Thomas Falasca, DO FACA FACPM
February 2, 2023
Hay fever, or seasonal allergic rhinitis has been estimated to affect 40 to 60 million Americans. a However, exposure to hay is not necessary to cause the symptoms of “hay fever” and “hay fever” typically does not produce a fever.
So, What Is Hay Fever?
Hay fever, or, more correctly, seasonal allergic rhinitis, is an allergic response to environmental substances that peak periodically and cause symptoms mostly related to the eyes, nose, and throat.
In spring, the environmental allergens producing the symptoms are typically the pollens from trees and grasses. In fall, the environmental allergens producing the symptoms are typically weed pollens and outdoor molds.
Symptoms of Hay Fever/Seasonal Allergic Rhinitis
The most common symptoms are 1
Runny nose from excess production of mucus
Stuffy nose from swelling of the nasal mucous membranes
Sneezing from irritation of the nasal mucous membranes
Itchy, red, and watery eyes from irritation of the ocular mucous membranes
Fatigue as a generalized effect and from impaired breathing and sleep
Less common symptoms are
Decreased decision-making capability
Irritability in children
Poor sleep
Cough
Why Not a Cold?
There are many different cold viruses and individual ones tend to predominate at different times of year. Consequently, a cold may occur in the spring and target the nose and throat. However, allergies last while the allergen is in the air, which is typically somewhat longer than the cold lasts. Also, the seasonal allergens tend to produce more itching of the nose and eyes than a typical cold. 2
Allergy Capitals 3, 4
Each year, the Asthma and Allergy Foundation of America releases its report of the 100 most populated cities in the US, from worst to best regarding seasonal pollen allergies. It is based on pollen scores, over-the-counter medication use, and availability of board-certified allergists/immunologists (physicians that specialize in allergy and immunology). The 2022 most challenging place to live for seasonal allergy sufferers was Scranton, Pennsylvania. The full list of 100 cities is available at https://aafa.org/wp-content/uploads/2022/08/aafa-2022-allergy-capitals-report.pdf.
What You Can Do
The best way to deal with a problem is not to have it. This translates to reducing exposure to seasonal allergens as much as possible whenever possible. Measures in this regard are 1, 2, 5
Stay indoors in mid-morning and early evening when pollen levels peak and especially on dry, windy days.
Avoid window fans because they draw pollen into the house.
Wear glasses and hats with brims when outdoors to minimize pollen entering the eyes.
Avoiding hanging the wash outdoors to dry as it can collect pollen on clothes and linens.
Avoid rubbing the eyes as this may transfer pollen to them.
Keep windows closed, use air conditioning, and keep the air conditioning unit clean.
Clean floors with a damp mop instead of dry-dusting or broom sweeping.
Replace carpeting with hardwood, tile, or other readily cleanable floor surface.
Wash hands frequently to avoid transferring pollen to eyes and nose.
Use a vacuum clean er with a certified asthma and allergy friendly filter.
Pets may bring in pollen from outdoors, so clean them with a damp cloth when they enter the house and keep them out of the bedroom and off furniture.
A Word of Caution avout Neti Pots
Some recommend the use of a neti pot to irrigate the nose to moisten dry nasal passages, thin nasal mucus, and flush allergens from the nose. 5
Although there is the possibility of nasal irritation or nosebleed, the primary danger from neti pots is associated with the use of untreated tap water instead of sterile solution. Tap water is safe to drink because the minim al amounts of bacteria, amebae, and protozoa are killed by stomach acid. However, in the nose, they can remain alive and cause meningitis, including the brain-eating amebic meningoencephalitis, which is almost always fatal. 6
The safe use of neti pots mandates only verified sterile solutions. Water can be sterilized by boiling at least one minute. Elevations above 6500 feet require boiling at least three minutes. Of course, the water should be allowed to cool and then used immediately. Also safe is water that has been passed through a filter of pore size one micron or smaller. 6
Medications
Physician now have multiple medications to treat hay fever/seasonal allergic rhinitis. Corticosteroid nasal sprays are highly and with markedly reduced side effects from systemic corticosteroids. Antihistamines can be given in eye drops, nasal sprays, tablets, and syrups. The second-generation antihistamines greatly reduce the sedation found with the first-generation antihistamine. Decongestants reduce the stuffiness resulting from swollen nasal mucosa. They are available both as nasal sprays and as oral preparations. Improper use of the nasal sprays can result in rebound nasal stuffiness. Orally, they are problematic with high blood pressure, closed angle glaucoma, and prostate hypertrophy. Leukotriene inhibitors are effective in asthma and allergic rhinitis. 1
Hyposensitization injections are an option for those who respond poorly to medications or who have allergen exposures that are unavoidable. These injections of diluted allergens are administered in increasing doses until a maintenance dose is reached. These may continue for a few years but can dramatically reduce symptoms. 1
Conclusion
Hay fever, or seasonal allergic rhinitis affects upward of 40 million Americans. It consists of allergic reactions to the pollen of trees and grasses in the spring and to weeks and molds in the fall. Symptoms mostly involve the nose, eyes, and throat. Sometimes, all that is required is taking measures to avoid the allergens. When this is impractical, your physician can offer medical solutions. Finally, it is not necessary to suffer with hay fever when effective solutions are available.
Thomas Falasca, DO
Sources
1 American College of Allergy Asthma and Immunology. (2022, November 7). Hay fever (rhinitis): Symptoms & treatment. ACAAI Public Website. Retrieved February 4, 2023, from https://acaai.org/allergies/allergic-conditions/hay-fever/
2 Asthma & Allergy Foundation of America. (2023, January 17). Nasal allergies (rhinitis). Asthma & Allergy Foundation of America. Retrieved February 4, 2023, from https://aafa.org/allergies/allergy-symptoms/rhinitis-nasal-allergy-hayfever/
3 Asthma and Allergy Foundation of America. (n.d.). Asthma capitals report - asthma and allergy foundation of America | AAFA. Asthma and Allergy Foundation of American Asthma and Allergy Foundation of America. Retrieved February 4, 2023, from https://www.aafa.org/wp-content/uploads/2022/10/aafa-2019-asthma-capitals-report.pdf
4 Asthma & Allergy Foundation of America. (2023, February 3). Allergy capitals. Asthma & Allergy Foundation of America. Retrieved February 4, 2023, from https://aafa.org/asthma-allergy-research/allergy-capitals/
5 Mayo Clinic. (2022, July 7). Hay fever. Mayo Clinic. Retrieved February 4, 2023, from https://www.mayoclinic.org/diseases-conditions/hay-fever/diagnosis-treatment/drc-20373045
6 Medical News Today. (n.d.). Neti pots: Uses, dangers, and warnings. Medical News Today. Retrieved February 4, 2023, from https://www.medicalnewstoday.com/articles/249460
