About Hay Fever

About 40 million Americans suffer from “hay fever,” a disease that allergists prefer to call “allergic rhinitis,” because HAY is not to blame and FEVER is rarely a symptom. This seasonal allergic rhinitis is commonly known as 'hay fever', because it is most prevalent during haying season It is particularly prevalent from late May to the end of June (in the Northern Hemisphere). However it is possible to suffer from hay fever throughout the year.

• Trees produce pollen, the dust-like, male reproductive parts of plants that cause most allergies. When an allergen such as pollen or dust is inhaled by a person with a sensitized immune system, it triggers antibody production. These antibodies mostly bind to mast cells, which contain histamine. When the mast cells are stimulated by pollen and dust, histamine (and other chemicals) are released. This causes itching, swelling, and mucus production.  The time of year at which hay fever symptoms manifest themselves varies greatly depending on the types of pollen to which an allergic reaction is produced. The pollen count, in general, is highest from mid-spring to early summer. As most pollen are produced at fixed periods in the year, a long-term hay fever sufferer may also be able to anticipate when the symptoms are most likely to begin and end, although this may be complicated by an allergy to dust particles.
  
  In some southern states, trees can produce pollen as early as January, while pollen production usually begins in April in the north. The oak tree, which is prevalent throughout the United States, produces large quantities of pollen and is a major cause of allergies. In northern latitudes birch (betula) is considered to be the most important allergenic tree pollen, with an estimated 15–20% of hay fever sufferers sensitive to birch pollen grains. Olive (olea) pollen is most predominant in Mediterranean regions. Other suspects include elm trees, which are common in the eastern and midwestern regions, sycamores, alder (Alnus), hazel (Corylus), hornbeam (Carpinus), horse chestnut (Aesculus), willow (Salix), poplar (Populus), plane (Platanus), linden/lime (Tilia), and sycamores). Cedar, juniper, cypress and sequoia trees also have all been known to cause allergies – and if you’re allergic to one, you may be allergic to them all.
• An estimated 90% of hay fever sufferers are allergic to grass pollen.
  Grasses usually come along to stir up allergy symptoms after trees are through pollinating – typically from late spring to early summer. Common culprits are timothy grass, Bermuda grass, sweet vernal, red top and some blue grasses. Grasses (Family Poaceae): especially ryegrass (Lolium sp.) and timothy (Phleum pratense).
• Weeds are guilty of causing most of the allergy misery that occurs in the late summer and early fall. Top on the list of offenders is ragweed – which affects as many as 75 percent of all hay fever sufferers. Common weed allergens are ragweed (Ambrosia), plantain (Plantago), nettle/parietaria (Urticaceae), mugwort (Artemisia), Fat hen (Chenopodium) and sorrel/dock (Rumex), sagebrush, found predominantly in the west, pigweed and goosefoot pollen. Note: ragweed is found in virtually every region of the United States and, with 17 different species of the weed.
• Molds are microscopic plants that reproduce by sending tiny spores into the air. They thrive in areas that are warm, dark and moist. Unlike pollen, which appears only in the warm weather months, mold can lurk in your house year-round.
• Dust Mites are small (hundreds can live in a single gram of dust), eight-legged creatures that belong to the same family as spiders, chiggers and ticks. These culprits are hardy creatures that live well and multiply easily in warm, humid places. Favorite hideouts include carpets, upholstered furniture, bedding, clothes, soft toys and the fur of pets. The intruder is particularly malicious when trapped inside a closed-up house.
• In addition to individual sensitivity and geographic differences in local plant populations, the amount of pollen in the air can be a factor in whether hay fever symptoms develop. Hot, dry, windy days are more likely to have increased amounts of pollen in the air than cool, damp, rainy days when most pollen is washed to the ground.

Categories of Allergic Rhinitis

The two categories of allergic rhinitis include:

• Seasonal - occurs particularly during pollen seasons. Seasonal allergic rhinitis does not usually develop until after 6 years of age.
• Perennial - occurs throughout the year. This type of allergic rhinitis is commonly seen in younger children. 

Symptoms

Symptoms vary in severity from person to person. The effect of hay fever can vary greatly. Common symptoms include:

• sneezing
• stuffy nose (nasal congestion)
• runny nose (and occasionally nosebleeds)
• watering eyes and/or plugged up ear canals.
• sore throat
• wheezing
• coughing
• headache
• itching nose, mouth, eyes, throat, skin, or any area exposed to the allergen.
• impaired smell
• conjunctivitis
• fever
• fatigue
• flushing
• irritability

• sneezing
• stuffy nose (nasal congestion)
• runny nose (and occasionally nosebleeds)
• watering eyes and/or plugged up ear canals.
• sore throat
• wheezing
• coughing
• headache
• itching nose, mouth, eyes, throat, skin, or any area exposed to the allergen.
• impaired smell
• conjunctivitis
• fever
• fatigue
• flushing
• irritability

• sneezing
• stuffy nose (nasal congestion)
• runny nose (and occasionally nosebleeds)
• watering eyes and/or plugged up ear canals.
• sore throat
• wheezing
• coughing
• headache
• itching nose, mouth, eyes, throat, skin, or any area exposed to the allergen.
• impaired smell
• conjunctivitis
• fever
• fatigue
• flushing
• irritability

Very sensitive individuals can experience hives or other rashes.

Diagnosing

The history of the person's symptoms is important in diagnosing allergic rhinitis, including whether the symptoms vary according to time of day or the season, exposure to pets or other allergens, and diet changes.

Allergy testing may reveal the specific allergens the person is reacting to. Skin testing is the most common method of allergy testing. This may include:

• intradermal,
• scratch,
• patch, or
• other tests.

In some individuals who cannot undergo skin testing (as determined by the doctor), the RAST blood test may be helpful in determining specific allergen sensitivity.

Prevention Tips
The following tips can help with preventing the allergic symptoms:

• Find and get rid of any problem plants. If you cannot remove problem plants, prune them back regularly.
  • Be aware of local pollen counts in your area (visit the National Allergy Bureau Web site).
  • Avoid peak times for pollen exposure (hot, dry, windy days, usually between 10 a.m. and 4 p.m.). Although pollens are usually emitted in early morning, peak times for dissemination are between around 10 a.m. and 4 p.m. Find and get rid of any problem plants. If you cannot remove problem plants, prune them back regularly.
  • Avoid planting high-pollen plants near windows or doors.
  • Avoid planting male (pollen-producing) plants.
  • Remain indoors in the morning and evening when outdoor pollen levels are highest.
  • Avoid mowing the grass or doing other yard work, if possible. Avoid fields and large areas of grassland. Garden on cool or cloudy days and in the late afternoon and evening when pollen levels tend to be lower.
  • Keep windows closed and use the air conditioner if possible in the house and car.
  • Do not hang clothes outside to dry where they can trap pollens.
  • Keep windows and car windows closed; use air conditioning in both if possible rather than opening windows.
  • Wash bed sheets weekly in hot water.
  • Avoid unnecessary exposure to other environmental irritants such as insect sprays, tobacco smoke, air pollution, and fresh tar or paint.
  • Always bathe and wash hair before bedtime (pollen can collect on skin and hair throughout the day).
  • Rinse your nose with salt-water (saline) when pollen counts are high.
  • Wash hands, and face regularly to remove pollen from areas where it is likely to enter the nose. Note:  A small amount of petroleum jelly around the eyes and nostrils will stop some pollen from entering the areas that cause a reaction Perform a thorough spring cleaning of your home, including replacing heating and A/C filters and cleaning ducts and vents.
  • Check bathrooms and other damp areas in your home frequently for mold and mildew, and remove visible mold with nontoxic cleaners.
  • Keep pets out of the bedroom and off of furniture, since they may carry pollen if they have been outdoors.
  • Wash pets often as they can carry pollen into the house.
  • Avoid bicycling, walking or jogging outside during the pollen season.
  • Wear particulate filtering face masks designed to filter out pollen if you must be outdoors.
  • Wear sunglasses, which reduce the amount of pollen entering the eyes.  
  • If possible have someone else mow lawns and weed flowerbeds.
  • If you will continue to garden or work outdoors during pollen season, use allergy medicine (like antihistamines or nasal sprays) before you begin gardening rather than after you get symptoms.
  • Avoid touching your face and eyes while working outdoors.
  • If working outdoors, wear glasses, a facemask, hat, gloves and long-sleeved shirt to reduce your contact with pollen.
  • Shower, wash your hair and change your clothes when you have finished working outdoors.

  Treatment
  
  The goal of treatment is to reduce allergy symptoms caused by the inflammation of affected tissues.
  
  The best "treatment" is to follow the tips suggested above to avoid what causes your allergic symptoms in the first place.
  
  Medication
  
  Options include the following:
  
  

• Be aware of local pollen counts in your area (visit the National Allergy Bureau Web site).
• Avoid peak times for pollen exposure (hot, dry, windy days, usually between 10 a.m. and 4 p.m.). Although pollens are usually emitted in early morning, peak times for dissemination are between around 10 a.m. and 4 p.m. Find and get rid of any problem plants. If you cannot remove problem plants, prune them back regularly.
• Avoid planting high-pollen plants near windows or doors.
• Avoid planting male (pollen-producing) plants.
• Remain indoors in the morning and evening when outdoor pollen levels are highest.
• Avoid mowing the grass or doing other yard work, if possible. Avoid fields and large areas of grassland. Garden on cool or cloudy days and in the late afternoon and evening when pollen levels tend to be lower.
• Keep windows closed and use the air conditioner if possible in the house and car.
• Do not hang clothes outside to dry where they can trap pollens.
• Keep windows and car windows closed; use air conditioning in both if possible rather than opening windows.
• Wash bed sheets weekly in hot water.
• Avoid unnecessary exposure to other environmental irritants such as insect sprays, tobacco smoke, air pollution, and fresh tar or paint.
• Always bathe and wash hair before bedtime (pollen can collect on skin and hair throughout the day).
• Rinse your nose with salt-water (saline) when pollen counts are high.
• Wash hands, and face regularly to remove pollen from areas where it is likely to enter the nose. Note:  A small amount of petroleum jelly around the eyes and nostrils will stop some pollen from entering the areas that cause a reaction Perform a thorough spring cleaning of your home, including replacing heating and A/C filters and cleaning ducts and vents.
• Check bathrooms and other damp areas in your home frequently for mold and mildew, and remove visible mold with nontoxic cleaners.
• Keep pets out of the bedroom and off of furniture, since they may carry pollen if they have been outdoors.
• Wash pets often as they can carry pollen into the house.
• Avoid bicycling, walking or jogging outside during the pollen season.
• Wear particulate filtering face masks designed to filter out pollen if you must be outdoors.
• Wear sunglasses, which reduce the amount of pollen entering the eyes.  
• If possible have someone else mow lawns and weed flowerbeds.
• If you will continue to garden or work outdoors during pollen season, use allergy medicine (like antihistamines or nasal sprays) before you begin gardening rather than after you get symptoms.
• Avoid touching your face and eyes while working outdoors.
• If working outdoors, wear glasses, a facemask, hat, gloves and long-sleeved shirt to reduce your contact with pollen.
• Shower, wash your hair and change your clothes when you have finished working outdoors.

Treatment

The goal of treatment is to reduce allergy symptoms caused by the inflammation of affected tissues.

The best "treatment" is to follow the tips suggested above to avoid what causes your allergic symptoms in the first place.

Medication

Options include the following:

• "Allergy shots" (Hyposensibilization, immunotherapy) are occasionally recommended if the allergen cannot be avoided and if symptoms are hard to control. This includes regular injections of the allergen, given in increasing doses (each dose is slightly larger than the previous dose) that may help the body adjust to the antigen. These tend to be offered as a last resort as the therapy is more expensive at first, although patients may save money on medications and doctor visits in the long run. They may also increase the risk of triggering a secondary allergic reaction such as an asthma attack.
• Fast-acting strong antihistamines such as drugs including chlorphenamine, which relieve the symptoms after a hayfever "attack".
• Short-acting antihistamines, which are generally over-the-counter (non-prescription), often relieve mild to moderate symptoms, but can cause drowsiness. One formerly prescription medication, loratadine (Claritin®), is now available over the counter in many countries. It does not tend to cause drowsiness or affect learning in children. Azelastine (Astelin®) is the only antihistamine available as a nasal spray. A pediatrician should be consulted before using these medicines in children, as they may affect learning.
• Longer-acting antihistamines cause less drowsiness, can be equally effective, and usually do not interfere with learning. These medications include fexofenadine (Allegra®), and cetirizine (Zyrtec®).
• New leukotriene receptor antagonists, such as montelukast (Singulair®) and zafirlukast (Accolate®) have proven very effective in dealing with allergic rhinitis, without the common side-effects of the first-generation antihistamines, such as drowsiness. These medicines are also long-acting, and are recommended to be taken once-daily.
• Corticosteroid nasal sprays are effective and safe, and may be effective without oral antihistamines. These medications include fluticasone (Flonase®, Flixonase®), budesonide (Rhinocort®), flunisolide (Syntaris®), mometasone (Nasonex®), triamcinolone (Nasacort AQ®) and beclomethasone (Beconase®).
• Cromolyn sodium (or cromoglycate) is a drug that stabilizes mast cells and prevents their degranulation and subsequent release of histamine. It is available as a nasal spray (Nasalcrom) for treating hay fever. Eye drop versions of cromolyn sodium (Crolom) are available for allergic conjunctivitis.
• Topical decongestants may also be helpful in reducing symptoms such as nasal congestion, but should not be used for long periods as stopping them after protracted use can lead to a rebound nasal congestion (Rhinitis medicamentosa).

• Quercetin is an increasingly popular treatment for hay fever even though only limited preliminary clinical research has suggested that it is beneficial to hay fever sufferers.
• The oral administration of a thymus extract known as Thymomodulinr has been shown in preliminary studies and double-blind trials to improve the symptoms of hay fever and allergic rhinitis. Presumably this clinical improvement is the result of restoration of proper control over immune function.
• The Japanese herbal formula known as sho-seiryu-to has been shown to reduce symptom, such as sneezing, for people with hay fever. Sho-seiryu-to contains licorice, cassia bark, schisandra, ma huang, ginger, peony root, pinellia, and asiasarum root.
• Tylophora is an herb used by Ayurvedic doctors in India to treat people with allergies. It contains compounds that have been reported to interfere with the action of mast cells, which are key components in the process of inflammation responsible for most hay fever symptoms. Mast cells are found in airways of the lungs (among other parts of the body). When mast cells are activated by pollen or other allergens, they release the chemical histamine, which in turn leads to a wide number of symptoms familiar to hay fever sufferers-itchy eyes, runny nose, and chest tightness. Ayurvedic doctors sometimes recommend 200-400 mg of the dried herb daily or 1-2 ml of the tincture per day for up to two weeks.
• Despite the lack of adequate scientific support, some doctors suggest taking 450 mg of nettle leaf capsules or tablets two to three times per day, or a 2-4 ml tincture three times per day for people suffering from hay fever.
• Ephedra sinica (ma huang) is an herbal remedy for hay fever in traditional Chinese medicine. The popular nasal decongestant pseudoephedrine is an active constituent of ma huang. It is has largely replaced the use of the herb in modern medicine.

Homeopathy

It has been claimed that homeopathy provides relief free of side effects. However, this is strongly disputed by the medical profession on the grounds that there is no valid evidence to support this claim. Meta-analyses provide no clear evidence for the efficacy of homeopathy in rhinitis (or asthma). However, for those that believes in the approach, the following list of suggested medication may prove helpful:

• Allium cepa: Indications for this remedy include watery eyes and a clear nasal discharge that irritates the upper lip, along with sneezing and a tickling cough. The person usually is thirsty, and feels worse indoors and when rooms are warm, and better in fresh air.
• Arsenicum album: A burning, watery, runny nose with a stuffy, tickling feeling during allergy attacks suggests a need for this remedy. Swelling below the eyes and a wheezy cough are common. The person may feel chilly, restless, anxious, and is often very tired.
• Arundo mauritanica. This remedy is used for symptoms of hay fever.
• Euphrasia: This remedy can be helpful if the eyes are swollen and irritated with acrid tears or pus. The nose also runs, but with a blander discharge. Symptoms are often worse in the daytime and worse from warmth, and the eyes may hurt from too much light. The person can also have a cough in the daytime, which improves at night.
• Ferrum phosphoricum: This is a very useful remedy in the early stages of any inflammation. Taken when allergy symptoms start, it often slows or stops an episode. Symptoms include runny eyes with a burning or gritty feeling, facial flushing, watery nose, and short, hard, tickling cough.
• Galphimia glauca: The plant Galphimia glauca is a homeopathic remedy that is used to ameliorate the symptoms of acute pollinosis.
• Gelsemium: A tired, droopy feeling during allergies with a flushed and heavy-feeling face suggests a need for this remedy. A sensation of dryness or of swollen membranes may be felt inside the nose—or the nose may run with irritating watery discharge, with the person sneezing frequently. Aching in the back of the head and neck, a trembling feeling, and chills along the spine are often seen when a person needs Gelsemium.
• Luffa Operculata: Commonly used to treat symptoms of asthma, Migraine Headache, Rhinitis, Seasonal Allergies / Hay Fever, Sinusitis / Sinus Infection.
• Natrum muriaticum: Allergy attacks with sneezing, watery eyes, clear nasal discharge that resembles egg white, and a loss of taste and smell will all suggest a need for this remedy. The person may have dark circles under the eyes, be thirsty, feel withdrawn and sad, and act irritable if comforted.
• Nux vomica: If the nose is alternately stuffed up (especially outdoors or at night) and running (indoors and in the daytime), this remedy may bring relief. Other symptoms include a teasing cough, a scraped or tickly feeling in the throat, and headache. A person who needs this remedy often feels impatient, irritable, and chilly.
• Sabadilla: Long paroxysms of sneezing, itching in the nose with irritating runny discharge, a feeling of a lump in the throat, and watery eyes will all suggest a need for this remedy. The person may feel nervous during allergy attacks, and trying to concentrate can bring on drowsiness or headache.
• Wyethia: Intolerable itching felt on the roof of the mouth and behind the nose—sometimes extending into the throat and ears—strongly suggests the use of this remedy. Everything in the person’s head feels dry and irritated, but the nose may still be runny.

Homeopathy Dosage Directions

Select the remedy that most closely matches the symptoms. In conditions where self-treatment is appropriate, unless otherwise directed by a physician, a lower potency (6X, 6C, 12X, 12C, 30X, or 30C) should be used. The frequency of dosage varies with the condition and the individual. Sometimes a dose may be required several times an hour; other times a dose may be indicated several times a day; and in some situations, one dose per day (or less) can be sufficient.

Many homeopathic physicians suggest that remedies be used as follows: Take one dose and wait for a response. If improvement is seen, continue to wait and let the remedy work. If improvement lags significantly or has clearly stopped, another dose may be taken. If no response is seen within a reasonable amount of time, select a different remedy.

Acupuncture

Meta-analyses provide no clear evidence for the efficacy of acupuncture in rhinitis (or asthma). It is not possible to provide evidence-based recommendations for acupuncture.

Treatment/Cures

In some cases (particularly in children), people may outgrow an allergy as the immune system becomes less sensitive to the allergen. However, as a general rule, once a substance causes allergies for an individual, it can continue to affect the person over the long term.

Most symptoms of allergic rhinitis can be readily treated.

More severe cases of allergic rhinitis require immunotherapy (allergy shots) or removal of tissue in the nose (e.g., nasal polyps) or sinuses.