Hay Fever (Rhinitis) | Symptoms & Treatment

Hay Fever

As hay fever (pollen allergy, seasonal allergic rhinitis) denote physicians hypersensitivity of the immune system proteins of different plant pollen. This affects around 15 per cent of people in the USA. A stuffy, runny, itchy nose and red, itchy eyes are the main symptoms of hay fever. Read more about the symptoms, causes and treatment of hay fever here.

Hay fever: description

According to the allergy information service, 15 per cent of people in the USA suffer from hay fever. It is the most common form of allergy. As with all allergies, the body’s immune system reacts excessively to actually harmless substances with hay fever – but not to hay, as the name suggests, but to proteins from plant pollen in the air (such as grass and tree pollen).

That is why hay fever is also referred to as pollen allergy, pollinosis or seasonal allergic rhinitis (seasonal allergic rhinitis, allergic rhinitis). “Seasonal” because the various pollen that can trigger hay fever is not present in the air all year round, but only when the respective plants are in bloom. So the hay fever complaints only occur in certain months of the year.

Hay fever: symptoms

People without hay fever can often hardly imagine how stressful the symptoms of a pollen allergy actually are: The itchy, watery eyes and the violent sneezing attacks with runny nose significantly limit the quality of life of those affected.

In addition, after a few years, allergic asthma also develops due to hay fever. Doctors also refer to this process as changing floors, as the symptoms from the upper airways spread deeper into the respiratory tract ( lungs and bronchi ).

You can read everything you need to know about the typical signs of hay fever in the article Hay fever symptoms.

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Hay fever: causes and risk factors

As with all allergies, the symptoms of hay fever (pollen allergy) are caused by an excessive reaction of the immune system: the body’s defences wrongly classify the harmless proteins as dangerous and fight them like a pathogen:

Certain immune cells – the so-called mast cells – release inflammatory messengers (histamine, leukotrienes) when they come into contact with the pollen proteins, which then cause the typical hay fever symptoms. These show up in the area of ​​the eyes, nose and throat because this is where the pollen proteins enter the body via the mucous membranes.

How does the dysregulation of the immune system arise?

The processes involved in the development of pollen allergies have now been well researched. But what triggers hay fever, in the end, can only be guessed at. Some risk factors are likely to contribute to the development of hay fever:

Inheritance Some people are more prone to allergic reactions than others. The allergic reaction is genetically determined and is called atopy. It is inheritable. However, this does not mean that every child from allergy parents also becomes an allergy sufferer themselves; only the risk is increased, as the following comparison shows:

  • If no family member is allergic, children have an allergy risk of around 5 to 15 percent.
  • If a parent or sibling is allergic, the risk is around 25 to 30 percent.
  • If both parents are allergic, there is a 40 to 60 percent chance that the child will also develop an allergy.
  • If both parents have the same allergy, the child’s allergy risk is around 60 to 80 percent.

And: Those who are prone to allergies often don’t have just one. Atopic dermatitis patients are often prone to hay fever, and many pollen allergy sufferers cannot tolerate animal hair.

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Excessive hygiene

In the development of an allergy (hay fever, etc.), the extent to which the immune system is challenged during childhood may also play a role. The so-called hygiene hypothesis assumes that the body’s defences are insufficiently challenged in childhood with very pronounced hygiene and, therefore, also take action against harmless substances at some point.

For example, children who grow up with siblings or who attend a day nursery suffer less often from allergies later, as observations show. Children who grow up in a rural setting (for example, on a farm) also have a lower risk of allergies. The contact with many other people (other children) or with “dirt” could be a “training” for the immune system, while excessive hygiene undermines the immune system and thus promotes the development of an allergy.

Tobacco smoke and other air pollutants

Substances in the ambient air that irritate the respiratory tract (fine dust, cigarette smoke, car exhaust fumes, etc.) can contribute to the development of allergies (hay fever, etc.) and asthma. Children who grow up with parents who smoke have a greatly increased risk of developing asthma, hay fever or other allergies later.

But even smoking during pregnancy is dangerous for the child, as the ingredients in tobacco smoke can lead to numerous malformations and developmental disorders (for example, in the lungs). An expectant mother should, therefore, never smoke during pregnancy. Later on, smoking in the presence of the child should generally be taboo.

More and more people suffer from hay fever.

Around 15 per cent of people in the USA already struggles with hay fever (pollen allergy). Experts from the allergological societies in USA suspect that this number will continue to rise: every second person could be sensitized to at least one type of pollen by 2050.

Researchers at the Center for Allergy and Environment (ZAUM) at the Technical University in Munich see an important reason for the increasing frequency of hay fever in climate change: the rising temperatures around the world are significantly extending the pollen season of many plants. The higher carbon dioxide (CO 2 ) content in the air also stimulates the plants to release even more pollen than before. In addition, the warmer temperatures make it easier for “foreign” plants to spread in USA. This applies, for example, to ragweed (ragweed) from the USA: around mid-August to mid-September, it releases highly allergenic pollen, which is the main cause of allergies (such as hay fever) in the USA.

Air pollution from fine dust or ozone pollution also leads to pollen proteins triggering even more violent reactions. Researchers at the Max Planck Institute for Chemistry in Mainz assume that birch pollen, for example, is two to three times more aggressive due to a chemical reaction with ozone (O 3 ).

Hay fever: examinations and diagnosis

The right person to contact if you suspect hay fever (pollinosis) is a doctor with the additional qualification “Allergology.” These are mostly dermatologists, ear, nose and throat (ENT) doctors, pulmonologists, internists or paediatricians who have completed additional training as allergists.

Initial meeting

During the first visit, the doctor will first take a detailed discussion of medical history ( anamnesis ). Usually, he can already assess whether it is hay fever based on the description of the symptoms. Possible questions from the doctor could include:

  • What complaints do you have?
  • When exactly do the symptoms occur, i.e., at what time of day and time of year?
  • Where do the symptoms occur – outdoors or only indoors?
  • Do you already have any allergies?
  • Do you have neurodermatitis or asthma?
  • Do your parents or siblings have allergic diseases such as asthma, hay fever or neurodermatitis?
  • Where do you live (in the country, next to a busy road, etc.)?
  • Do you take medicine?
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The doctor can determine with relative certainty whether it is hay fever by simply speaking with the anamnesis. Finding the triggering allergen, however, is sometimes very difficult and is like detective work. The first step is to take a look at the pollen calendar. The times when the various plants usually release their pollen are listed there: For example, anyone who has typical hay fever symptoms as early as January is likely to be overly sensitive to the pollen of alder and / or hazel.

Further investigations

Various diagnostic tests are available to identify the type or types of pollen that someone is allergic to. The examinations include skin tests, provocation tests, and, if necessary, a blood test for antibodies against pollen proteins (IgE antibodies). Three days before a skin test and provocation test, the patient should no longer take medication that suppresses allergic reactions (for example, cortisone or antihistamines). Otherwise, the test result will be falsified.

Prick test: The doctor or a helper pricks lightly into the patient’s skin with a fine needle and drips various allergenic solutions (e.g., with proteins from birch pollen, hazel pollen, etc.) onto these small wounds. After a certain period of time, he examines the skin’s reaction and can see which allergens have caused an allergic reaction (such as reddening of the skin).

Provocation test: the doctor applies the suspicious substance into the nose, onto the bronchial or conjunctival mucosa of the patient. If the reaction is positive, the mucous membranes swell, and symptoms arise. This test can lead to further, sometimes severe allergic reactions (up to anaphylactic shock ), which is why the patient should then remain under medical supervision for at least half an hour.

Blood test for antibodies: The “RAST” test can be used to examine whether certain antibodies (specific immunoglobulins IgE) against pollen proteins are present in the patient’s blood. The more such antibodies against pollen protein circulate in the blood, the stronger the allergic reaction.

Hay fever in children

Hay fever can also occur in babies and young children. Usually, the doctor refrains from performing a skin test and provocation test, as both are uncomfortable for the children and the offspring usually resist it vehemently.

Hay fever during pregnancy

Even with hay fever during pregnancy, the doctor should avoid a prick test and a provocation test because of the potential allergic overreaction (anaphylactic reaction)

Hay fever: treatment

The doctor has several options for treating a pollen allergy. Many patients are given medication to relieve the symptoms of hay fever. These include, for example, antihistamines. They are available as nasal sprays and tablets.

Another way of treating hay fever is desensitization. One tries to gradually get the person’s immune system used to the pollen proteins.

You can read more about the various treatment options in the article Hay fever therapy.

Prevent hay fever symptoms

The safest method of avoiding hay fever symptoms in the first place is – in addition to specific immunotherapy – to avoid pollen. However, this is not that easy, especially since these float hundreds of kilometers through the air and can therefore trigger hay fever even if the plants in question are not even blooming at home. However, the following tips can help:

Travel: Those who have the opportunity should travel during the pollen season of “their” plants to areas where the plants in question are not yet or no longer blooming. Alternatively, pollen allergy sufferers can drive to regions in which these plants are not found at all, such as in high mountains at altitudes above 2,000 meters, in coastal areas or on islands. There is a general lack of pollen there.

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Ventilate only at certain times: In rural areas, the pollen concentration is highest between four and six in the morning, which is why people with hay fever should only ventilate in the evening between 7 and midnight. It is the other way around in the city: there the pollen concentration is lowest in the morning between six and eight o’clock, which is why the city should be ventilated in the morning hours.

Attach a pollen screen to the window: A pollen screen looks similar to an insect net. However, it not only keeps flies and mosquitoes away but, above all, prevents pollen from entering the living space. Especially for hay fever patients who like to sleep with the window open, a pollen guard on the bedroom window is recommended.

Keeping the bedroom pollen-free: If you take off your street clothes in front of the bedroom and wash your hair before going to bed, you will prevent pollen from spreading in the bedroom. Freshly washed laundry (such as bed linen) should not be dried outside if possible, as otherwise, pollen could adhere to it.

Free-living space of pollen: Hang a wet towel in the apartment; the pollen will stick to it. In addition, daily vacuuming and regular dusting are advisable in the pollen season to remove the pollen from carpets and furniture. However, hay fever patients should leave the sucking to someone else and not be present during this time, as the pollen is stirred up. Alternatively, those affected can get a special fine dust mask from the hardware store (so-called FFP3 fine dust mask) for this housework.

Pay attention to the pollen forecast: There are now numerous ways to find out about the current pollen count, similar to the weather. Radio, newspapers and above all, the internet (pollen count app!) Offer regular pollen forecasts for your own region. On days with high levels of pollen, hay fever patients should avoid physically strenuous activities as far as possible. It is possible that those affected need more medication if they have a high pollen count.

Get a pollen calendar: A pollen calendar (see above) provides hay fever patients with an approximate orientation when to expect symptoms. This can be very useful for vacation planning, for example. Pollen calendars are also available free of charge in almost all pharmacies.

Pollen protection when driving: In the car, people with pollen allergies should switch off the ventilation and keep the windows closed. In many car models, it is also possible to retrofit the ventilation system with pollen filters. This is a worthwhile investment in the case of severe hay fever, as uncontrollable sneezing attacks while driving has a severe negative impact on road safety.

Rain instead of the sun: Rain reduces the pollen concentration in the air. People with hay fever should, therefore, rather use rain showers and the time shortly afterward for walks.

disease course and prognosis

Many people affected have hay fever relatively early, i.e., in childhood or adolescence. Ultimately, however, it can appear for the first time in any phase of life.

The pollen allergy usually lasts for a lifetime and usually increases in intensity without treatment. Above all, the change of floor, i.e., the expansion of the pollen allergy to the airways up to allergic asthma, is a problem here. With the right therapy, however, the symptoms can be significantly alleviated, and possible complications with hay fever can be prevented.

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