Take a deep breath
Are you ready for the hay fever season?
For anyone celebrating the arrival of spring by stockpiling overthe-counter hay fever treatments, news of a new vaccine may come as blessed relief. The treatment, developed in Vienna, involves synthetic grass pollen being injected into the sufferer’s system, reducing the classic wheezing and sneezing symptoms by 25 per cent. It is also said that three injections a year could leave sufferers symptom-free.
That’s the good news. But those for whom spring and summer are synonymous with red eyes and handkerchiefs – an estimated one in five of the population – there’s bad news, too. Though the vaccine, known as BM32, passed its latest trials earlier this month, it has another round before it can be approved – and won’t be available until 2021 at the earliest.
While the latest research, published in the Journal of Allergy and Clinical Immunolog y, is certainly encouraging, that’s three more summers to sneeze our way through. So if you’re one of the estimated 18 million Britons with established hay fever, or one of the newly affected – figures from the Royal College of General Practitioners (RCGP) showed last summer that the rate of patients presenting in surgeries with hay fever had doubled since 2016 – how best to tackle the condition now?
There’s no time to waver. For many, hay fever kicks off in late March, when tree pollen gets airborne. As that wanes in mid-may, grass pollen becomes a trigger for three months, with weed pollen becoming an issue from the end of June into September.
“Hay fever – or allergic rhinitis – is an allergic reaction to pollen,” explains Professor Helen Stokes-lampard, chairman of the Royal College of GPS. She says: “It’s something that many people suffer from, particularly in the spring and summer months, when it’s often warm, humid and windy.”
She adds: “In most circumstances, symptoms can be helped with over-the counter antihistamine medication, and by taking simple steps to reduce a person’s exposure to pollen.
“Measures can include making sure windows and doors are shut, having a shower after being outside, applying Vaseline to nostrils to help trap pollen particles, and buying pollen filters for indoor air vents. It’s also advised that patients avoid keeping fresh flowers indoors, stay away from smoke and, where possible, keep pets outside.”
Interestingly, antihistamines are coming under new scrutiny. Recent research, from the Institute of Biology and Experimental Medicine in Argentina, said that hay fever tablets can affect the production of male sexual hormones in the testicles, which can lead to lower quality sperm, as well as a reduced sperm count.
Moreover, the widespread consumption of hay fever pills could be contributing to the increase of antibiotic resistance by changing the growth of bacteria in the human gut.
Researchers from the European Molecular Biology Laboratory (EMBL) looked at the impact of 1,000 common drugs on 40 strains of gut bacteria and found that loratadine, a common hay fever medication, was one of those having a negative impact as it may be encouraging so-called “unhelpful bacteria” to develop new resistant strains in the same way as antibiotics do.
Part of the problem for suffers, says Anand Kasbekar, a consultant ENT surgeon and honorary assistant professor at Nottingham University Hospitals and The Spire Nottingham Hospital, is that good management of hay fever can be a bit of a postcode lottery.
“It’s managed variably across the country, in primary and secondary hospital care. There are recommended guidelines which doctors should be following,” Mr Kasbekar says.
“In addition, the financial strain on the NHS means that people don’t always get referred for specialist help as quickly as they could.”
He recommends that anyone presenting with hay fever is also asked a few key questions to pick up possible undiagnosed asthma.
“A lot of patients with asthma also have allergic rhinitis, and effective treatment of the nose improves the chest and asthma symptoms. Similarly, effective treatment of the asthma improves the nasal symptoms.”
If you do get referred, options include steroids, which may be delivered as tablets or in a nasal spray. But steroids bring significant side effects which must be weighed up.
Prolonged use of most nasal steroid sprays are safe although can lead to thrush infections in the throat, as well as hoarseness.
Stronger doses taken by mouth, or Kenalog injections of triamcinolone acetonide (usually into the buttock, and before the hay fever season gets going), can cause nausea, bloating, stomach pain, osteoporosis, high blood pressure and insomnia.
Prof Stokes-lampard said: “Kenalog injections were withdrawn from the NHS several years ago.
“Despite being highly effective drugs for some conditions such as hay fever, research demonstrated that they also led to serious adverse side effects in a few people, which was too great a risk for the NHS to continue with. It is possible to administer steroids in different
New research says hay fever tablets may lower a man’s sperm count
ways, which can be nearly as effective and have far fewer side effects. However, patients specifically seeking the injection may wish to enquire about it privately.”
Most of us will make do with an over-the-counter treatment, but are you getting the full benefit? “For some people, [to get the most out of a nasal spray] surgery is needed,” says Kasbekar, “as medication may not be able to get into the nose if the nasal cartilage is really bent.
“A septoplasty, where we straighten the nasal septum, allows the medicine to get into the nose and can really help with effective symptom control.”
In certain circumstances, if the treatment doesn’t work, a patient might be sent for immunotherapy working with a specialist allergy team. This means being exposed to increasing doses of an allergen, such as grass pollen, under medical supervision.
Currently, that might mean an injection four times a year or a few months’ worth of daily tablets taken for three years. A study by Imperial College London, published in the journal JAMA last February, found that immunotherapy treatments were highly effective as long as they were pursued for three years.
These results – at about 60 to 70per cent reduction of symptoms – are better than those offered by the new Austrian immunotherapy vaccine still undergoing trials, according to
Professor S Hasan Arshad, chairman in allergy and clinical immunology at the University of Southampton.
Prof Arshad says: “Traditional immunotherapy desensitises the patient by exposing them to the whole protein that is causing the allergy. Now scientists are isolating the part of the protein, the peptide that engages with the immune system.
“If we inject that, patients won’t get a reaction but will still build up tolerance. It’s safer and effective and we can use a high dose immediately and reduce the number of injections, so everyone is happy.”
He adds: “I think the Austrian vaccine looks promising, but will need to show better efficacy before it will become available.” By comparison, traditional antihistamine tablets have been shown to cut hay fever symptoms by up to 20 per cent, and nasal sprays by up to 30per cent.
And what about a drug-free approach? Dee Atkinson, a medical herbalist, says that sufferers should be proactive – and start their regime now. “My top tip is to start treatment a good three weeks before your hay fever usually begins.”
She recommends “a multi-faceted approach – some dietary advice, often to cut out dairy products, combined with a focused herbal remedy. My ‘go-to’ herbs include Luffa operculata
(sponge cucumber), to relieve typical hay fever symptoms such as sneezing, a tickly nose or throat and blocked nose, and I often recommend
Euphrasia (eyebright) eye drops and a Luffa nasal spray to be used at the same time.”
Like Prof Stokes-lampard, Kasbekar says the most important measure we can take is to avoid allergens in the first place. “Keep the window shut at night when pollen levels are high. Keep your house clean to avoid dust mites. These are simple things you can do before you think about medication.”