Hay Fever

Hay Fever is a term used to describe an allergic reaction involving the upper respiratory tract resulting from inhaling in an airborne allergen. Common symptoms of the allergic reaction involve sneezing, runny nose, nasal congestion, and itchy, watery eyes. The immune system is producing these symptoms to expel the allergen (sneezing, watery eyes, and runny nose) and to prevent more of the allergen from entering the body (increase mucus production and swelling of the nasal passages).

A more accurate name for hay fever is Allergic Rhinitis. The word rhinitis comes from the root word rhino, meaning nose. Rhinitis more accurately describes the irritation of the nasal lining and the swelling of the nasal passages.

Airborne Allergens

There are many different kinds of allergens that people can become allergic to. Allergic rhinitis refers to airborne allergens that are inhaled. This reference to airborne allergens can be indoors and outdoors and also includes seasonal and year-round allergens.

Seasonal hay fever
The season of hay fever depends on the type of allergen that you are allergic to.

1.) Pollen: Pollen allergies (sometimes called pollinosis) are caused by three main types of pollen.

• Trees: Spring
• Grass: late spring and early summer
• Weeds: late summer through autumn

2.) Mold: Mold allergies are caused by the mold spores that the colony produces. The function of the spores is to reproduce for the colony just like pollen reproduces for the plants.

Hay fever lasting all year long
Perennial hay fever does not have a season. The allergic reaction will occur when you come in contact with the allergen.

1.) Dust mite debris: Dust mite allergies are caused by their fecal waste matter, the cast skin (shed skin) and the decaying body parts from dead mites.

2.) Cockroach debris: Cockroach allergies are caused by the cast skin, secretions, saliva, eggs, the waste product, and parts from dead and decaying cockroaches.

3.) Pet protein: Pet allergies are caused by a protein found in the dander (skin flakes), the saliva, and the urine.

4.) Mold Spores: Indoor mold is usually referred to as mildew.

The Allergic Reaction

Our bodies have a highly complex system called the immune system to defend against foreign invaders. Bacteria and viruses are just a few of the many outside invaders that it will seek out and destroy in the fight against infection and disease. In these instances, the antibodies work quite well.

It is not quite fully understood why the immune system will launch an attack against a harmless substance like pollen or house dust. An attack is launched by cells releasing a flood of inflammatory chemicals called allergy-mediators. Normal amounts of these chemicals do not bother us. But too much production, as in the case of an attack, causes discomfort and irritation. Symptoms develop that are known as having allergic rhinitis.

The allergic reaction can be broken down into four general steps:

STEP 1: Inhaling the allergen: There are many different particles that we inhale as we live our lives. These non-self particles are called antigens. If the foreign particle is known to cause an allergic reaction, it is called an allergen. Different types of pollen, mold spores, dust mite droppings and pet dander are all examples of known allergens that cause hay fever.

These airborne particles find the front line of defense in the nose. The body can trigger a sneeze or cough to force out the foreign object. The body can also produce more mucus which can carry the foreign particle to the back of the throat where it can be swallowed or coughed out.

If the foreign object survives this, it makes its way through the walls of the nasal passageway. It reaches the layer where B cells and T cells lie in wait for any foreign invader that made it through the body’s front line of defense.

STEP 2: Detection of the foreign object is the second step in the process. The immune system has a remarkable ability to distinguish between substances that are foreign and substances that belong to self. But here is where the immune system acts differently between people who have hay fever and people who do not. For those who do not have hay fever, these substances such as pollen, dust mite droppings, and pet dander are seen as a harmless substance. There is no need to sound an alarm. For those who have allergies, however, the immune system sees these substances as a foreign invader. The immune system reacts.

White blood cells, called B cells are signaled to begin the immune response by telling the plasma cells to produce antibodies. The type of antibodies produced in the case of hay fever is Immunoglobulin E (IgE). This is one of the distinguishing differences between immune systems that are prone to allergies and immune systems that are not. Those who have hay fever carry about 10 times as much IgE antibodies in the blood compared to those people who do not have hay fever.

The IgE antibody is very unique and has a very specific target. One type of IgE antibody is made for dust mites while another type would be made for cockroach allergens. Once the correct kind of IgE antibody is produced, they attach themselves onto mast cells and basophils. Mast cells are tissue cells found at the ports of entry of the body and basophils are blood cells that circulate around in the blood stream.

With the IgE antibodies now produced and attached to the mast cells, the immune system is now said to be sensitized. The IgE antibody is waiting for contact with the specific allergen that it was made for. Sensitization requires being exposed to an allergen over time. Some people think that their allergy symptoms developed with first contact. But they had to be exposed prior, to have the build up of IgE antibodies attached to mast cells to develop hay fever symptoms.

STEP 3: The attack: The next time that there is exposure to the same allergen, the IgE antibody attached to the mast cells captures it and marks it for destruction. This activates the mast cells. These cells put out as many as 30 chemicals.

This process of mast cells and basophils releasing their chemicals is called degranulation. Mast cells are designed for a quick response. They burst open, spraying out histamine which is their first defensive substance against the allergen.

The inflammatory chemicals put out by the mast cells are what hay causes hay fever symptoms such as:

• fluid leaking from cells
• dilation of blood vessels making them abnormally permeable
• smooth muscle contraction
• swelling of tissues
• excess mucus production
• nasal congestion
• sneezing
• itching
• irritation
• runny nose
• red, itching, and watery eyes

STEP 4: After the attack: When there is no longer exposure to the allergen, the cells and inflammatory chemicals causing the hay fever symptoms will slowly fade away. Some of the activated B cells will become memory cells. As a result, not many of these cells need to remain behind and stand watch. The next time that the same allergen is detected, these cells will be ready to respond quickly.

Who is at Risk?

It is not known for sure why some people develop hay fever and others do not. People react to allergens in different ways. Scientist now believe that heredity plays a role in developing allergies. Atopy is the word to describe the condition of having a family history and a genetic predisposition to develop allergies. But just because you have the genes from your parents to have a tendency to develop allergies does not mean that you will automatically develop allergies. There is still a lot that is just not known. Research has not yet shown why some people develop hay fever and others do not. Some people can go for years before developing symptoms to the family pet that they just brought home, while others can develop symptoms right away.

Genetics: Scientist believes that your family history might be one of the most important factors. You inherit your genes and your tendency to develop allergies from your parents. Even though you have a higher likelihood of developing allergies, it is not to a specific allergen or a specific allergy. The mom, for example, may be allergic to ragweed and the child can become allergic to dust mites. Inheritance may increase the likelihood but environment may play a role in what allergen you become allergic to.

Environment: The environment of an individual, particularly while they are young, seems to play a role in developing allergies. Variables such as second hand smoke, strong perfumes, air pollution, strong chemicals, and other irritants can increase the likelihood of developing allergies. Homes are built much better today than how they were built in the 1960’s and 1970’s. They are more draft-proof and sealed up better. This causes a higher concentration of irritants and allergens in the air and exposure to them are for longer periods of time. This increase exposure for a longer period of time can stimulate the immune system to make too many IgE antibodies. Furthermore, this increase exposure makes people even more vulnerable during times of illness when the immune system is in a weaken state.

You may not be able to do anything about the genes you inherit; however, there are steps you can take to address your environment and exposure levels. They all contribute together in playing a role in who develops hay fever and who does not.

Allergy or a Cold?

Many of the hay fever symptoms resemble the condition of someone coming down with a cold or flu. It is important to be able to distinguish between the two so that the right hay fever treatment plan and/or medication is obtained. Talk to your doctor about the signs and symptoms that you are experiencing so that you will know the difference between cold or hay fever.

Hay Fever Treatment

The three most common forms of hay fever treatment are;

1. drugs
2. immunotherapy
3. avoidance

1. Drugs

Drugs are an option for hay fever treatment. Caution must always be observed when considering this option. All drugs have the potential for side effects. Furthermore, what plan of action you take depends heavily on your current health condition. For example, you may take a decongestant to relieve nose symptoms. Before doing so, you need to know that a decongestant can increase your heart rate. If you have high blood pressure, a decongestant could make your condition worse!

Always consult with a professional first before beginning a drug treatment plan because:

• Drugs can interact with other medications and have adverse effects.
• What medicine you should take depends on your health condition.
• Using the medication correctly with the correct dosage is extremely important.
• It may require a combination of medications to produce the desired results and this should only be done under the supervision of a doctor.

Below is general information for you to be aware of as you consult with your physician. Five popular options are:

• Antihistamines
• Decongestants
• Nasal Corticosteroids
• Leukotriene Modifiers
• Cromolyn Sodium

Antihistamines: Short acting antihistamines are available over-the-counter. They are mostly used for mild to moderate symptoms. Over-the-counter antihistamines tend to cause more drowsiness than prescription medication. Prescription antihistamines are usually longer acting. Antihistamines fall into two categories; First Generation and Second Generation. The first generation is usually cheaper. They cause more drowsiness, have more side effects, cause dry mouth, and other difficulties. The second generation of antihistamines has been improved. They cause less drowsiness and have fewer side effects. They are longer acting. As a result, they are more expensive.

Antihistamines can work in one of two ways. They can inhibit the release of histamine from mast cells or they can block the receptors for histamine once the histamine has been released. Histamine is one of the major inflammatory chemicals released causing sneezing, nasal discharge, itchy eyes, and runny nose. By reducing the histamine and competing with the histamine at the receptor sites, antihistamine blocks the action of histamine thereby reducing the symptoms.

• Advantages
• Allows less histamine released from the mast cells
• Blocks the receptor sites so the histamine cannot produce the symptoms
• Been around for a long time and proven
• Disadvantages
• Has less of an effect on congestion
• Can cause drowsiness, dry mouth, blurred vision, and other side effects

Decongestants: Available over-the-counter and also by prescription. They come in many forms. The purpose of a decongestant is to reduce nasal congestion. It works by shrinking the blood vessels in your nose. This results in less fluid leaking out into the lining in your nose which causes the stuffiness. By reducing and drying the nasal congestion, breathing becomes easier.

• Advantages
• Dries up the mucus in your nose
• Temporarily relieves the stuffiness in your nose
• Shrinks the blood vessels in your nose thereby clearing the congestion and improving the breathing
• Disadvantages
• Can raise blood pressure
• Helps the symptoms but does not address the cause
• Problems can develop if you take decongestants too long
• Only short term nasal allergy relief
• Side effects may include nervousness, insomnia, and rapid pulse to name only a few

Nasal Corticosteriods: Used for moderate to severe symptoms. It functions as both a treatment and prevention. Nasal corticosteroids are usually used when most of your symptoms are primarily in the nose. The nasal form works well at putting the medicine where you need it. This is better than the pill form where the drug would have to travel throughout your body to reach the effected areas.

• Advantages
• Works as a treatment. As an anti-inflammatory drug, it counteracts the effects caused by histamine
• Works as a prevention. Histamine is released from mast cells and nasal corticosteroids reduce the number of mast cells in the nose
• Very effective for hay fever
• Reduces mucus production
• Disadvantages
• It can take up to a week for you to benefit from the full effect
• Does not address the eye symptoms caused by hay fever
• May cause a dry or burning sensation in the nose
• May have other side effects

Leukotriene Modifiers: Available only by prescription. Leukotriene is another inflammatory chemical released by the mast cells in the nose along with histamine. Leokotriene modifiers block the action of leukotriene that is released. It also helps blocks the release from the mast cells. People who have asthma may see benefits since leukotrienes can irritate the smooth muscles in the airways.

• Advantages
• Considered mild to use
• Used when nasal sprays cannot be tolerated
• Prevents swelling of the airways
• Relatively few side effects and well tolerated
• Disadvantages
• Side effects are minimal, but can include headache, dizziness, nausea, and abdominal pain
• Expensive
• Not effective for moderate to severe symptoms
• Less effective than nasal corticosterioids for hay fever

Cromolyn Sodium: A mast cell stabilizer and prevents the release of histamine from the mast cells. Cromolyn Sodium is used for mild allergies. It is most effective when trying to prevent symptoms rather than trying to address the symptoms once they occur.

• Advantages
• Reduces the symptoms caused by hay fever
• Addresses both the nose and eye areas
• Side effects are usually short lived
• Disadvantages
• Not as effective for more severe symptoms
• May take a couple of weeks of use to experience the full effect
• Used multiple times during a day

To learn more about different kinds of drugs for allergies, the American Academy of Allergy Asthma & Immunology provides an Allergy and Asthma Drug Guide.

2. Immunotherapy

Immunotherapy is another form of hay fever treatment. Allergy shots (sometimes called desensitization or hyposensitization) can be thought of like a vaccination against allergies. Immunotherapy works on the same principle as immunization against the flu. Allergy shots seem like a contradiction. That is, to develop immunity and tolerance by being injected with the very substance that you are allergic to. But by being injected with a dose large enough to stimulate the immune system and small enough to not cause a big allergic reaction, the immune system can build up a tolerance to the substance by reducing the strength of the IgE response.

The Goal
The goal of immunotherapy is to become less sensitive to the allergen that you are allergic to. The objective is to build up tolerance with the result of reducing the signs and symptoms of the allergy. By achieving this, the need for medication becomes less.

Candidates
People most likely to choose allergy shots are those who suffer from perennial allergic rhinitis and experience symptoms all year long. Others with seasonal allergies choose allergy shots if they experience severe symptoms and not getting the relief that they are looking for from medication. Some people don’t like the idea of taking drugs indefinitely and look to allergy shots as an alternative.

The Injections
There is a commitment of time and money for those who choose immunotherapy as a form of hay fever treatment. Injections begin with a weak purified extract of the allergen that is causing the hay fever. It is just enough to affect your immune system but not enough to cause a significant reaction. As your body gets use to the injections, the strength of the solution is gradually increased. As the dose becomes stronger and stronger, this is called the “build up” stage and can last up to 6 months or longer.

Everybody is different and may be in the build up stage for a different period of time. But at some point in time, the maximum level will be reached. Allergy shots at this level are called the “maintenance” stage and can last for 3 to 5 years. Whether the injections are given every other week or once a month depends on the patients’ progress.

Limitations
Even though there has been some great success stories using immunotherapy as a form of hay fever treatment, there are also some limitations that should be discussed with your allergist.

Understand that immunotherapy is not a guarantee for complete protection. And it is not available for all kinds of allergies. Some medications can interfere with the treatment so make sure your allergist knows about what drugs you are taking.

Skin tests are not always 100% accurate. And sometimes not every single allergen that you are allergic to is identified. So obviously, allergy shots are not going to help if it does not address all or the correct kind of allergens. The effectiveness will depend on the severity of your hay fever symptoms and the number of allergens that you are allergic to.

Being given allergy shots does not help everyone to improve. Eighty to ninety percent is a closer number of the people who will benefit from immunotherapy. But if you are in that minority, it is time and expense wasted for those who show no signs of improvement.

It is rare for people to experience a severe allergic reaction to the injection but that does not mean that it never occurs. If it does occur, immediate medical attention will be needed. For this reason, immunotherapy should only be administered by a board certified allergist. As a safety precaution, there is a waiting period between the time that you receive the injection and the time that you are allowed to leave.

Summary
Immunotherapy is an effective and viable option in the fight against hay fever. But remember, it is a treatment and not a cure. It works well for most but not all. For those who it does work well for must have a commitment to it. Like any treatment or drugs, there are risk factors to consider.

3. Avoidance

There is no dispute that avoidance is the best “medicine” and should be part of every hay fever treatment plan. The concept is simple: avoid the very thing that causes irritation, allergy symptoms, or reduces the quality of life.

There are many avoidance tips for allergies. To find out, click on;

• Avoid Dust Mite Allergies
• Avoid Pet Dander Allergies
• Avoid Cockroach Allergies
• Avoid Mold Allergies
• Avoid Pollen Allergies

Avoidance often requires a lifestyle change. If you are allergic to cats, don’t allow the cat into your bedroom. If you are allergic to mold or dust mites, don’t allow the humidity to build up in your home. Clean your home more often using a HEPA filter if your symptoms are coming from indoor allergens.

Avoiding the substance and utilizing environmental controls is the most natural, cost effective and least invasive hay fever treatment strategy that you can implement.

The strategy is simple and involves three steps;

STEP 1: Identify the allergen that is giving you problems. In most cases, people are allergic to more than one. Pay attention to the circumstances in which you develop allergy symptoms.

STEP 2: Learn how to avoid the allergen that is giving you problems. If you are allergic to pollen, you may not be able to avoid exposure but you can learn how to minimize your exposure. Step 2 would involve learning that pollens are released in the mornings so that mornings would be a good time to stay indoors. There is less pollen after a rain and that would be a good time for outdoor chores.

STEP 3: Allergy Proof Your Home. Start with one room and make it an oasis from your allergens. For most people, the bedroom is the best room to start in. Small changes can make a big difference. If you are allergic to dust mites, just by encasing your bedding with allergen impermeable material will make a huge difference. Move on to other rooms as it is appropriate for you.

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