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Hay Fever Treatment

Hay fever affects 2 in 5 people in Australia and New Zealand. While it is often considered to be a trivial illness, untreated hay fever has a significant impact on mood, learning and work performance. Symptoms last for several years in most cases. Although there are no cures, effective treatment is available.

What is hay fever?

Hay fever is the common name for allergic rhinitis (from rhino meaning of the nose and itis meaning inflammatory) and allergic conjunctivitis (meaning allergic inflammation of the lining of the eyes). People with hay fever can also have problems with their throat and ears, and sinus infections are more common.

Substances called allergens trigger symptoms in people with hay fever. Symptoms occurring mainly in Spring and Summer are usually triggered by wind blown pollen from grasses, weeds or trees. When problems occur all year, they are usually triggered by house dust mite, animal dander or mould spores. Cockroaches only occasionally cause problems in Australia.

Hay fever symptoms

As well as sneezing, runny and blocked nose and irritated eyes, untreated hay fever can result in poor quality sleep, fatigue and daytime sleepiness.
Severe hay fever can also:

make asthma more difficult to control;
make people more prone to sinus infections;
impair learning and performance in children;
result in bad breath, a husky voice and sore throat;
make people tired and run down due to poor quality sleep;
worsen snoring and the tendency to have sleep apnoea in adults; and
result in more frequent eye infections because people rub itchy eyes.

Effective treatment is available

Although there is currently no cure for established hay fever, symptoms can be effectively treated and even prevented. Options include:

Avoidance of allergic triggers
Medication (topical and oral)
Non-medicated treatment
Immunotherapy

AVOIDANCE OF ALLERGIC TRIGGERS

It is best to avoid the cause or reduce exposure if possible. Neither medication nor immunotherapy
(allergy vaccination/desensitisation) are substitutes for reducing exposure to allergic triggers.

In some cases a cause may be obvious (eg pet allergy). In other cases it may be necessary to seek medical advice to help identify the offending allergen/s. To do this, doctors will ask you a series of questions and may use allergy tests (eg Skin Prick Tests or RAST blood tests) to identify the cause.

Once the cause(s) is identified, steps can be taken to minimise exposure or remove it. Some allergens such as pollen can be difficult to avoid.

NON-MEDICATED TREATMENT

However "natural" it may seem, you should inform your doctor or pharmacist of any "non-medicated" treatments (eg dietary supplements, herbs) you are taking. This is because they can sometimes cause side effects or interact with medications. It is important to note that alternative medicines have not been subjected to the rigorous study of effectiveness and side effects that conventional drugs undergo.

Steam and salt water (saline) sprays used on a regular basis can help to relieve nasal blockage and thick secretions.
Echinacea should be used with caution, particularly in people who are allergic to pollen, as several adverse reactions to echinacea have been reported.

DIET AND HAY FEVER

Diet has only a minor influence on symptoms in most people. The results from strict "elimination diets" are usually disappointing and may affect nutrition. Despite common mythology, there is no good evidence that "milk makes mucus", or that milk worsens either hay fever or asthma. Nasal symptoms may sometimes occur after eating hot or spicy food or alcohol. This is called "gustatory rhinitis". It appears to be a reflex phenomenon, resulting from stimulation of nerve endings that trigger glands to secrete more mucus. Anticholinergic (Atrovent) nasal spray is often effective, particularly if used before eating.

MEDICATION

Although medications do not cure allergies, those currently available are much more effective with fewer side effects than those used several years ago. You just need to know the best way to use them, and avoid medicines that can cause more problems than they solve, like decongestant ("unblocking") nose sprays. Your doctor or pharmacist can advise you about the best medicines to use to treat your symptoms.

TOPICAL MEDICATION - NASAL SPRAYS, EYE DROPS

Topical medications are applied directly to the part being treated. They include nasal sprays and eyedrops.

Corticosteroid nasal sprays (eg Rhinocort HayFever, Rhinocort, Nasonex, Budamax, Beconase, Allermax, Aldecin) have been shown to be very effective in preventing and treating hay fever, particularly in people with severe and prolonged symptoms, including nasal blockage, discharge, sneezing, nasal itch, post-nasal drip and eye symptoms. They are more effective than antihistamines when nasal congestion and mucus are major problems. They need to be used regularly as directed to be effective. Like corticosteroid "puffers" used in asthma, corticosteroid nasal sprays reduce inflammation, which is the cause of nasal blockage and other symptoms. Once symptoms have been controlled, the dose may be reduced, but the nasal spray will still need to be used regularly. If required, corticosteroid nasal sprays are safe to use long term, under medical supervision.
Antihistamine nasal sprays and eye drops - (eg Rhinolast, Livostin, Azep) are effective quickly (within minutes) in relieving sneezing or itching in both the nose and eyes.
Decongestant nasal sprays or drops provide quick relief, but should only be used in the short-term (up to a maximum of 5 days) to clear excessive nasal blockage. They may be used in this way before starting to regularly use corticosteroid nasal sprays. If used for longer periods they can cause damage.
Mast cell stabilising nasal sprays - (eg Rynacrom nasal sprays, Patanol eye drops, Opticrom eye drops, Lomide eye drops) reduce inflammation with regular use.
Anticholinergic sprays - (eg Atrovent aqueous) can help drippy noses.

ORAL MEDICATION

The most common oral medications taken for hay fever are antihistamine tablets.

Antihistamines help control sneezing and itching, but are not as effective for controlling severe nasal blockage and dribble. The advantage of antihistamines is their flexibility. They can be used as needed, regularly or to reduce or prevent symptoms when exposure to allergen is anticipated. The newer antihistamines (eg Zyrtec, Telfast, Lorastyne, Claratyne, Claramax) are significantly less sedating than the older antihistamines.
Decongestant tablets (Pseudoephedrine or Phenylephrine) - eg Sudafed, will unblock and dry the nose. Uncomfortable "stimulant" side effects like tremor, trouble sleeping, anxiety or an increase in blood pressure may occur in some people. Those with high blood pressure (hypertension) should not take these.
Combination drugs containing antihistamines and decongestants (eg Telfast Decongestant, Clarinase) provide greater symptomatic relief than antihistamines alone, particularly when nasal congestion is a major problem. As with decongestants, these can cause side-effects in some people.

IMMUNOTHERAPY

Immunotherapy is the closest thing to a cure for allergy. It involves the administration of gradually increasing amounts of allergic material, usually given to patients by injection over a period of years. These allergy injections alter the way in which the immune system reacts to allergens, by "switching off" allergy. The end result is that you become "immune" to the allergens, so that you can tolerate them with fewer or no symptoms.

Immunotherapy is often recommended for treatment of hay fever (and sometimes asthma) when:

symptoms are severe;
the cause is difficult to avoid (eg grass pollen); and
medications don't help or cause side effects.

ALLERGY PREVENTION IN CHILDREN

Allergies are often life-long and although treatable, are not curable. It therefore makes sense to try to prevent allergies in children.

In children with a strong family history of allergies it is suggested to breast feed infants (where possible), avoid exposure to environmental tobacco smoke, delay introduction of allergenic foods and minimise exposure to dust mites.

REFERENCES AND FURTHER READING

1. What is hay fever: http://www.allergy.org.au/content/view/119/133/

2. Allergen avoidance: http://www.allergy.org.au/content/view/187/126/

3. Allergy prevention in children: http://www.allergy.org.au/content/view/182/127/

4. Immunotherapy: http://www.allergy.org.au/content/view/148/128/

5. What is causing your allergy?: http://www.allergy.org.au/content/view/120/125/

6. Pollen allergy: http://www.allergy.org.au/content/view/132/131/

Disclaimer

ASCIA Education Resources (AER) information bulletins are peer reviewed by ASCIA members and represent the available published literature at the time of review. It is important to note that information contained in this bulletin is not intended to replace professional medical advice. Any questions regarding a medical diagnosis or treatment should be directed to a medical practitioner.

For further information on allergy, asthma or immune diseases, visit http://www.allergy.org.au/ - the web site of the Australasian Society of Clinical Immunology and Allergy (ASCIA). ASCIA is the peak professional body of Clinical Allergists and Immunologists in Australia and New Zealand.