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.
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.
- Avoid planting high-pollen plants near windows or doors.
- Avoid planting male (pollen-producing) plants.
- Use allergy medicine (like antihistamines or nasal sprays) before you begin gardening rather than after you get symptoms.
- When working outdoors, wear glasses, a face mask, hat, gloves and long-sleeved shirt to reduce your contact with pollen.
- Remain indoors in the morning and evening when outdoor pollen levels are highest.
- Garden on cool or cloudy days and in the late afternoon and evening when pollen levels tend to be lower.
- Avoid touching your face and eyes while working outdoors.
- Keep windows closed and use the air conditioner if possible in the house and car.
- Don't dry your bedding outdoors when pollen counts are high, since pollen clings to fabric.
- Avoid unnecessary exposure to other environmental irritants such as insect sprays, tobacco smoke, air pollution, and fresh tar or paint.
- Avoid mowing the grass or doing other yard work, if possible. Avoid fields and large areas of grassland.
- 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
- 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.
- Wash pets often as they can carry pollen into the house.
- Have someone else mow lawns and weed flowerbeds.
- To cut down on allergens: 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).
- Over the Counter Treatments:A large number of over-the-counter treatments are sold without FDA approval but are known for their positive effects, including herbs like eyebright (Euphrasia officinalis), nettle (Urtica dioica), and bayberry (Myrica cerifera), which have not been shown to reduce the symptoms of nasal-pharynx congestion. In addition, feverfew (Tanacetum parthenium) and turmeric (Curcuma longa) has been shown to inhibit phospholipase A2, the enzyme which releases the inflammatory precursor arachidonic acid from the bi-layer membrane of mast cells (the main cells which respond to respiratory allergens and lead to inflammation) but this is only in test tubes and it is not established as anti-inflammatory in humans.
Allergen Immunotherapy
- Allergen immunotherapy (also called allergy vaccine therapy) is commonly used in patients suffering from allergic rhinitis. Allergen immunotherapy is safe and has been shown to be effective in the treatment of stinging-insect hypersensitivity, allergic rhinitis or conjunctivitis, and allergic asthma.Allergen immunotherapy involves the administration of gradually increasing quantities of specific allergens to patients with IgE-mediated conditions until a dose is reached that is effective in reducing disease severity from natural exposure. The major objectives of allergen immunotherapy are to reduce responses to allergic triggers that precipitate symptoms in the short term and to decrease inflammatory response and prevent development of persistent disease in the long term.
Dietary Changes
- Changes People with inhalant allergies are likely to also have food allergies. A hypoallergenic diet has been reported to help some people with asthma and allergic rhinitis, but the effect of such a diet on hay fever symptoms has not been studied. Hay fever sufferers interested in exploring the possible effects of a food allergy avoidance program should talk with a doctor.
Nutritional Supplements
- 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.8 9 10 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).
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.
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