HEALTH Managing hay fever

NO FUN IN THE SUN?Hay fever can knock the joy out of the warmer months.

Hay fever while the sun shines


Doctor's Insight
Dr Ronan Clancy

The weather has taken a very positive turn, and the long evenings of the summer have arrived. It’s heartening to see walkers, runners, cyclists and lawnmower-wrestling garden enthusiasts enjoying the fine weather! The only small price for this outdoor nirvana is hay fever (and the odd bee sting…).
Although generally not a serious condition in its own right, hay fever can be very bothersome, and for people with a severe form, it can knock the joy out of the warmer months.
Hay fever is the summertime manifestation of an allergic condition known as allergic rhinitis, which involves inflammation of the nasal passages, sinuses and eyes. In the dry summer weather, it is caused by airborne pollen and is referred to as seasonal allergic rhinitis.
When the membranes lining the nasal passages, sinuses and eyes are exposed to these airborne particles, a complex immune-system reaction occurs, and substances, such as histamine and other allergic mediators, are released. These substances cause the classic symptoms of hay fever: increased mucus production (clear runny nose), sneezing, itchiness of the nasal passages, nasal congestion where the passages and ducts in the nasal passages and sinuses swell and narrow, and itchy, gritty, sore and watery eyes.
Allergic rhinitis can also be caused by a wide array of triggers, such as dusts, animal dander, moulds, fumes and sensitivities to certain foods. When severe, the irritation of allergic rhinitis can also cause poor breathing during sleep and consequent daytime problems with tiredness and poor concentration. It can be associated with poor performance at school and work.
Interestingly, there is a strong association between allergic rhinitis and asthma, which is also an allergic disorder. In fact, up to 80 percent of asthmatics will have allergic problems involving the nose and sinuses, and people with allergic disorders of the nasal passages carry a 20 percent chance of developing asthma.
Diagnosis of both hay fever and allergic rhinitis is made taking symptoms into account and physical findings. A good response to anti-histamines supports the diagnosis. Allergy testing can be helpful in making a diagnosis and in establishing which allergens should be avoided.

What can you do?
While there are excellent medications to manage hay fever, there are many basic and practical measures to be taken.

• Stay indoors in the early morning and early evening
• Avoid smoking and smokers
• Sleep with the windows shut
• Shower and change your clothing after a day outside
• Dry bed clothes and clothing indoors
• Take holidays near the coast
• Avoid drying animals

What if it’s not hay fever?
It is important to point out that there is a host of other conditions that can mimic those of hay fever and allergic rhinitis. Examples include chronic rhinosinusitis, sinusitis, nasal polyps, deviation of the nasal septum and even tumours of the upper airways.
Symptoms that may suggest a cause other than hay fever/allergic rhinitis are green/yellow nasal discharge, post nasal drip (dripping sensation at back of throat), unilateral or one sided symptoms only, recurrent nose bleeds, loss of smell sensation, and pain in the face.

Medication
Anti-histamines and decongestant medications are the first-line agents for treating the classic symptoms of hay fever – ask your pharmacist about them.
If these measures are ineffective, if you have persisting symptoms or symptoms as above that may suggest an alternative cause, your GP should be consulted.
In the past, long-acting steroid injections were given with great success during the hay fever season. Unfortunately, these were withdrawn in the UK and then Ireland due to the potential long-term adverse side effects of potent steroid injections.
Nowadays, there are a number of different inhaler devices that administer small quantities of steroid to the nasal passages only. These are very effective, safe and come with excellent safety profiles when used appropriately. Others contain combinations of steroid and anti-histamine.
Other medications can be prescribed to modify the allergic response or treat specific or persisting symptoms.

Dr Ronan Clancy is a GP at the newly opened Clancy Medical Practice, James street, Westport (www.westportgp.ie). He is in practice with Sarah Kavanagh, chartered physiotherapist.