HAYFEVER.

Does it help to get allergy testing?

What is Hay fever?

Hay fever is medically known as Allergic Rhinitis. The word “Hay fever” suggests it is trivial but those people who who suffer with hay fever will know it is not. Hay fever can impair performance and cause fatigue. For example, evidence shows that people drop around 1 grade in school exams with uncontrolled Hay fever. You really can’t function normally with poorly controlled hay fever.

The symptoms of hay fever are well known – sneezing, runny nose and nasal obstruction. There may also be an itchy & watery eye. Hayfever also worsens symptoms of Asthma.

What causes Hay fever?

Allergic Rhinitis is a nasal allergy that develops following exposure to a variety of different allergens – for example, pollen.

The allergy may be seasonal & caused by different types of pollen.

Or the allergy may be year-round (perennial) and be caused by house dust mite, moulds & domestic pets. note that some pollens are also year-round. Allergy to house dust mite may be worse in the winter because of longer periods spent indoors.

Allergy to cats and dogs is usually airborne, with fur being the most important reservoir.

Hayfever

What types of pollen cause Hay fever?

Pollen in South East Queensland commonly comes from Grasses, Trees & Weeds.

  • Grass pollen – the highest pollen counts are December to March – the most common pollen to cause hay fever. Common grasses that cause hay fever are Perennial ryegrass, Timothy, Bahia & Bermuda grasses. In Queensland, The Bermuda & Johnson grasses are generally year-round except for 2-3 months in the winter. Bahia occurs during the 6 months of the summer, and also in June. Timothy pollen is in January, and Ryegrass is September to November.
  • weeds:  Plantain flowers august to may, Ragweed march to may, & Parthenium from September to march
  • Trees such as The Murray pine (any time of year), Cypress, Silver Birch, & Olive trees.

There is a a Pollen Forecast website for Brisbane that was developed by QUT.

It’s unlikely to be a particular plant, tree or grass next to your house that is causing the problem. The pollen that causes hayfever is the small size of pollen that is carried in the wind. Being outside is the trigger – for example, walking, cutting the grass and windy weather. Pollen levels are higher after thunderstorms and during windy weather.

What allergy tests can be done?

There are two types of allergy testing for sensitisation to specific allergens. Either test may be arranged directly by The GP. Consideration is given as to which potential allergens to test for (each one needs to be requested separately or as a known group). The two types of allergy test are:

  • Blood test for antibodies to specific allergens.
  • or Pin Prick testing to specific allergens – this is done on the front of the forearms. Avoid antihistamines for at least 4 days prior to testing.

Limited blood allergy testing may be medicare rebatable but full blood allergy testing is quicker and involves fewer tests when done privately. The out of pocket laboratory costs of either test are usually under $100.

It can’t be emphasized enough: The tests are for sensitisation and do not necessarily mean the allergen is the cause of the symptoms. A negative test will (usually – but not always) rule out that possible allergen.  A positive test means that the nature of the symptoms and the allergen need to be matched up before saying that the symptoms are caused by that specific allergen.

The allergy tests are for sensitisation and do not necessarily mean the allergen is the cause of the symptoms.

What can I do to avoid exposure to house dust mite?

It is not usually possible to avoid exposure to house dust mite but there may be an improvement if the following actions are tried out:

  • Vacuum carpets every week; consider using a vaccum cleaner with a high efficiency particulate air filter
  • Clean soft furnishings such as couches and curtains regularly
  • Replace curtains with blinds, and carpets with a hard floor (but this might not work)
  • Improve Ventilation within the house
  • Use house dust mite impermeable covers on pillows, mattresses & bed covers
  • Finally, wash bedding in water above 55°C (otherwise tumble dry for at least 20 minutes)

Hayfever Treatments available without prescription

The nasal symptoms are best treated with a nasal steroid spray. Interestingly, the nasal steroid spray often helps any eye symptoms.

A recent review in an American medical journal states that “there is no evidence that one intranasal corticosteroid is superior to another.” However, the cost can vary considerably, some are not licensed in young children, they look and feel different, have different applicators, and some are twice daily rather than once daily.

The dose of the once daily nasal sprays is 1-2 puffs each nostril once per day. Some bottles have 120 doses and some 60. I recommend a once daily generic formulation – have a word with a pharmacist.  Flixonase is an example (currently, it’s licensed in Australia over the age of 12 and seems to be a cost-effective option).  Just remember, though, that you can buy the 120-dose bottles for a lot less than 2 x 60-dose bottle.

Using the sprays correctly is important; so follow the simple instructions in the pack. Don’t “sniff it” or it will just end up in the back of the throat. Also, pointing the nozzle away from the middle of the nose (septum) will reduce the risk of nose bleeds. The longer the steroid sprays are used the better they work, and preferably start them a week or two before your hay fever season, and should be used every day.

Use of nasal sprays is important: Don’t “sniff it” or it will just end up in the back of the throat.

For persistent nasal symptoms, or additional eye symptoms, you can add an oral non-sedating antihistamine. It’s important to check they don’t make you drowsy because even the “non sedating” antihistamines can still cause drowsiness in a few people. The common “non-sedating” antihistamine are loratadine (eg. Clarityn), desloratadine, levocetirizine and fexofenadine (telfast). Interestingly, cetirizine (zirtek) has been identified as perhaps more likely to cause drowsiness.

Eye symptoms also respond to the antihistamine tablets, or can be treated with anti-allergy eye drops such as sodium cromoglycate (cheap and effective but needs to be used for a few days to work properly) or an antihistamine eye drop (eg eyezep) that’s more expensive but works quicker and is used only twice daily.

So, it all depends on your symptoms (eye and/or nose). Typically, start with a nasal once daily steroid, add in eye drops if you need them; and you can use one of the non-sedating antihistamines or even all three if you need them – these tablets don’t work for nasal congestion (blockage). Antihistamines work for breakthrough symptoms (as-required basis) because they work within 30 minutes.

There are other treatments some people try (nasal cromoglycate spray, nasal decongestants for strictly very short term use, nasal irrigation some people say is very effective) but the above are the mainstay. A nasal antihistasmine is also available over the counter (eg. azep) but it does need using four times a day and is more likely to cause nasal side effects than the nasal steroids; it’s well worth considering adding in with the nasal steroid, though, if you get breakthrough symptoms and you don’t want to use an oral antihistasmine. The nasal antihistamine spray is now available with a nasal steroid spray as a combined spray.

Immunotherapy for Hayfever

Immunotherapy may be helpful (via an allergy clinic) for people with severe hay fever that is not responding to normal treatments and where it’s not possible or practical to avoid the thing causing the allergy (the allergen).

Immunotherapy is most commonly given as an injection. Immunotherapy may also be given as medication (drops or tablets) that dissolves under the tongue.

The injection immunotherapy covers the widest range of allergens and might have the edge over effectiveness of treatment. On the other hand, the sublingual (dissolving under the tongue) therapy is clearly convenient to use but is perhaps slightly less effective than the injections and covers a narrower range of allergens. Sublingual therapy in Australia now covers grass pollens, cats, dogs & house dust mite. Sublingual therapy is increasingly been used by patients in their own home.

Immunotherapy is taken every week for around 3 months followed by the same treatment every month for 3 years. The treatment is costly and inconvenient and so is reserved for those people who may benefit.

It is possible not to benefit from Immunotherapy. Given the considerable investment in time and money to undergo immunotherapy, possibility (less than 1%) of a severe allergic reaction, and it doesn’t always work, most GPs would refer patients for an initial opinion to an allergy clinic – perhaps after doing the initial allergy tests to see if there is any treatable issue. Subsequent injections may be given in the general practice setting.

WRITTEN BY: Dr Richard Beatty
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