It’s the time of year again that is dreaded by millions: the start of hay fever season.
Many people who don’t suffer from hay fever, or only suffer mildly, don’t understand what a torment it can be.
Sometimes it’s dismissed or trivialised – even by doctors – but pollen allergies can badly affect the quality of a person’s life, making it difficult to work or go to school.
As spring gets underway and temperatures rise, my surgery is already filling up with patients seeking help for the all-too-familiar symptoms which – after months of respite over winter – have returned with a vengeance: congestion, a runny nose, itchy eyes that are constantly streaming, and a throat that’s raw from sneezing.
And the bad news is that research suggests this summer will be particularly harsh for hay fever.
One of the most common things desperate sufferers ask me about is the so-called hay fever injection.
This drug, called Kenalog, works by suppressing the body’s immune response to pollen. And it is very popular in Europe and the US.
However, several years ago, the NHS decided to stop offering Kenalog due to concerns that it triggered serious side effects.
When Dr Ellie Cannon is asked by patients about the Kenalog injection, she makes them aware of the safer option of immunotherapy
These include high blood pressure, headaches, dizziness, skin rashes, depression and breathing difficulties. There is even some evidence it can make patients more susceptible to infections such as flu and shingles.
Yet, despite these concerns, Kenalog is available at many private clinics in the UK, which is why patients still ask me what I make of it.
Many are surprised when I tell them that there is a much more effective – not to mention safer – option already available on the NHS.
This relatively new treatment is called immunotherapy and I’m personally very interested in it because I’m hoping it will work wonders for my son.
Hay fever, also known as allergic rhinitis, is a pollen allergy that affects around 13million people in the UK – one in four adults and one in ten children.
It’s caused by the body’s natural defence cells wrongly identifying pollen as a threat and over-reacting.
The bloodstream is then flooded with the chemical histamine – which causes the unpleasant symptoms as the body tries to flush out the pollen.
The idea behind immunotherapy is to expose the body to tiny amounts of pollen over a long period of time, so that the immune system becomes desensitised and doesn’t over-react.
This involves taking daily pollen tablets every day, usually beginning at the end of the summer in order to prepare the body for the next hay fever season.
For the past nine months my 18-year-old son, Jude, has been taking a pollen immunotherapy tablet called Grazax.
He developed hay fever in primary school but it got worse as he progressed through secondary school. The condition is particularly unfair for young people, because hay fever strikes exactly when they’re doing exams and need to be well – and when they want to be out enjoying themselves.
Jude got through his GCSEs with standard hay fever treatments: nose sprays such as Beconase or Pirinase which contain corticosteroids that narrow the blood vessels in the nose to ease congestion, and over-the-counter antihistamines such as cetirizine and fexofenadine which block the effects of histamine to tackle the symptoms.
But with A-levels and university looming, he was keen to explore other treatments too. Last summer he saw an allergist who carried out tests which showed he is extremely allergic to tree and grass pollen – but not to dust, food or pets.
The allergist recommended a three-year course of immunotherapy tablets containing tree and grass pollen.
The first dose has to be taken under supervision in case it triggers a severe allergic reaction. And although the first pill made Jude’s tongue tingle, he’s been fine with the tablets ever since.
It’s still too early to be sure how well it’s working, but we’re really optimistic. If the symptoms are a half or even a quarter as bad as they were before, that might mean only taking one anti-histamine a day rather than three, or maybe not needing eye drops – which would be great.
Unfortunately, patients who want to access immunotherapy on the NHS often have to wait as long as a year to be seen. And, typically, only those with the most severe allergies will be offered the treatment.
Some people choose to go private and purchase the tablets for around £130 a month. However, any patient who thinks their hay fever is bad enough to warrant this treatment should speak to their GP now so they can begin the process of getting a referral to an allergy specialist.
And, in the meantime, here are some other steps patients can take to beat the misery of hay fever…
Many patients use their nasal spray incorrectly, which makes it less effective and also increases the risk of side effects, such as soreness and nose bleeds (picture posed by model)
Get tested to find out whether it’s trees or weeds causing suffering
If you’re suffering from bad hay fever it can be useful to know exactly what you’re allergic to.
The NHS doesn’t typically offer allergy testing – except for children with severe food allergies. But it’s worth considering privately. This can usually be done for around £150.
It might show that pollen isn’t, in fact, to blame. Some people wrongly believe they have hay fever when the cause is actually dust or pet allergies
However, if you are allergic to pollen, knowing which type triggers the allergy can help you prepare better for hay fever season.
Tree pollen is most common in mid-February to mid-July, while grass pollen is most common in June and July and weed pollen between May and August.
Knowing which type of pollen is responsible for symptoms means patients can start taking their hay fever medicine at the right time.
Start taking the pollen pills before symptoms start
One problem with the commonly available treatments is that people don’t start taking them early enough.
Even if patients haven’t had allergy testing, they generally know from past experience when in the year their symptoms are likely to begin.
Steroid nasal sprays reduce inflammation and can relieve symptoms such as sneezing and a runny or blocked nose. But a lot of people don’t realise they take a few days to work, so it’s best to begin taking them one or two weeks before you think your symptoms will start. The same is true for anti-histamine tablets.
Once a patient’s allergic reaction to pollen starts, it’s harder to stop. But, by starting antihistamines a few weeks early, you can effectively block the reaction before it begins.
Likewise, many patients are guilty of only taking the tablets sporadically – usually when their symptoms flare up. But this is always too late to make much difference.
Instead, patients should take an antihistamine daily, even twice or three times a day, if that’s what the doctor or pharmacist has recommended.
You’re probably using anti-pollen nasal spray the wrong way
I’m always astonished how many of my patients don’t know how to use nasal sprays properly.
Many simply shove it up their nose and hope for the best. Using them incorrectly not only means the medication may not be effective, it also increases the risk of side effects, such as soreness and nose bleeds.
The aim of these sprays is to narrow the blood vessels in the lining of the nostrils, thereby reducing the amount of swelling and mucous produced.
The right way is to blow your nose first, then tip your nose down towards your toes, and insert the nozzle just inside your nostril.
I often advise patients to use the opposite hand for each side, so if you’re spraying up your left nostril, use your right hand and vice versa.
This directs the medication outwards, away from the centre of your nose. Repeatedly applying these sprays to the centre of the nose is what typically triggers uncomfortable side effects.
Then, press the spray to release the dose and breathe in steadily through your nose. Do not sniff hard or you risk swallowing the medication, reducing its effectiveness. Finally, remove the spray from your nostril and breathe out through your mouth.
Vaseline could be the answer when drugs fail
Smearing Vaseline on the base of the nose can trap pollen, stopping the particles from going up the nose
It might seem as though pollen is inescapable in the summer but, in fact, there are steps patients can take to avoid the allergen in the first place.
When pollen levels are highest, doctors often advise those with lung conditions, such as asthma, to stay indoors to avoid inhaling the particles. This can flare up their symptoms.
But even for those with milder allergies, keeping windows closed can go a long way to keeping pollen out of the house.
In the same manner, washing the hands and hair when coming indoors can prevent pollen from getting on to sheets and surfaces.
Wraparound sunglasses can prevent pollen from getting into your eyes, as can splashing them regularly with cold water. If your eyes do become red, itchy, or swollen, don’t be tempted to rub them as it will only irritate them further. Instead, press a cold, damp, cloth against them – and use an antihistamine eye drop to reduce the inflammation.
Finally, one piece of advice many people do not know is that smearing Vaseline gel on the base of the nose can trap pollen, stopping the particles from going up the nose.
The truth is that no one will ever be cured of hay fever. It’s a lifelong condition which, even with immunotherapy, will always be somewhat annoying in the summer months.
But, I hope by following the steps I’ve laid out, people can drastically reduce the disruption and discomfort caused by this very common allergy.