The heatwave over the past couple of weeks has left many islanders reaching for the tissues and queueing at pharmacies for over-the-counter hay fever remedies. As GPs, we have also seen a noticeable increase in the number of patients attending clinics with severe hay fever symptoms. With pollen counts currently running very high, what is often dismissed as a minor seasonal nuisance is proving a significant source of misery for many people.
Despite the name, hay fever has little to do with hay and rarely causes a fever. The term has simply persisted over time, even though it is somewhat misleading. The medical name for hay fever is ‘allergic rhinitis’ – with ‘rhin’ meaning nose and ‘itis’ meaning inflammation.
The condition occurs when the immune system mistakenly identifies pollen as a harmful substance and mounts an allergic response. The result is a range of symptoms including sneezing, a blocked or runny nose, itchy watery eyes and an itchy palate.
More than just a runny nose
What many people do not realise is just how much hay fever can affect day-to-day quality of life. Poor sleep is common, concentration can suffer, and many people find that exercise becomes more difficult during periods of high pollen. At this time of year, it can be particularly problematic for students sitting exams, as symptoms cause fatigue and poor concentration, affecting performance.
Understanding the pollen seasons
The timing of symptoms often provides a clue as to which pollen is responsible. Tree pollens, particularly silver birch and hazel, tend to cause problems in the first few months of the year. Grass pollens, such as Timothy grass, dominate during late spring and early summer and are responsible for most hay fever cases. Later in the summer and into early autumn, weed pollens such as mugwort and wall pellitory become more important.
Is hay fever becoming more common?
Hay fever certainly appears to be becoming more common. There are two important reasons for this. Firstly, allergic conditions in general are increasing worldwide, although the exact reasons are not fully understood. Secondly, pollen levels themselves are rising. Climate change is contributing to longer pollen seasons and higher concentrations of pollen in the air. Together, these trends mean that more people are developing hay fever and those who already suffer are being exposed to higher levels of pollen for longer periods.
Reducing your exposure to pollen
When it comes to treatment, avoidance of the trigger remains the first principle, although this is easier said than done when pollen is all around us.
There are, however, some practical measures that can help. Keeping windows closed during periods of high pollen, particularly in the car, can reduce exposure. Wearing sunglasses outdoors may help protect the eyes. Showering and washing your hair before bed can remove pollen collected during the day and may improve overnight symptoms. It is best to avoid drying washing outside during periods of high pollen, as pollen readily sticks to clothes and bedding.
Some people find that applying a small amount of petroleum jelly around the nostrils helps trap pollen particles before they enter the nose. Saline nasal rinses can also be surprisingly effective at washing allergens away.
Treatments that work
For most sufferers, treatment involves a combination of medicines. Modern, non-sedating antihistamines are usually the first step and are readily available from pharmacies. Steroid nasal sprays are often the most effective treatment for nasal symptoms, while anti-allergy eye drops can provide relief for itchy and watery eyes.
A common mistake is waiting until symptoms become severe before starting treatment. In many cases, beginning medication before the pollen season reaches its peak can lead to much better control.
If over-the-counter treatments are not enough, it is worth speaking to your GP. Prescription options include stronger antihistamines and combination nasal sprays that contain both an antihistamine and a steroid. These can be highly effective for people whose symptoms remain troublesome despite standard treatment.
Treatments to avoid
I am often asked about steroid injections such as Kenalog for hay fever. These were widely used many years ago but are no longer recommended due to concerns about safety and potential side effects and should not be used nowadays. Another medication to be aware of is nasal decongestant sprays such as Sudafed. These can give very rapid short-term relief and may seem highly effective at first, but if used for more than a few days they can actually worsen symptoms, leading to a cycle of rebound congestion and increasing use. They should therefore only be used for a few days at most, and ideally avoided. In contrast, steroid nasal sprays are safe and effective for longer-term use.
When specialist treatment may help
For a small number of patients with severe symptoms that are difficult to control, referral to an allergy clinic may be appropriate. Allergy testing can identify exactly which allergens are responsible and may reveal additional allergies that are contributing to ongoing symptoms.
Some patients may also be suitable for immunotherapy. This treatment involves regular exposure to tiny amounts of the allergen over several years, helping the immune system develop tolerance. It requires commitment but can offer long-term benefits and, in some cases, effectively cure the allergy.
Is hay fever worse on islands?
People sometimes ask whether hay fever is particularly bad in island communities. There is no evidence that this is the case. In fact, coastal areas often benefit from sea breezes that help disperse pollen. Unfortunately, when pollen levels are exceptionally high, as they are currently, sufferers can feel the effects wherever they live.
If you are struggling with symptoms, do not simply put up with them. Effective treatments are available, and for most people there is no reason why hay fever should dominate the summer months. Hay fever sufferers who would like to discuss the issues highlighted here in more detail can book an appointment with me or my colleague Dr Chloe Savident at the Allergy Clinic. We regularly help patients identify triggers, optimise treatment and gain better control of their symptoms. Further information about the Allergy Clinic, including how to book an appointment, can be found on the Healthcare Group website.
Hay fever myth busters
Myth: Hay fever is caused by hay.
Fact: Hay fever is usually triggered by pollen from grasses, trees and weeds. The name dates back to a time when symptoms were noticed during the hay-making season.
Myth: Hay fever only happens in summer.
Fact: Different pollens appear at different times of the year. Tree pollen tends to peak in spring, grass pollen in late spring and summer, and weed pollen in late summer and autumn.
Myth: Hay fever is just a minor nuisance.
Fact: For many people it can have a major impact on quality of life, affecting sleep, concentration, exercise, work productivity and exam performance. It can also worsen asthma.
Myth: Spending more time outdoors helps build immunity.
Fact: Deliberately exposing yourself to pollen is unlikely to improve symptoms and may make them worse. Medical immunotherapy works in a completely different way, using carefully controlled doses under specialist supervision.
Myth: Local honey cures hay fever.
Fact: There is little scientific evidence that local honey helps hay fever. Most honey contains flower pollens rather than the wind-borne pollens that typically trigger symptoms.
Myth: Rainy weather makes hay fever better.
Fact: Rainfall can help by reducing pollen levels and washing pollen out of the air. However, stormy weather can make things much worse. Thunderstorms can break pollen grains into tiny fragments and concentrate them in large airborne clouds. These microscopic pollen particles can enter the body more easily and penetrate deeper into the airways, triggering severe allergy symptoms and, in some people with allergic asthma, potentially dangerous asthma attacks.
Myth: Antihistamines always cause drowsiness.
Fact: Older antihistamines were often sedating, but modern treatments are much less likely to cause sleepiness, although individual responses vary.
Myth: Hay fever only affects children.
Fact: Many people first develop symptoms as teenagers. Allergies often improve as people get older, or sometimes after pregnancy.
