Hay fever is not life threatening – it is often considered a nuisance rather than a major disease. But for those living with frequent sneezing, itchy eyes and a stuffy nose, there is a huge impact on quality of life.

Hay fever is the common name to describe allergic rhinitis and involves a recurrent runny, stuffy, itchy nose, and frequent sneezing. It can also affect your eyes, sinuses, throat and ears.

Like any other allergy, allergic rhinitis is an inappropriate immune system response to an allergen.

Allergic rhinitis occurs when an allergen comes into contact with the sensitive, moist lining in your nose and sinuses and sets off the allergic response.
If you have seasonal allergic rhinitis that strikes you in spring and summer, this is commonly caused by pollen.

At this time of year, tree, grass, and weed pollen become airborne and can result in sneezing, a runny nose, and itchiness in your nose, throat, and eyes.
If you suffer perennial allergic rhinitis that can hang around most of the year, the common causes are house dust mite, pets and mould.

HAY FEVER SYMPTOMS
Hay fever can be a combination of symptoms and not everyone will have the same symptoms. Because pollen counts can vary from day to day, symptoms also can vary.

According to Allergy New Zealand, a person with allergic rhinitis may have any of the following symptoms:

• Watery discharge from the nose all the time, occasionally or during certain seasons of the year
• Stuffy nose all the time or during specific seasons
• Reddened, pebbly lining in the lower eyelids
• Frequent throat-clearing
• Breathing through the mouth
• Snoring
• Rabbit-like movements of the nose
• A horizontal crease across the nose as a result of constant rubbing
• Frequent sneezing, especially in the morning
• Repeated nosebleeds
• Headaches due to pressure from inside the nose
• Frequent earaches, fullness in the ear, ear infections or hearing loss
• Dizziness or nausea related to ear problems
• Chronic cold without much fever
• Nasal voice because of blocked nasal passages
• Dark circles under the eyes as a result of pressure from blocked nasal passages on the small blood vessels. These are often referred to as “allergic shiners”
• Occasionally rashes and swelling of the face.

Some highly sensitive people can develop symptoms within minutes of going outside in the morning.


AVOIDING SPRING ALLERGY TRIGGERS
If you have seasonal allergic rhinitis caused by pollen allergies, you may be tempted to hibernate over spring and summer. But that’s no solution. The allergens floating around outside will make their way inside your house, and eventually up your nose!

In New Zealand the hay fever “season” is not very distinct and can vary throughout the country because of the different climates. The season starts about a month earlier at the top of the North Island than the bottom of the South Island.
Below are some Dos and Don’ts to help you manage your hay fever symptoms so you can enjoy the outdoors over spring and summer.



Do:
Plan outdoor activities – hot, dry, and windy days are peak allergy days. Plan to be outside when it’s cooler and less windy. After a rain is a good time to head outdoors.

• Get someone else to mow the lawn – lawnmowers stir up allergens. If you must mow the lawn, use a mask and protective glasses. You can choose a simple disposable paper mask, or for tougher allergies, a “respirator mask” with a HEPA filter.
• Wash your clothes and have a shower after you come in from outdoor activities.
• Wear natural fabrics – some experts say natural fabrics such as cotton, attract less pollen. Silks and synthetic fabrics tend to build up static electricity, which attracts pollen.
• Wash your hair before bed – this ensures any pollen collected on your hair during the day won’t rub off on your pillow. If you’re a morning shampoo person, you may have to change your routine.
• Wear sunglasses – this can help keep pollen out of your eyes.
• Select garden plants carefully – choose low pollen producers, usually native species. If you know the exact tree, grass, and weed pollen that affect you, you can try to remove them and replant low pollen species.
• Take a holiday during high pollen season – a seaside location is usually lower in pollen.
• Replace carpeting and curtains – these can trap pollen inside your home so consider tile and hardwood floors, and shutters and blinds, instead of curtains.
• Keep indoor humidity levels below 50% – this applies especially if mould spores cause your allergies. You may need a digital thermometer with a humidity gauge to keep track of humidity levels, and a dehumidifier to get a level lower than 50%.

Don’t:

• Dry clothes outside – pollen can collect on clothing or bed linen left outside to dry.
• Open windows and doors – although fresh air is good for us, pollen-laden air isn’t. Keeping your house closed on high pollen days will help keep pollen out.
• Drive with open car windows and sunroofs – especially on high-pollen days, recirculate the air in your car instead of using the vent, which may let in pollen.
• Allow leaves and garden debris to gather – keep your garden area clear of anything that can harbour pollen or moulds.
• Wear outdoor shoes in the house – take shoes off at the door or at least wipe them well on an outdoor mat.
• Visit farms or orchards – these are typically high pollen areas so stay away.

THE WONDERS OF POLLINATION
Wind pollinated plants are most likely to cause hay fever symptoms. These plants produce high numbers of light and buoyant pollen grains which are easily distributed through the air.

During pollination, the wind blows pollen off the male anthers and carries it through the air. It can land on the ground, in lakes and also find its way into the noses and eyes of humans.

Because this is a very “hit and miss” form of pollination, wind pollinated plants compensate by sending clouds of pollen into the air with only a very few finding their way to a receptive female stigma.

Brightly coloured flowering plants and trees are unlikely to cause hay fever because these plants attract bees and other insects to transfer their pollen from flower to flower. They produce fewer pollen grains that don’t generally become airborne.

WHY WE REACT TO POLLEN
The reason humans react to pollen grains all comes down to proteins.

Our immune systems are designed to reject “foreign” proteins from the
body and pollen grains can carry 30-40 different proteins.
 
When we breathe in pollen grains and they come into contact with our nasal passages or the membranes of the eye, they release these proteins to the immune system in the blood vessels of the mucous membranes.

Sometimes our immune systems don’t get rid of some of these pollen proteins through the usual route, but instead produce a special kind of antibody which leads to the release of a chemical called histamine. It is this histamine that causes allergy symptoms such as swelling, redness, itchiness and secretion of mucous.


HOW CLOSE IS TOO CLOSE?
The highest concentrations of pollen are within 10 metres of the plant and concentrations drop quickly as you move further away. If you know what plants trigger your hay fever you can significantly reduce your exposure to pollen by removing yourself physically from the plant when it is pollinating. Before and after the pollination period, the plant should pose no harm to you, unless you have a contact type of plant allergy.




POLLEN OUT AND ABOUT EARLY
Pollen counts can vary during the course of one day but are usually highest between 10am and 4pm.

Weather conditions also play a role in pollen levels. Pollen sticks around in moderate temperatures with low humidity and little or no wind. Dry weather and high winds keep pollen in the air, and in these conditions airborne pollen can travel hundreds of miles from where they originated. However, wet weather washes pollen away so you’re usually safe to go outside after rain.


SOME FACTS AND FIGURES ON HAY FEVER

• About 20% of the general population suffers from hay fever
• One third of these people develop problems before the age of 10
• Around 50% of patients experience symptoms for more than four months of the year
• 20% have symptoms for at least nine months per year
• Hay fever sufferers have more frequent and prolonged sinus infections
• Hay fever sufferers who also have red, itchy eyes, risk developing infective conjunctivitis due to frequent rubbing
• Persistent hay fever symptoms and poor quality sleep can result in lethargy, poor concentration and behavioural changes which can impact on learning in young children
• Allergic rhinitis may predispose people to obstructive sleep apnoea, due to the upper airways collapsing during sleep. This results in reduced airflow, a drop in oxygen levels and disturbed sleep
• Patients with allergic rhinitis also suffer from more frequent and prolonged respiratory infections, and asthma has been shown to be more difficult to control unless allergic rhinitis is also managed.

TREATING ALLERGIC RHINITIS
Non-sedating antihistamines – help control sneezing, itching, and a runny nose. Can be used alone or in combination with nasal sprays.

Anti-inflammatory nasal sprays (corticosteroids) – reduce inflammation in the lining of the nose. Best used as a preventative like an asthma preventer. Can be used long-term during the allergy season.

Decongestant nasal sprays – help unblock the nose but should not be used for more than a few days at a time as this can lead to worse nasal congestion known as rebound congestion.

Eye drops – mild to moderate eye problems can benefit from eye drops containing decongestant or a decongestant combined with antihistamine. Prolonged use of decongestant eye drops can also cause rebound worsening when stopped. However, some brands of eye drops can be used preventatively and are safe to use for prolonged periods so, talk to your doctor or pharmacist about the options.

Desensitisation – also known as immunotherapy, this can ‘turn off’ the abnormal response of the immune system to an allergen if medication does not work. ?
Sublingual immunotherapy is another method, where drops of the allergen solution are taken under the tongue, but is not widely used outside of Europe.

THE POLLEN CALENDAR
The New Zealand pollen calendar contains useful information on how to limit your exposure to pollen. Once you know which specific plants trigger your allergy, you can track which months they are pollinating and be better prepared for when your symptoms flare up.

Click here to download Allergy NZ’s pollen calendar or visit www.allergy.org.nz Click on Allergy Help, A-Z allergies, Allergic Rhinitis. 




Allergy New Zealand is a charity providing reliable information, education and support so you can manage your allergy and live an active and healthy lifestyle. Family Health Diary acknowledges the help of Allergy New Zealand in putting this feature together. www.allergy.org.nz




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