It’s hay fever season, as sufferers will well know. But experts say many people are inadvertently making their symptoms worse.
‘There’s a huge cohort of people suffering needlessly with hay fever symptoms such as itchy eyes, congestion and sneezing either because they are not aware of effective treatments that exist or because they are using medications incorrectly,’ says Dr Helen Evans-Howells, a GP and hay fever sufferer, who runs a private allergy clinic in Dorset.
Or worryingly, some may also be going to private clinics or even hairdressers for so-called ‘hay fever injections’ – large doses of Kenalog, a steroid that experts warn carries risks of serious side-effects such as cataracts and depression.
Hay fever is an allergy to pollen. Medically known as seasonal allergic rhinitis – ‘rhinitis’ refers to inflammation of the nasal lining – it develops because hay fever sufferers are genetically predisposed to producing higher levels of the antibody immunoglobulin E (IgE) in response to harmless substances such as pollen.
This triggers an explosive release of chemicals, including histamine, as the body attempts to flush out the pollen.
So far this year, we’ve seen high levels of tree pollens including birch and oak in several parts of the country – and levels of grass pollen, responsible for the allergic reaction in around 90 per cent of hay fever sufferers – are also edging higher. But could you be tackling your symptoms in the wrong way?
NASAL DECONGESTANTS MAKE MATTERS WORSE
While you might think a decongestant is an obvious solution to a blocked nose, this isn’t true for hay fever, says Professor Michael Rudenko, a consultant in allergy and immunology at the London Allergy and Immunology Centre.
Over-the-counter decongestants (containing oxymetazoline and phenylephrine, which constrict swollen blood vessels in the nose and sinuses, making breathing easier) can improve symptoms for a couple of days, ‘but if used for more than three to five days [as you’d need to, for hay fever symptoms] they cause “re-bound” congestion, where symptoms come back more severely’, he explains.
‘There’s a huge cohort of people suffering needlessly with hay fever symptoms,’ says Dr Helen Evans-Howells
‘This creates a cycle of dependency whereby you’re permanently congested unless you are using it,’ adds Professor Rudenko, who sees patients who have become dependent on these medications.
Instead, saline washes such as Sterimar or Sinusalt can help people with milder symptoms by cleaning out allergens and mucus.
Note that nasal decongestants are different from antihistamine nasal sprays, which can help, by blocking the receptors to histamine on blood vessels and nerves (histamine is a chemical responsible for triggering the allergic symptoms).
Using antihistamines as a spray means they act directly on the nasal lining where symptoms occur, so offer quicker relief than oral antihistamines.
Professor Rudenko says the most effective are antihistamine sprays containing azelastine (brand name Alestin, available over the counter) or olopatadine (brand name Opatanol, on prescription).
Your GP or allergist can also prescribe nasal sprays that combine both antihistamines and corticosteroids if stronger medication is needed.
ARE YOU USING THE WRONG ANTIHISTAMINE?
When it comes to pills, ‘many people either pick the first antihistamine they see on pharmacy shelves, or assume they are all equally effective – but this isn’t the case,’ says Professor Adam Fox, a consultant paediatric allergist at Evelina London Children’s Hospital.
Saline washes such as Sterimar can alleviate milder symptoms
Antihistamines work by blocking the effects of histamine (released by the body as it tries to rid itself of the pollen, causing sneezing etc).
Older-style medications such as Piriton, containing chlorphenamine maleate, only work for a few hours and also have a sedating effect, says Professor Fox.
But the new generation of non-sedating antihistamines work for 12 to 14 hours and rarely cause drowsiness.
Look for medications containing cetirizine (e.g. Zirtek) and loratadine (e.g. Clarityn) – generic versions are just as effective as branded products.
ARE YOU SQUIRTING YOUR NASAL SPRAY INCORRECTLY?
‘Many people don’t use these properly, so don’t receive the full dose – they end up thinking their hay fever is hard to manage, when in fact improving their technique could make a big difference,‘ says Dr Evans-Howells.
‘Most people simply sniff them but you need to tip your head forwards then squirt a couple of sprays into each nostril – aim towards your ear to get the correct angle.
‘There’s a temptation to tip your head back, but if you do this the medication drips down the back of your throat rather than being absorbed into your nasal lining,’ she explains.
Correctly using a nasal spray can also help relieve eye symptoms, including itchiness and redness, says Professor Fox, due to a ‘reflex connection’ between the eyes and nose (i.e. a neural pathway connecting two areas).
STOPPING YOUR MEDICATION TOO SOON
‘Many people stop taking their medication once their symptoms ease, but hay fever requires consistent treatment,’ adds Professor Rudenko, who advises taking antihistamines and nasal sprays daily until the season ends, regardless of symptoms, as ‘stopping early leads to flare-ups’.
A 2021 Allergy UK survey found 42 per cent of hay fever sufferers stopped taking medication once symptoms improved, leading to symptoms recurring.
DON’T JUST RELY ON THE MEDICATION
Experts agree that to manage hay fever symptoms successfully you also need to take practical steps to avoid coming into contact with pollen in the first place.
Allergy UK advises staying indoors when the pollen count is high (you can check the pollen count on the Met Office website, metoffice.gov.uk); wearing wraparound sunglasses to prevent pollen getting into your eyes; washing and showering to rinse away pollen when you come home; and avoiding hanging washing outside to dry – it can become a ‘pollen trap’.
CAN’T SEE IT? DON’T ASSUME THERE’S NO POLLEN
‘Some people assume that visible pollen – such as the poplar’s fluffy white seeds – is the main cause of their hay fever,’ says Professor Rudenko.
‘However, poplar pollen is large and sticky – designed to be carried by insects, not the wind,’ he explains.
‘Most hay fever is actually triggered by smaller, lighter pollen from grasses or trees such as birch, which are microscopic and more easily inhaled.’
Making assumptions about what type of pollen is to blame for your allergy can lead to ‘ineffective avoidance strategies’, he says, such as tracking and avoiding the wrong pollen counts.
SYMPTOMS THAT MEAN IT’S NOT ‘JUST’ HAY FEVER
Quite apart from the classic sneezing, dripping congested nose and itchy red eyes, hay fever can also lead to other, less obvious, symptoms.
Headaches may be another sign, as a congested nose can lead to a blocked sinus and inflammation.
This in turn can cause pressure to build up, triggering a headache.
You may particularly feel the pressure around the upper part of your nose and behind your eyes, which may even extend down to your jaw.
Reduced sense of smell – and taste – known as anosmia, may also develop, due to the inflammation in your nasal passages.
However, you should see your GP if you experience symptoms, including a total loss of smell, nosebleeds, post-nasal drip, a nose that’s blocked on one side only, loss of vision and facial pain – as these could be early signs of a nasal tumour, says Dr Evans-Howells.
Don’t be fooled by not being able to see the pollen – smaller, less visible variants can be inhaled more easily
Conversely, if you develop certain hay fever-like symptoms in your 60s, do not immediately conclude an allergy is to blame, she adds.
They could instead be due to non-allergic rhinitis (when nasal congestion and sneezing aren’t caused by an allergy).
This might be as a result of taking aspirin, or other non-steroidal anti-inflammatory drugs such as ibuprofen, which have been found to trigger or worsen these symptoms in some people.
Equally, developing red, gritty, itchy eyes for the first time in your 60s and 70s, is unlikely to spell hay fever, says Dr Evans-Howells.
One reason is that it’s rarer for people to develop allergies as they get older – symptoms tend to peak when the immune system is at its strongest in our 20s and 30s.
However, the immune system weakens with age, leading to a weaker allergic response – and less troublesome symptoms.
Instead, eye symptoms are more likely to be due to blepharitis – inflammation of the eyelids, which causes a gritty or burning sensation in the eyes and swollen, itchy eyelids – which is more common in those aged 50 and over.
This is due to natural age-related changes in the eye’s secretions, which mean the eyes are more likely to become clogged up, leading to infection.
Older people are also more prone to dry eye, a condition linked to blepharitis, adds Dr Evans-Howells.
DON’T BE TEMPTED BY ‘HAY FEVER INJECTIONS
‘Don’t suffer this summer!’, ’Just one injection needed to reduced hay fever symptoms for the whole season’. These are just two of the adverts that the Mail found on social media this week enticing hay fever sufferers to pay for ‘hay fever injections’, with the drug Kenalog.
Now discontinued by the NHS. experts unite in warning against its use for hay fever.
The treatment – which costs around £50 a shot – involves injecting a large ‘depot’ dose of steroids, usually into the buttock muscle, and suppresses the body’s immune response to pollen over the following weeks and months.
Kenalog (generic name, triamcinolone) is also used in specialist clinics, with appropriate supervision, to treat joint pain from inflammatory conditions such as rheumatoid arthritis.
But its use was discontinued for hay fever by the NHS following warnings from the UK’s independent medicines regulator, the Medicines and Healthcare products Regulatory Agency (MHRA), about the potential side-effects.
‘Current medical evidence strongly warns against using steroid injections for hay fever due to serious risks,’ says Professor Rudenko.
‘Studies show repeated injections can cause adrenal insufficiency – where the body stops making vital hormones, leading to fatigue, low blood pressure and nausea – and may also cause glaucoma [where the optic nerve connecting the brain and eye becomes damaged], cataracts, osteoporosis, diabetes and depression,’ he explains.
Dr Evans-Howells adds: ‘Yet despite this, plenty of private aesthetic clinics and even hairdressers still offer this treatment for hay fever – and influencers extol its virtues.
‘You should avoid these risky injections,’ she warns.
