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Hay Fever: What You Need to Know

Summer is officially on the way, and with it the promise of beer gardens, barbecues and… blowing our noses. According to the NHS, around 10 million Brits suffer from hay fever and, though it doesn’t pose a serious health threat, it can be extremely disruptive to our everyday lives.

The question most hay fever sufferers find themselves asking is "why me?" Known risk factors include a family history of hay fever, and having other allergies. But if recent research is anything to go by, hay fever could also be closely related to month of birth. Researchers found that babies born in the autumn and winter were more likely to develop asthma, hay fever and food allergies than those born in the spring and summer.

The good news is that – no matter when they were born – lots of people find their symptoms improving as they get older, and in some cases disappearing altogether. And for those who still find themselves in the pollen firing line every summer, there are many ways to make life easier.

What causes hay fever?

Hay fever is caused by an allergy to pollen, which is released from plants during their reproductive cycle. The pollen gets into your eyes, mouth, nose and throat when you go outside, and causes an allergic reaction.

There are three types of pollen that can cause hay fever: tree, grass and weed. Tree pollen is released during spring, grass pollen is released during spring and the beginning of summer, and weed pollen is released during autumn. Around 90% of people in the UK who suffer from hay fever are allergic to grass pollen, while around 25% are allergic to tree pollen. An allergy to weed pollen is less common.

Though spring and summer are the worst times of year for hay fever, sufferers should find that their symptoms vary from day to day depending upon the pollen count. The pollen count records how much pollen is in the air, and the higher it is, the worse symptoms will be. It is also affected by the weather; on warm, humid, windy days the pollen count will be higher.

You can check the pollen count for the UK here.

What are the symptoms of hay fever?

Hay fever affects the eyes, nose, ears and throat. The classic symptoms are sneezing, a runny or blocked nose, itchy or watery eyes, itchiness in the nose, ears or throat, and coughing. Some people also experience pain in the sinuses, headache, earache and a general feeling of tiredness.

If you suffer from asthma, you might find that a flare up of hay fever causes your asthma symptoms to get worse.

How is hay fever treated?

Hay fever does not normally require medical attention, as it can be easily treated and managed at home.

Antihistamines are the most common treatment for hay fever. They are a type of medicine taken to treat mild allergic reactions, and are very effective at easing itchiness, sneezing, and watery eyes. They are available over the counter from pharmacies in tablet form, and also as droplets or sprays. You can take antihistamines to treat existing symptoms, or to prevent yourself from developing symptoms. Other over-the-counter treatments include nasal decongestants and eye drops.

If you find that over-the-counter treatments are not working, you can visit your GP or a trusted online health service such as The Online Clinic. Doctors can prescribe stronger antihistamines, corticosteroids, prescription nasal decongestants, and – immunotherapy – but this needs to be commenced well in advance of the hay fever season. If your hay fever leads to sinusitis (inflammation of the sinuses) or an ear infection, you may require antibiotics.

At The Online Clinic, you can order a range of effective antihistamine tablets, nasal sprays and eye drops using our safe and secure private prescription service. Click here to receive a hay fever consultation.

How can I avoid the symptoms of hay fever?

Unfortunately it is not always possible to avoid the symptoms of hay fever. However, taking a few simple precautions can help you manage your condition. Keep track of the pollen count during the months you are affected, and if it is particularly high, take antihistamines before you leave the house, and wear sunglasses to protect your eyes.

The increase of allergies is a growing problem across the UK and it is estimated that one in three suffers from some of the most common allergies. The effect of allergies does not only affect the sufferers in their daily lives, but also lead to hospital visits. The most recent figures suggest that a total of 20,000 hospital visits were made last year due to allergies. One explanation that seems to be as persistent as the allergies is the idea that we are in this situation because we are living lives where we often avoid both good and bad bacteria which leads to a lower immune system. Here we consider whether less bacteria means more allergies.

The idea of us leading a lifestyle devoid of bacteria and not developing resistance to essential bacteria began in 1989 and was called the hygiene hypothesis. It has since then cropped up in debates under various names, with “our old friends” being the most recent one. Any decent scientist will tell you that some ideas stick more than others. It is not hard to see the appeal of the idea, as it explains complex systems in a simple way. But is there any weight to it?

The development of a strong immune system is something that occurs during interaction with the environment at various stages in the lifespan. Yet the field of research has tended to focus on pre-natal and post-natal environment.

For instance, studies that have shown that individuals who were born via Caesarean are more likely to suffer from asthma have postulated that this could be due to the lack of contact with the bacteria present in the birth canal. However, those researchers have stressed that this could be a contributing factor, rather than a cause. Similarly, studies that have found that bottle-fed babies appear to have a higher prevalence of allergies have argued that perhaps bottle-fed babies do not have complete access to nearly 900 different types of bacteria that can be produced in breast milk.

Whilst the above field of research is compelling, it does not provide us with a comprehensive overview of the forces at hand. It would be surprising to find any study that says a person’s health is determined after breast or bottle-feeding. Similarly, as individuals are more exposed to a wide range of foods later on in life it would hold that this increased exposure would decrease allergy development rather than the other way round.

An interesting field of research suggests that an inactive lifestyle where a person stays primarily indoors has a strong impact on the development of allergies. The most convincing studies have supported this by demonstrating that children on farms have lower levels of asthma. This is further heightened by a recent study that argued that there is a relationship between having indoor plants and lower level of allergies. On a side note it may be worth mentioning that research is yet to find that the use of cleaning products indoors appears to have negative effects.

It is also important not to ignore the effects of genetic vulnerability. Whilst some studies show that the use of antibiotics at an early age can have negative effects, it does not affect all individuals. In addition to that, it can be seen that some studies downplay or do not adjust appropriately for a family history of allergies when analysing their results.

What these examples show is that bacteria (or lack thereof) often play an important role in a complex interaction between genetic vulnerabilities and environmental factors. It also shows that it is impossible to lead a lifestyle devoid of bacteria. It is therefore not enough to say that we have too much or too little of a certain bacteria. We need to look at the whole picture.

Researchers have long believed that allergies are the result of a complex interplay between genetics and the environment. Despite significant efforts to unravel these mechanisms, most findings have tended to find ways to alleviate symptoms rather than eradicate them. However, a recently published study has opened a new avenue for research to consider the role of genetics in the development of allergies.

In the study, which was published in Science Translational Medicine, the researchers looked at the occurrence of allergies in a group of 58 children who all had Loeys-Dietz Syndrome (LDS). Within that sample, 31% had food allergies, 45% suffered from asthma and a significant number of them had various types of nasal allergies.

The patient sample was particularly suitable for research into allergies, as the proportion of participants that had one or more allergies was at a significantly higher rate than would generally be found in the population. In addition to that, the participants were particularly suitable for the purpose of the study, as it is commonly known that LDS patients tend to have mutations in specific genes that can result in abnormal TGF-beta signalling. This was paramount to the research, as the role of TGF-beta was one of the key areas of the current study.

After analysing the blood samples, the researchers confirmed that the participants had abnormally high levels of the so-called TGF-beta protein as well as unusually high levels of regulatory T-cells. In addition to that, the researchers noted that the regulatory T-cells were secreting cytokines, which are molecules commonly known for their allergy promoting effects.

As regulatory T-cells have a part in immune cells maturation, which in turn is controlled by TGF-beta, the researchers were keen to see what role TGF-beta played in this situation. Further analysis revealed that the participants had abnormally high levels of a transmitter of TGF-beta signalling called SMAD. This was further corroborated by other research that has indicated that LDS patients treated with a medication that tends to tame TGF-beta signalling had reduced levels of the protein. However, it was not currently known if that sample had a lower level of allergies.

Based on this, the researchers argued that the genetic glitch that leads to the development of illnesses such as LDS also could hold the key for understanding the development of a range of allergies that are common co-morbidities associated with LDS.

Although the tests in the current study were rigorous, we are not yet convinced by the findings. The sample was very limited and had a broad age range between 7 and 20, which means that there could have been several other factors that affected the outcome.

Having said that, there is little doubt that the mechanisms described are plausible and offer an attractive explanation for a complex issue. However, we feel that more research in various populations is needed to replicate and corroborate the findings. A very simple explanation of this study can be found here.

A research team from University of Cambridge claims to have found the way the body’s immune system detects cat allergen, which has raised hopes of new treatments being developed.

The study behind this announcement was recently published in the peer-reviewed Journal of Immunology. The purpose of the study was to look at how cat dander (tiny skin particles from cats) affects the so-called TLR4-signalling on the LPS protein on a molecular level. The key findings indicated that cat dander firstly binds to the bacterial surface of LPS, which is recognised by TLR4. Then, once it is recognised, a signalling cascade will commence, which will ultimately result in an immune response. In order for this to occur, there also has to be a protein called MD2. MD2 binds LPS to TLR4.

As the purpose of the study was to establish a series of events at a molecular level that are necessary for the immune system to be activated, the researchers did two types of analyses. Initially they included cat dander but excluded MD2, which led to a small increase in TLR4 signalling. This indicated that cat dander on its own would not be sufficient to create an allergic response. Then the researchers added MD2, which led to a 16 fold increase in TLR4 signalling. This suggested that both cat dander and MD2 are needed for an allergic response to occur.

Based on this, the researchers stated that they had solid data to support further trials with treatments that use TLR4 antagonists to prevent LPS binding to TLR4.

The findings from the current study are certainly intriguing and could open up the possibility for new treatments being developed and marketed in the near future. We are aware of trials that are currently looking at the efficacy of treatments with TLR4 antagonists; however they are still in very early stages. It is our hope that the current trials prove fruitful and that it leads to new avenues for treatment and research.

The Online Clinic is pleased to announce that we now have Dymista available to prescribe for hay fever sufferers. Dymista is a novel hay fever treatment as it contains both a steroid and an antihistamine. The combination of these two types of medications ensures that the treatment starts working to relieve symptoms very quickly. The active ingredients in this product are fluticasone and azelastine. This medication is designed for hay fever sufferers who experience rhinitis.

One of the problems with current hay fever medications is the time that they take to work, so we run into patient adherence issues: Patients think that the medication is not working so they stop their treatments and the lack of success becomes a self-fulfilling prophesy. Dymista appears to provide clear benefits within a few days, so it may be substantially better than anything else that we have available to us for prescription.

Dymista contains a steroid so we need to be very careful that this product does not exacerbate any existing condition or infection. Please complete our online questionnaire to check if Dymista is going to be suitable for you. This treatment is available for next day delivery. You can read more about Dymista here.