How to manage grass pollen exposure this hay fever season: an expert guide



Spring has sprung, which means it’s hay fever season.
From shutterstock.com

Janet Davies, Queensland University of Technology; Connie Katelaris, South Western Sydney Local Health District, and Danielle Medek, Australian National University

Nearly one in five Australians are affected by hay fever. If you’re one of the unlucky ones, you’ll know how troublesome the symptoms can be.

Grass pollen is the major outdoor trigger of hay fever and allergic asthma. Pollen grains contain a variety of allergens that can trigger allergic reactions in people who are sensitised to pollen.

The good news is, if pollen is a problem for you, there are things you can do to manage your exposure to it. By adopting some simple tips alongside preventative medications, you may find this hay fever season a little more manageable.




Read more:
How do you know if your child has hay fever and how should you treat it?


What causes hay fever?

People who are genetically prone to develop allergies may become sensitised to pollen.

Sensitisation involves development of specific antibodies (called Immunoglobulin E, or IgE) that can bind to the triggering allergen. Repeated exposure to the triggering allergen leads to the activation of inflammatory cells, causing the release of histamine and other mediators. That’s when the symptoms kick in.

An allergic reaction to pollen can lead to hay fever symptoms affecting the upper airways, including itchy, watery eyes, an itchy, inflamed throat, a runny or blocked nose, and sneezing.

Pollen allergy can also lead to what we call allergic asthma – if the allergen components enter deeper into the lungs, this can cause inflammation and symptoms of asthma, like shortness of breath.

While hay fever has long been regarded a trivial condition, it can be a serious chronic disease associated with other problems such as sinusitis, sleep disturbance because of nasal blockage, and asthma, leading to fatigue and poor performance at work or school.

What can you do to reduce exposure to pollen allergens?

The tragic thunderstorm asthma epidemic of November 2016 in Melbourne shocked many and elucidated the potential harm of grass pollen exposure.

Lessons from this event illustrate staying indoors with the windows closed reduces risk of experiencing severe symptoms.

Many people affected by thunderstorm asthma recall being outside prior to the passage of the thunderstorm across the greater Melbourne region during the late evening of November 21, 2016.




Read more:
What’s the link between hay fever and asthma, and how are they treated?


Of course, this was an uncommon event, and the majority of people who get hay fever will not experience this level of illness.

On high pollen days, or after thunderstorms in spring, people who are allergic to pollen should stay inside with windows closed when possible. They should also drive with the car windows closed and the air on a setting where it’s circulating, rather than coming in from outside.

Other actions people can take to reduce allergen exposure are to hang washing inside or use a tumble dryer on high pollen days, avoid activities such as mowing the lawn, wear sunglasses outdoors, and shower after activities likely to involve pollen exposure.

Close to one in five Australians suffer from hay fever.
From shutterstock.com

A national standardised pollen monitoring network

For people with hay fever, knowing when the pollen count is likely to be high can be helpful in managing exposure. There are an increasing number of mobile apps you can use to monitor the pollen count in your area in real time.

A screenshot from pollen monitoring app ‘Melbourne Pollen Count’.
Screenshot

In 2016, the National Health and Medical Research Council funded the AusPollen Partnership. Since its inception, and with the efforts of many researchers, a national standardised pollen monitoring network is being established to help address unmet needs of patients with hay fever and allergic asthma in our community.

The AusPollen Partnership seeded the growth of a number of projects in which pollen monitoring is a key activity; for instance AirRater in Tasmania and VicTAPS in Victoria. Australian pollen monitoring sites now adopt standard protocols to harmonise pollen monitoring processes so data is comparable between locations.

While expanding the pollen monitoring network, we’ve had the opportunity to evaluate how providing people with local, current daily pollen information helps.

In a pilot study, we found people who didn’t have access to local pollen information indicated a desire to have local pollen information, while people who did have access to pollen information reported it was very useful. Respondents used pollen information to plan their daily activities, to minimise pollen exposure and to optimise medication use.




Read more:
Health Check: what are the options for treating hay fever?


Preventative medication has an important role

While minimising exposure to pollen may help reduce symptoms when pollen levels are high, the cornerstone to symptom management and safety during the pollen season is preventative medication like steroid nasal sprays and antihistamines. These can reduce the underlying allergic inflammation and alleviate symptoms of hay fever.

Before the onset of the pollen season, people who are allergic to pollen and suffer from troublesome symptoms should start using medications daily. Control of underlying allergic inflammation in the upper airways is best achieved with nasal sprays containing a topically active steroid. Non-sedating antihistamine tablets and eye drops provide symptom relief (but don’t alter the underlying inflammation).

Seasonal asthma and/or thunderstorm asthma can occur during the grass pollen season in some people with pollen allergy. Those who experience lower airway symptoms during the grass pollen season such as a cough, tight chest, breathlessness or wheeze, should seek medical attention to consider whether they have undiagnosed asthma.




Read more:
Thunderstorm asthma: who’s at risk and how to manage it


The Conversation


Janet Davies, Professor, Queensland University of Technology; Connie Katelaris, Professor of Immunology and Allergy, UWAS & Head of Unit, South Western Sydney Local Health District, and Danielle Medek, Physician trainee, researcher, Australian National University

This article is republished from The Conversation under a Creative Commons license. Read the original article.

How do you know if your child has hay fever and how should you treat it?



It comes down to the persistence of symptoms.
Littlekidmoment/Shutterstock

Paxton Loke, Murdoch Children’s Research Institute

Spring has sprung and if you’re one of the one in five Australians who get hay fever, you’ve probably noticed some of those pesky symptoms: sneezing; an itchy, runny or stuffy nose; and red, itchy, watery eyes.

Unfortunately children aren’t immune. One in ten will get hay fever – or allergic rhinitis, as it’s known in the clinic – and the rate appears to be rising.

Pollens generally cause seasonal symptoms (in spring or summer), while house dust mites are mainly responsible for year-round symptoms.

Children who are allergic to both seasonal and perennial allergens may experience a marked increase in their symptoms during spring.

Hay fever can lead to fatigue, irritability and poor concentration, and can affect children’s learning and social behaviour. But the good news is it’s usually easily treated.




Read more:
Future hay fever seasons will be worse thanks to climate change


Why do kids get hay fever?

Hay fever can begin as early as 18 months of age, when children are exposed to pollens or house dust mites.

Tiny particles get trapped in the hairs and mucous that line their nasal cavity, or can enter via the conjunctiva – the tissue that covers their eye.

The body treats these invaders as dangerous and mounts an attack, using antibodies called immunoglobulin E, or IgE.

When the allergens bind to IgE antibodies, which are present on immune cells (such as mast cells), the cells quickly release chemical mediators, including histamines and leukotrienes. This causes sneezing, itchy and/or runny nose, and itchy, watery eyes.

The body then recruits other immune cells, such as T cells, causing more inflammation and worsening symptoms.

How do you know if it’s hay fever?

While hay fever can be a life-long health issue, symptoms can fluctuate over time.

As well as sneezing, an itchy, runny nose, and itchy watery eyes, you might notice your child has a dry cough, is snorting or sniffing, or continually clears their throat.

In some instances, they might make a clicking sound with their tongue when they use it to scratch the roof of their mouth.

Hay fever symptoms in children are the same as adults.
Creatista/Shutterstock

While these symptoms may initially look like the common cold, the persistence of symptoms after weeks usually points towards hay fever.

Children with hay fever usually don’t have fevers (which are more common with infections) but they may be more prone to recurrent colds.




Read more:
Health Check: how to tell the difference between hay fever and the common cold


If you’re unsure, take your child to your local doctor for a diagnosis. If necessary, they can use skin prick or blood tests to detect the presence of relevant IgE antibodies to the suspected allergens.

Your doctor may then discuss the three main treatment options: avoiding the allergen, oral and topical medications, and allergen immunotherapy.

Avoiding the allergen

Once you suspect or know the allergen, you can help minimise your child’s contact with the cause of their hay fever.

For children who have seasonal allergic rhinitis, allergen minimisation strategies could include:

  • staying indoors on windy days with high pollen counts
  • avoiding activities with allergen exposure (such as grass mowing)
  • having a shower promptly after outdoor activities
  • using re-circulated air in the car.
Try to keep kids with hay fever indoors on days with a high pollen count.
Eva Foreman/Shutterstock

For cases of perennial allergic rhinitis, where house dust mite is the dominant cause, avoidance strategies could include:

  • washing household bedding (sheets and pillow cases) in hot water (above 60°C)
  • removing soft toys
  • replacing woollen underlays with dust mite covers
  • vacuuming carpets with vacuum cleaners fitted with high efficiency particulate air (HEPA) filters.

Medications

Medical therapy is often required in addition to avoiding the allergen.

First line treatments are non-sedating oral antihistamines such as cetirizine, loratadine, fexofenadine and desloratadine. These are available as a syrup or tablets, and can be used for children aged 12 months and over.

They’re available over the counter at pharmacies, or your doctor can advise you on which might work best for your child.




Read more:
Health Check: what are the options for treating hay fever?


Nasal steroid sprays (also called intranasal corticosteroids) are also very effective in alleviating symptoms when used correctly.

For children who suffer from seasonal allergic rhinitis, nasal steroid sprays should be started prior to the start of the pollen season, and maintained throughout the season.

Nasal steroid sprays can be used for children aged two years and above, and need to be started under the direction of your doctor.

Side effects can include nose bleeds or nasal dryness. While long-term use is generally safe, it’s best to have ongoing reviews by your doctor.

Other treatment options include:

  • intranasal decongestants – sprays to dry the nose – which relieve congestion in the nose by shrinking swollen blood vessels in the nose. These can be used for up to three days
  • antihistamine nasal sprays, which may act more quickly than oral antihistamines but only in the nasal passages
  • nasal irrigation with saline (salty water) to clear the nasal passages of the allergens.

Desensitisation

Allergen immunotherapy involves monthly injections, or daily drops or tablets.
Microgen/Shutterstock

Allergen immunotherapy, also known as desensitisation, is an option for children who aren’t getting enough relief from medications and avoiding the allergen.

It involves a regular administration of the allergen, either via monthly injections (called the subcutaneous route) or daily drops/tablets under the tongue (known as the sublingual route).

Allergen immunotherapy is available for children aged five years and above via a paediatric allergy specialist, and successfully reduces symptoms in 40-50% of patients.

Treatment is usually given for a period of three to five years, with costs ranging from A$50-A$200 monthly, depending on the number of allergens and products used.




Read more:
Health Check: what’s the right way to blow your nose?


The Conversation


Paxton Loke, Paediatric Allergist and Immunologist, Murdoch Children’s Research Institute

This article is republished from The Conversation under a Creative Commons license. Read the original article.