Everything about hay fever you need to know

Everything about hay fever you need to know.

Today we will discuss hay fever in detail. Going through this discussion it will help you to reduce the frequency and severity of hay fever.

As you may be already knowing hay fever is called allergic rhinitis. We have already discussed in detail about allergy and its prevention. You may refer to the earlier post to get some idea about it.

Nowadays it is a common complaint we see daily on our OPD. People come with complaints of getting coughs and colds daily.

Mainy do have sneezing in the morning when they wake up or after taking a bath. That cold and runny nose is so severe that it affects their day to day function.

When sneezing starts it appears like gunshots fired by the machine gun. They come in succession multiple times to be precise anywhere 5-35 times.

Usually you may feel an annoying feeling of itchy nose, eyes and ears. The thin water discharge from the nose is so profuse that it may literally soak your handkerchief as if it was washed with water.

In the above description we have given a general idea of the allergic rhinitis or hay fever. Now we will further expand this topic for you so that with a clear background idea you will feel it interesting to read.

First let us list the headings so that it will become systematic for you to understand.

• What is hay fever?
• What are symptoms of hay fever?
• How does hay fever affect your life?
• What is the difference between hay fever and common cold?
• What are factors causing hay fever/allergic rhinitis?
• What is treatment for hay fever?
• How to prevent Hay fever?

What is hay fever?

From the above discussion you might have got an idea about it. Hay fever is also called allergic rhinitis as we have discussed previously.

Essentially hay fever is an allergic condition. When you are allergic to some allergen in your surrounding that is capable of inducing cold-like symptoms you may experience hay fever.

In the past it was found that allergic rhinitis symptoms occur in some persons when they are exposed to certain types of grass. So, this condition was named as hay fever.

Later on it was cleared that along with the grass other agents too can induce the similar symptoms and the term hay fever was not limited to conditions associated with grass.

Later the allergic cause was found and proven, it was appropriately named as allergic rhinitis but still in common language and even medical literature hay fever is the more commonly used term than allergic rhinitis.

Please note hay fever and allergic rhinitis are the two names given to the same condition but since hay fever is more commonly used we too will use hay fever in this article.

In latest ICD-10 classification this condition is classified as 

J30.0	Vasomotor rhinitis
J30.1	Allergic rhinitis because of pollensAllergy NOS due to pollenHay feverPolinosis
J30.2	Other seasonal allergic rhinitis
J30.3	Other allergic rhinitisPerennial allergic rhinitis
J30.4	Allergic rhinitis unspecified

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What are symptoms of hay fever?

Earlier too we have stated some most common symptoms of the hay fever. But it is very important to know the symptoms in detail so that it can be differentiated from other cold cough which are very common to occur.

First we will list symptoms for you and then we will go into the details of each symptom.

Hay fever signs and symptoms can include:

• Runny nose and nasal congestion
• Watery, itchy, red eyes (allergic conjunctivitis)
• Sneezing
• Cough
• Itchy nose, roof of mouth or throat
• Swollen, blue-colored skin under the eyes (allergic shiners)
• Postnasal drip
• Fatigue
• Fever
• Headache
• Ear pain
• Breathlessness

Now let’s see the details of symptoms as you would like to know about your condition.

Runny nose and nasal congestion

One of the most annoying complaints you may experience is runny nose. This runny nose may affect your day to day function.

The nasal discharge from runny nose of allergic rhinitis is watery thin and profuse. It is more annoying when a person is sitting or standing.

Literally those who have hay fever need to clean their nose every few minutes. It affects the concentration and working capabilities.

The people working in public or going to school or class may feel ashamed and they may be blamed by others as they disturb the entire class while cleaning their noses.

Nasal congestion may be associated with the condition. It may occur in night time too to disturb the sleep of the patient. 

Watery, itchy, red eyes

Other common complaints associated with running a runny congested nose is itching of eyes.

There is a feeling of itching in the eyes and there is a strong urge to rub the eyes. Person is found vigorously cleaning his nose and rubbing his eyes

Eyes become red called conjunctival congestion. Sometimes sticky eye discharge may be found with eyelids sticking together..

Eyes typically as if they have got conjunctivitis. As there is no infection causing conjunctivitis in these cases so they are called as allergic conjunctivitis.

Sneezing

Sneezing is typically present in allergic rhinitis. The characteristic of sneezes is identifiable and generally similar in hay fever.

The person with hay fever usually has loud explosive sneezes and that come in rapid succession like a machine gun. 

You may experience episodes of anywhere 4-5 sneezes or may be as many as 25-30 sneezes. Additionally there are many such episodes present.

Cough

Cough may be present in patients with hay fever. The cough may be dry or with expectoration. 

The cough may be because of post nasal drip or may be because of irritation in nose and throat.

Sometimes hay fever may be associated with asthmatic attacks too. In such cases cough may indeed be a prominent symptom with difficulty in breathing and wheezing sound from the chest.

Patients with hay fever are more likely to get asthmatic symptoms and vice versa is true.

Itchy nose, roof of mouth and throat

With the above symptoms already the person is annoyed and more to that there is an uncomfortable feeling of itching of nose, roof of mouth and throat.

Because of this itching sensation which is uncomfortable the person looks annoyed and keeps on rubbing his nose vigorously. This act of rubbing the nose frequently with an annoyed face is called an allergic salute.

This itching affects the working capability of the students and they feel annoyed and disabled.

Allergic shiners

Those who have frequent symptoms for prolonged periods may have swollen skin below the eyes.

That swollen skin may look bluish slightly and may be identified typically as it is strongly associated with allergic rhinitis.

This appearance of the skin in people with hay fever is an important sign and it is called as allergic shiners.

Post nasal drip

If you have hay fever the nasal secretions may come out from nose as seen by you externally.

These secretions are so profuse and large that they also drip into the pharynx from the back side of the nose. 

This secretion can be viewed when the patient opens the mouth with tongue out and depressed with tongue depressor. This visible flow at the back was of oropharynx is called as post nasal drip.

This is typically very common in children.

Fatigue

With these ongoing symptoms you feel fatigue.

The fatigue comes as part of the condition itself or as a consequence of symptoms. 

If the person with hay fever experiences the symptoms at the time of the sleep and is not able to sleep nay feel fatigued at the workplace. There is a feeling of the decreased energy and decreased capacity to work.

With this fatigue you may experience pain in limbs. You want to take rest but you are unable to do so due to symptoms.

Fever

All the above symptoms can be associated with mild grade fever. The fever is typically mild grade and is felt when there are other symptoms.

The fever is associated with feeling of fatigue and feeling of loss of energy too.

Headache

Above all symptoms are usually associated with feeling mild headaches.

This headache occurs when you are fatigued with symptoms. It is typically mild grade and in the frontal region above your nose.

If you have sinusitis along with hay fever the headache in this condition is worsened to moderate grade. The headache is relieved typically when symptoms are decreased.

Ear pain

Suffering from all above symptoms you are trying vigorously to get rid of them. You try to clear your nose in the process.

In vigorous attempts to blow your nose forcefully there is a feeling of blockade in the ear with decreased capability of hearing. This symptom may suddenly come after blowing your nose.

Ear pain can be an associated symptom in this process and should be treated.

Breathlessness

Some people may feel breathless when there is a nose block. This is especially the case in small children and infants.

Some have a tendency to get bronchospasm like asthma when they have symptoms of hay fever and they may get wheezing and difficulty breathing needing immediate intervention.

How does hay fever affect your life?

Hay fever is a condition which is usually not life threatening but you may call it causing a morbidity or inability to work and annoying symptoms. In this section we will see how hay fever affects the life of normal human beings.

Life is called affected when the normal function of someone is affected or disturbed by a condition. In case of children normal functions can be playing, eating, sleeping and studying. In case of adults there is additional day to day work and office.

Suffering: Though not being a life threatening condition life becomes difficult with hay fever. Suffering is almost daily or in the entire season. It affects them when they are at home or at the workplace.

Loss of time: As this condition may affect daily people with hay fever experience inability to work when they suffer and daily they may lose some hours in suffering. This time is lost as they cannot be creative or perform their function during this suffering.

Work performance: This condition reduces the capability of the people to work with their full potential. They cannot concentrate at work and may not show their full performance.

Academic loss: Children and students suffering from this condition may miss their school and college attendance and cannot concentrate in studies and other extracurricular activities may see loss in academics and sports.

Psychological effects: People with this condition may try to stay isolated as they feel incapable due to suffering. This gives a huge psychological blow to this group. These people may suffer depression and sleeplessness and tiredness.

Disturbed sleep: Additionally these people tend to have disturbed sleep and that makes them feel tired during daytime further degrading their performance. This disturbed sleep may be due to blocked nose or breathless feeling and also wrongly taken medicines.

Effects of medicines: Medicines available OTC used to treat cough cold may be effective in this condition but they show temporary effect. Used wrongly without doctor’s advice these people may get addicted to those medicines.

Financial: Not able to use work potential to its fullest comes with financial loss and also treatment with safe medicines gives wrong effects and makes the condition worse.

What is the difference between hay fever and common cold?

Hay fever and common cold have similar symptoms. There are differences in symptoms that can be useful for differentiating two conditions from one another,

Hay fever	Common cold
This is an allergic condition.	This is an infectious condition.
Hyperreactivity to an allergen.	Viral infection.
Occurs very frequently.	Occurs only after infection.
Does not spread person to person.	May spread person to person.
Needs long term intervention.	Needs only temporary common cold medications.
For prevention, avoiding exposure to allergen is needed.	For the prevention mask and frequent hand wash may be useful.
Patients may suffer for a long time.	Usually those suffering are OK in 3-7 days.
Nasal secretions are watery, thin and profuse.	Nasal secretions may be thick white to greenish yellow colored.
Sneezing is prominent and occurs as multiple episodes in succession.	Sneezing may be there but it is not usually multiple episodes in succession.
Other signs like allergic shiners and allergic salute are seen.	There are no allergic shiners or allergic salutes.

Above table explains the difference between hay fever and common cold.

Hay fever is an allergic condition and is caused by allergy while common cold is an infectious condition occurring because of infection.

Hay fever occurs when someone is exposed to an allergen that can occur in the surrounding but common cold is caused by viral infection.

Hay fever occurs very frequently; typically patients are frustrated because frequent symptoms may be daily or more than 3 days a week. Whenever there is exposure to allergen they do suffer.

Common is frequent occurrence too but usually in normal individuals common cold occurs 6 or less times a year.

Hay fever being allergic in nature it does not spread from one person to another by contact. Common cold being an infectious condition spreads from one person to another by contact.

Hay fever needs long term intervention but common cold may subside by its own or the symptomatic treatment can be given for some days.

Best prevention for hay fever is avoiding exposure to allergens. Best prevention for the common cold is protecting oneself from infection.

Patients suffer for a long time because of hay fever if not managed properly. With common cold people are OK within a week’s time.

In Hay fever typically nasal secretions are mostly thin watery and profuse in nature. In common cold nasal secretions may be thick greenish yellow.

In Hay fever sneezing occurs multiple times in succession and can be literally like a machine gun. Multiple episodes of multiple sneezes may annoy the patients.

What are factors causing allergic rhinitis or hay fever?

Now here in this section we will see what are the factors that cause allergic rhinitis or hay fever. They are more or less similar to our earlier discussion in a blogpost on allergy. Let us summarize them here for you.

• Pollen grains
• Grass
• Exposure to dust and soil particles
• Smoke
• Cement particles
• Strong scents
• Dhoop and agarbattis
• Chemical insecticides
• Pollutants in air
• Exposure to insects
• Exposure to cold
• Cold food
• Food containing coloring agents and preservatives
• Food containing allergens
• Hair of pet animals

Let us explain them all one by one

Pollen grains: Pollen grains are released by plants into air, If you are allergic to them you may get allergic rhinitis. Typically allergy to pollen grains is seasonal and occurs in a typical season.

Grass: Some types of invasive grass like congress grass release particles in air that are highly allergic. If someone with an allergy is exposed to such an environment he/she may suffer allergic rhinitis.

Exposure to dust and soil particles: Dust and soil particles is a main cause of allergic rhinitis. The persons with a tendency of hay fever or allergic rhinitis may suffer when exposed to the duct. The symptoms may come in the summer season when there is dust or may come when someone is cleaning the house after a long time.

Smoke: Tobacco or other types of smoke is a strong factor that induces allergy. Person may be exposed to the smoke by their own smoking habit or by others. The active or passive smoking has the same effect on hay fever.

Cement particles: If you are staying near a construction site or if you are working at a construction site you may be exposed to soil and cement particles in the air. Person with allergic tendencies may suffer in such a polluted environment.

Strong scents: Strong scents and deodorants may induce hay fever and allergic rhinitis. Patients give a history of symptoms on exposure to the strong scents and smell.

Dhoop and agarbattis: They can act like smoke and induce allergic rhinitis symptoms in the patients.

Chemical insecticides: Chemical insecticides used indoor may be harmful to health in multiple ways and they may cause allergic rhinitis and hay fever as you may suffer.

Pollution in air: This is one of the main culprits to cause allergies. In the lockdown period pollution levels were low and so were a number of patients suffering from hay fever.

Exposure to insects: Insects release some chemicals in air that may be pheromones and other materials that can induce allergies if a person comes in contact.

Exposure to cold: Not using proper protective gear to prevent exposure to cold environments may induce allergic tendencies and hay fever in some people.

Cold food: The common culprit in children and those who regularly consume cold foods.

Readymade food: Readymade food may contain allergens and preservatives that can be allergic to some people and induce allergic symptoms including allergic rhinitis.

Food containing allergens: Some people may be allergic to some food ingredients and they may induce symp\toms.

Pet animals: Unfortunately pet animals like cats and dogs have hair and those hair are released periodically. The proteins on those hair are capable of inducing allergic symptoms.

Here we have given an extensive list of causes of allergic rhinitis. We hope it helps you to know the cause of your suffering.

What is treatment for hay fever?

Many of those who are suffering from hay fever may try to get relief from over the counter medicines first. They get frustrated as those measures give only temporary relief to them. Additionally without proper treatment patients may suffer side effects of medicines or may get addicted to medicines.

Here we are going to discuss the treatment of allergic rhinitis in detail.

There are two types of treatment one works immediately for immediate symptomatic relief and other treatment is for long term prevention of the problem. Let us first list the important points in treatment of allergic rhinitis and then explain it.

• Acute management with antihistamines, phenylephrine, oral steroids and anti-inflammatory drugs, nasal sprays of metazolines.
• Long term management with steroid nasal sprays and cell membrane stabilizers like montelukast and respiratory probiotics.

General instructions

The aim of treatment in hay fever is reducing the symptoms and improving the quality of life of the patients. Additionally it is also taken care that symptoms do not reappear in such patients to make them possible to function normally.

The role of patients and their caretakers in case of children is very important. They should maintain a diary stating the day to day symptoms and how many hours they lost for that day. They should also note down how many nights in week they had sleep disturbance.

Acute management

Acute management is aimed at reducing the current symptoms in those suffering from allergic rhinitis. Current symptoms may range from mild to severe.

When the current symptoms are affecting day to day function of the person they should be treated.  Following are the treatment options available in this condition

Antihistamines

Antihistamines are antiallergic in nature. They reduce the secretion of histamines by the histamine secreting cells and histamine is the main allergy inducing agent that causes symptoms of the allergy.

Antihistamines show effects in hours depending on which drug was used. Antihistamines are classified according to the time they were invented. Older generation antihistamines cause more sedation and newer ones are comparatively less sedating.

Hydroxyzine and promethazine and chlorpheniramine are amongst older antihistamines.

Loratadine, fexofenadine, cetirizine and levocetirizine and bilastine are among newer ones.

Antihistamines can be used orally or locally as a nasal spray like azelastine nasal spray. 

These agents though are many available OTC should be used cautiously as they may cause addictions if used in the wrong way and also dangerous if given in overdose.

Some of them like hydroxyzine and fexofenadine may cause arrhythmia in some patients.

The anticholinergic effects which they have helps 

• Dry up the nasal and pharyngeal mucosa 
• Reduce the stuffiness of the nose 
• Itching sensation

Sedating antihistamines is a drug choice in children where sleep disturbance is there along with nasal secretion and stuffiness symptoms.

Adults who need to drive or work at places where attention is needed should be given newer antihistamines which cause less sedation. You should keep in mind though newer antihistamines too may cause decreased alertness with other medications.

Phenylephrine

This is the drug that causes the constriction of blood vessels in the nasal mucosa. Due to this constriction of the blood vessels in nasal mucosa the blood flow to nasal mucosa is decreased.

The secretions on nasal mucosa are decreased and dried up. It gives relief from symptoms of nasal secretions and stuffiness.

This is given usually orally in combination with antihistamines. Many OTC cough cold medications contain phenylephrine as a content. 

This should be given in proper dosages and with advice of the doctor as overdoses are dangerous and it may cause high blood pressure.

This drug is not safe to use in pregnant ladies and infants and small children. It can be dangerous in older adults too.

Oral steroids

Steroids are known for their antiallergic and antiinflammatory effects. They do reduce the symptoms of allergy in hay fever.

They can be given orally or by injection or by nasal spray. They show their effect in a few hours and are safe given by doctor’s advice.

Some of the examples are prednisolone for oral use and dexamethasone for injection and fluticasone and mometasone as nasal spray.

Used for prolonged periods these may cause hypertension, diabetes and cataract and kidney failure. They should always be used with the advice of a doctor.

Used in the wrong manner they may cause severe immunosuppression and that can be dangerous to the person. In the long run these can weaken your bone altering your calcium metabolism.

Antiinflammatory drugs

Antiinflammatory drugs reduce the pain and inflammation. Hay fever may be associated with headache and bodyache and feeling of tiredness.

Antiinflammatory drugs help to reduce those symptoms. They also reduce the fever if present. 

Some of the examples are paracetamol and ibuprofen. Many OTC cough cold medications contain combinations of antihistamines and phenylephrine plus paracetamol. They may have added caffeine to reduce the side effect of sedation.

Nasal sprays of oxymetazoline

Oxymetazoline and xylometazoline give immediate relief of symptoms when sprayed into the nose. They act by constricting the blood vessels in the nasal mucosa.

They give symptomatic relief from the symptoms of nasal secretion and nasal stuffiness. They show their effect within a few seconds.

These medicines though many times available as OTC should not be used for more than 5-7 days as they have habit forming potential.

They do cause sleepiness and feeling fatigue. They may give you a stingy sensation in your nose.

Those with hypertension and older adults should not use these medicines as they are not safe in this age group. 

Additionally these drugs are to be avoided for those below 12 years of age as they are not safe to use in this age group.

Long term management:

As this problem occurs repeatedly and above mentioned drugs give temporary relief we need to do intervention that acts to prevent the symptoms.

Patients suffering symptoms and then treating those is an annoying process. It is better if we stop symptoms from occurring.

So following are strategies that are useful for this purpose.

Steroid nasal spray

Used with medical advice these are useful for keeping the check on symptoms. They drastically reduce the symptoms.

They contain a very minute amount of steroids. They act locally and do not get absorbed into blood. So these cause very minimal or no side effects systemically.

They contain steroid doses which are 10-100 times less than oral or injectable steroids. When oral steroids are given they do get absorbed in blood and then reach to intended areas. So they have more side effects. This side effect is solved in case of local steroids.

The thing is these are to be used for prolonged periods and they are administered by nasal sprays so are easy to take.

Some side effects like nasal bleeding and feeling of nasal dryness and stingy nasal sensation can occur in some people.

Those who have vasomotor rhinitis and nasal polyps and respond to this therapy very effectively.

Steroid nasal sprays also help to reduce the frequency and severity of bronchospasm in patients who have asthma symptoms with allergic rhinitis.

Mometasone and fluticasone are some examples of the steroid nasal sprays.

Montelukast

Montelukast is a membrane stabilizer. It reduces the secretion of allergy inducing agents by the cells.

These drugs are used in chronic allergies and allergic rhinitis. These drugs are useful in allergic rhinitis and hay fever too. 

It is given orally once or twice a day. Initially 14 days it is given in combination with levocetirizine and  then given as mono drug therapy or in combination with steroid nasal spray.

This also helps to reduce other allergic and asthma symptoms apart from allergic rhinitis.

Antihistamine nasal sprays

Antihistamine nasal sprays are newer in this category and they have all benefits of oral antihistamines with lesser side effects. 

Newer antihistamines like azelastine can be used by this route.

Combination nasal sprays

Combination of steroid plus local antihistamines are good for initial control without need of oral medicines.

Combination of mometasone and azelastine is available for this purpose. They combine the benefits of both steroids and antihistamines.

Respiratory probiotics

New class of drug called respiratory probiotics is very effective in controlling allergic rhinitis symptoms.

They do show their effect within a few days and 70 percent of patients given this treatment for 3-6 months are relieved of symptoms for prolonged period time.

One such respiratory probiotic RespiStrong is very effective for this use. They are given orally as powder that can be chewed or in some cool water and drink.

This new class of drug has less side effects among all above medicine with very satisfactory effects.

How to prevent hay fever?

In this section we are going to describe ways to prevent hay fever. It will be providing you a great value to prevent allergic rhinitis.

The strategy to prevent hay fever includes:

• Avoiding the allergens
• Avoiding exposure to cold 
• Taking medicines as suggested
• Regular physical exercises
• Regular breathing exercises

Now let us explain each strategy one by one

Avoiding allergens

Avoiding allergens listed above which include dust and strong scents, smokes, pollens, dhoop and agarbattis, Pet animals, readymade foods with added coloring agents and preservatives.

Foods with allergy causing ingredients should be avoided.

Stay away from chemicals and chemical insecticides that may induce allergies.

Paste control should be done in a way that will not harm you with ill effects.

Allergy causing grass and weeds should be cleared from the vicinity of the house or workplace.

Use vacuum cleaners to clean the duct and other measures will actually push those in air and will induce you symptoms.

Cold exposure

Cold exposure should be avoided and cold is the major factor that can induce hay fever.

When you are outside in the cold you should wear protective clothes.

While riding a bike in the cold you should use protective clothing and a helmet to protect you from cold.

Don’t eat cold food. Avoid cold food like ice cream as they cause allergic rhinitis by cold and also contain coloring agents may be preservative.

Cold fruits from the fridge should first thaw and be brought to room temperature before use.

Medicines

With all preventive measures failed you should follow your doctor’s advice for medicines.

Taken with doctor’s advice medicines are very effective in controlling the symptoms and minimise the side effects.

Don’t self medicate or use over the counter medicines for prolonged periods without medical advice.

Regular physical exercise

Regular physical exercise helps you to improve the condition in general.

You should exercise regularly daily at least for half an hour a day.

Remember allergic rhinitis and asthma are not contraindications for exercise.

Those with allergic rhinitis should take care that they should not swim in very cold water as it may worsen their condition.

They should wear protective clothing that protects them from cold when it is cold outside while exercising.

If you are going to play on the ground you should wear a mask while playing it will protect you from the dust on the ground.

Breathing exercises

Regular breathing exercises help to reduce the symptoms of allergic rhinitis and asthma symptoms by unknown mechanism.

They may give subjective feelings of betterment. 

You should do breathing exercises regularly.

This is the complete guide about hay fever. We hope it will be helpful for you and if you have any further doubts and queries you can comment or call us or send us a message on whatsapp.

We welcome you if you are going to visit us in person at Bhole children’s clinic.

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