plants, weeds are the most prolific producers of allergenic pollen.
Ragweed is the major culprit, but other plant pollens that routinely affect hay fever sufferers include sagebrush, lamb’squarter, Russian thistle, and English plantain. Grasses include timothy grass, Kentucky bluegrass, Johnson grass, Bermuda grass, redtop grass, orchard grass, and sweet vernal grass. Trees that produce allergenic pollen include oak, ash, elm, hickory, pecan, box elder, and mountain cedar.
Diagnosis
The diagnosis of hay fever is usually simple. A thorough history of the illness is important in diagnosing allergies, including whether the symptoms vary according to time of day or the season, and possible exposures. When symptoms always appear during a particular season and disappear with the onset of cold weather, hay fever is almost certainly the culprit.
For a more definitive diagnosis, a skin prick test is used, in which a diluted extract of the suspected allergen is injected superficially or scratched into the skin and the reaction is observed. Another test is a provocative challenge, which is performed by putting an extract of the suspected allergen onto the conjunctiva of the eye or in the nose or lungs.
When such direct skin testing is not possible, various methods of testing the blood may be used. Other conditions causing rhinitis, such as infection, may have to be ruled out by a nasal smear, in which a sample of mucus is taken on a swab for examination.
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Treatment
Alternative treatments for hay fever often focus on modulation of the body’s immune response. They frequently center around diet and lifestyle adjustments. A healthy diet high in fiber and whole foods, including generous amounts of vegetables, grains, nuts, and raw seeds should be maintained. Plenty of fluids should be consumed. Six to eight glasses of water daily are recommended, along with plenty of herbal teas.
Raw vegetable juices are also beneficial, particularly carrot, celery, beet, cucumber, spinach, and parsley. Meat, dairy, and foods high in saturated fats may aggravate a hay fever condition, and should be limited in the diet. It is also best to avoid dairy products, wheat, eggs, citrus fruits, chocolate, peanuts, shellfish, food colorings, and preservatives, especially sulfites. These are all common food allergens that may worsen hay fever symptoms. Caffeine, alcohol, tobacco, and sugar should be avoided, as well.
Beneficial supplements for treating hay fever include vitamins A, E, and B complex. Vitamin C, especially the buffered type, is a natural antihistamine. In substantial amounts it can help stabilize the mucous membrane response to allergens. Bioflavonoids prevent the release of histamine, and can be taken in combination with vitamin C. Essential fatty acids, contained in evening primrose oil, fish oil, or flaxseed oil, are also recommended as a daily supplement.
Glutathione peroxidase is an enzyme that blocks a key inflammatory reaction in the hay fever cycle. It can play a key role in neutralizing the allergic reactions of hay fever. Selenium is a trace mineral that may help stop the inflammation due to allergens and reduce other allergy symptoms.
For symptom relief, nettles (Urtica dioica) have been reported to have the ability to clear the sinuses and to greatly reduce other symptoms. Tincture of licorice (Glycerrhiza glabra) is also recommended. A good tincture combination for hay fever is comprised of equal parts of black cohosh (Cimicifuga racemosa), Chinese skullcap (Scutellaria baicalensis), pleurisy root, orbutterflyweed (Asclepias tuberosa), catnip (Nepeta cataria), and cayenne pepper (Capsicum frutescens).
Other western herbal remedies herbs found to be effective include ginger root (Zingiber officinale), eyebright (Euphrasia officinalis), goldenseal (Hydrastis canadensis), ephedra, horseradish (Amoracia rusticana), and mullein (Verbascum thapsus). Bee pollen may also be effective in alleviating or eliminating hay fever symptoms. Bee pollen should be taken a few months before the hay fever season starts. It desensitizes the body and can dramatically reduce hay fever symptoms.
Acute attacks of hay fever often respond to homeopathic remedies. Possible hay fever remedies include Allium cepa, Arsenicum album, euphrasia, Ferrum phosphoricum, gelsemium, Natrum muriaticum, Nux vomica, sabadilla, and wyethia, depending on the associated symptoms. Since hay fever is often associated with deep-seated health problems, it is often best addressed with a constitutional remedy and the guidance of an experienced homeopathic practitioner.
Indoor allergens can cause increased sensitivity to outdoor allergens. Therefore allergy testing for allergens other than pollen should be done, and those allergens should be removed from the diet or the environment to the greatest extent possible.
Allopathic treatment
The goal of most medical approaches to hay fever treatment is reduction of symptoms. Avoidance of the allergens is best, but this is often not possible. When it is not possible, drug therapy is the major form of medical treatment used. Care should be taken, however, since a wide variety of antihistamines are available, and they all have potential side effects that impact function. These may include drowsiness, heart problems, and harmful interactions with other medications and medical conditions. The extended use of topical decongestants can cause rebound congestion that is worse than the original problem.
Antihistamines block the action of histamine. They are most effective when used preventively, before symptoms appear. Over-the-counter antihistamines are often sufficient to provide relief for hay fever symptoms. People with severe or frequent symptoms, however, may need stronger, prescription antihistamines. Azelastine, an antihistamine nasal spray, is effective and causes fewer side effects than oral antihistamines. When antihistamines do not relieve nasal symptoms, a nasal spray of cromolyn sodium is sometimes used. It works by preventing the release of histamine and similar chemicals.
Decongestants constrict blood vessels and counteract the effects of histamine. They may also be helpful in reducing symptoms such as nasal congestion. Nasal sprays are available that can be applied directly inside the nose. Oral decongestants are available as well. Phenylpropanolamine, phenylephrine, or pseudoephedrine are available in many preparations combined with antihistamines to increase the effectiveness of the drugs. Decongestants are stimulants and may cause increased heart rate and blood pressure, headaches, and agitation.
Corticosteroids may be prescribed to reduce severe symptoms. An intranasal corticosteroid spray can be quite useful in reducing inflammation of the mucous membranes. Severe symptoms that do not respond to other treatment may require a course of oral corticosteroids. Corticosteroids are best started before allergy season begins. They are especially effective because they work more slowly and last longer than most other types of medication.
Late in 2001, researchers reported the first of many new drugs that may change treatment of hay fever and asthma: omalizumab. A monoclonal antibody, omalizumab works by blocking immunoglobulin E (IgE), an antibody produced in excessive amounts in people suffering from hay fever.
Expected results
It is possible that hay fever can be outgrown if the immune system becomes less sensitive to the pollen. However, while hay fever may improve over time, it may also get worse or even lead to the development of new allergies. Hay fever treatment may sometimes cause uncomfortable and even dangerous side effects. However, most people can achieve acceptable hay fever relief with a combination of preventive strategies and treatment.
Prevention
There is no known way to prevent development of hay fever, but subsequent attacks may be reduced or prevented. Immunotherapy, also known as desensitization or allergy shots, involves injections of very small but gradually increasing amounts of an allergen over several weeks or months, with periodic boosters.
This serves to acclimatize, or familiarize, the body to encountering the allergen without having a major allergic response. Individuals receiving allergy shots will be monitored closely following each shot because of the small risk of anaphylaxis. Full benefits of the shots may take up to several years to achieve, and even then about one person in five does not receive any benefit from the immunotherapy.
Reducing exposure to pollen may reduce symptoms of hay fever. Most trees produce pollen in the spring, while most grasses and flowers produce pollen during the summer, and ragweed and other late-blooming plants produce pollen during late summer and early autumn. People with hay fever should be aware of their particular “pollen season” and remain indoors whenever possible during that time. A pollen count can be used as a general guide for when it is most advisable to stay indoors to avoid contact with the pollen. Unfortunately, moving to a region with consistently low pollen counts is rarely effective, since new allergies often develop to the local flora.
Further strategies to prevent or reduce hay fever attacks include the following:
- Remain indoors with windows closed during the morning hours, when pollen levels are highest.
- Car windows should be kept rolled up while driving.
- A surgical facemask can be worn when outside.
- Forests and fields of grasses should be avoided, especially at the height of the pollen season.
- Clothes and hair should be washed after being outside.
- Air conditioners or air filters should be used in the home, and their filters should be changed regularly.
