Who gets hay fever?
Hay fever is now the most common long-term illness in Britain. It typically develops in childhood and is most troublesome in 15 – 25 year olds – one in 4 British teenagers now have the condition. The number of GP consultations for hayfever has quadrupled in the last 30 years.
The season typically runs from May to July but recent variations in weather have seen that extend from February to late August – particularly for those sufferers sensitive to tree pollens released early in the year.
Men / boys are more likely to suffer than women / girls, and hay fever often runs in families and is closely associated with asthma and eczema. It is also more common in people born in spring and summer and in those brought up in smoky homes.
Most people will eventually grow out of it and severe hayfever is unusual after the age of 45.
Cities or the country?
Hay fever can, paradoxically, be more of a problem in urban environments than rural ones. This may seem strange but pollens produced in the countryside are easily carried into densely populated towns and cities where their impact on the delicate linings of the eyes and nose of hay fever sufferers is thought to be magnified by other irritants such as traffic fumes and other air pollutants.
People living on the coast tend to be least affected.
Which treatments work best?
• Step 1. Avoid unnecessary contact with pollen. Wear sunglasses, keep your doors and windows shut at home, avoid spending too much time outside first thing in the morning, and in the evening, when counts tend to be highest. Keep your car windows closed and, if possible, choose a car with air conditioning and a pollen filter. Be careful not to wash pollen from your hair into your eyes when showering.
• Step 2. If you only get symptoms on a few days then keep a packet of antihistamine tablets handy and take as required – ask your pharmacist to point you in the right direction of the modern non-sedative types. My preferred choices are generic – non branded – cetirizine or loratidine. Avoid branded versions as they are much more expensive.
• Step 3. If you have more persistent symptoms then take the antihistamine daily and, if still troubled, add in a nasal spray for sneezing and other nasal symptoms, and eye drops for itchy red eyes. I prefer steroid nasal sprays (particularly good for a blocked nose) and cromoglycate eye drops – both are available on prescription and over-the-counter. Make sure you follow the instructions to get the best out of them.
• If all three fail I sometimes consider a short course of steroid tablets – long acting steroid injections should be avoided.
Immunotherapy is the only chance of a cure and is becoming increasingly available in the UK. The standard approach is to give a course of desensitising pollen injections or tablets under the tongue (Grazax). Both techniques should be supervised by a specialist allergy clinic – of which there are far too few in the NHS. Treatment can last six months or more and won’t work, or be suitable for everyone. Only severe sufferers are likely to be eligible for treatment on the NHS.
What’s the alternative?
Petasites hybridus (butterbur, or bog rhubarb) contains anti-inflammatory chemicals, and a study published in the British Medical Journal found that it compared favourably with an antihistamine for the treatment of hay fever. The study used a dose of 32 mg of butterbur extract a day – the safest way to take butterbur, as the plant contains toxins that are removed during manufacture. You can buy a similar product from pharmacies or health food shops for around £6 for a month’s supply.