What to do if summer gets up your nose

Summer begins in early March in Jill Richardson's house. It may not be particularly sunny outside, but she'll wear sunglasses when she leaves the house, and she monitors weather reports with an almost religious observance. But Richardson, unlike the rest of the nation, is not hoping for sunny days. She's praying for rain.

Richardson suffers from hay fever. Not the occasional sneeze and sniffle, but painful, miserable, relentless irritation. Like thousands of other sun-starved Brits, she and her partner and their four-year-old daughter Amy spent the heatwave weekend earlier this month at the seaside. She hoped the pollen count would be lower because of the sea breeze, but woke up with infuriatingly itchy eyes and throat, and didn't stop sneezing all day.

Her partner also has hay fever, and they believe Amy has developed the disease. The family returned home feeling exhausted, headachey and utterly miserable. "You get to the stage when you are weighing up whether it's worth leaving the house at all," she says.

Hay fever, like the common cold, is one of those seasonal diseases we have to muddle through as best we can, hoping for a change in the weather. Where it differs from colds and flu is that only part of the population is vulnerable to it, those who have a specific allergy to pollen. That proportion, however, is increasing every year. In the past 20 years the number of GP consultations for hay fever has quadrupled.

Up to a fifth of Britons may now have the allergy, many of them probably known only to their long-suffering colleagues and families and their local pharmacist. As British summers hot up and our nasal tracts get increasingly pollen-sensitive, hay fever could soon overtake the weather as the nation's favourite summertime gripe.

For that unfortunate 20%, we are in prime griping season. Late June is the peak grass pollen season in the south of England - Wimbledon fortnight, ironically, is the worst time to be around grass. And this has been the worst year for a generation. "With pollen counts over 50 grains per cubic metre, virtually every person with hay fever will be feeling the effects," says Professor Jean Emberlin, director of the national pollen research unit at Worcester university, which compiles the pollen count figures published in the media: 150, she says, is considered high. Last Monday Derby had a pollen count of 683, the highest since 1968.

We tend to assume that environmental extremes are necessarily our fault, but while global warming may have had a part to play in muddling up flowering seasons, pollution does not cause hay fever. It may aggravate the symptoms and irritate an already streaming nose, but it's not the trigger.

So what's to blame? Doctors themselves confess to being unsure as to what prompts the allergy. "We think it's to do with the western lifestyle," says Dr Stephen Durham, professor of allergy and respiratory medicine at the Royal Brompton hospital in London. "Things like immunisation and, ironically, hygiene, have been implicated.

"If you are a snotty-nosed kid running around with 10 siblings who all catch coughs and colds, you are probably more likely to be protected from hay fever in later life." Mollycoddling immune systems when we are children produces softies too enfeebled to fight off pollen allergies in their teens and 20s, the disease's peak years.

The key to coping with hay fever, says Durham, is understanding how it works. Despite the name, grass pollen is not the only trigger - a minority of sufferers are affected by tree pollen or, most commonly, birch.

Tree pollen allergy can be linked to asthma, and sufferers often experience a cross reaction when they eat apples and stone fruits like peaches. Because tree pollen peaks earlier, those who suffer symptoms in March and April are likely to have this type of allergy. "Lots of councils plant birch trees because they are pretty," says Emberlin, "but they don't realise that this has a big role in promoting hay fever."

Sufferers also may not realise that their parents may be to blame. Before concerned mums and dads start rolling their toddlers in grime and pushing them out the door to catch a few colds and grow up hardy, they should pause to check if their own noses need wiping. The best thing you can do to avoid developing hay fever, says Durham, is choose your parents. The child of two parents who are sufferers has a 70-90% chance of developing the disease, which falls to 50% with one parent, and less than 20% if neither has the allergy. Nice thought, if hardly practical advice for the millions of sufferers.

But there are steps you can take to avoid the disease. Maternal smoking during pregnancy and passive smoking as a child are known to contribute to the allergy's development in later life. Wearing sunglasses, keeping car windows shut and fitting a pollen filter to your car can also help, as can staying indoors in late afternoon, when the pollen count is at its highest - " it's the last set of the day at Wimbledon that's going to set your hay fever off," says Durham.

Emberlin counsels watching the pollen forecast carefully - her unit can supply information of counts on certain days. Useful if, for instance, you have suffered badly on the day of an A-level paper and want to appeal to the exam board. If all else fails, says Durham, try to take a holiday abroad or by the coast in the last two weeks in June.

The reason for this year's record highs, ironically, is that the weather has been good but not good enough. Extended periods of very hot, dry weather suppress the pollen-releasing mechanism in plants, while wet drizzly weather dampens it down. It's when the weather is hot in bursts, then cool and damp for a few days, that pollen is at its worst. Just like this summer.

Jill Richardson confesses to looking forward to September, when her six-month season of medication and misery finally comes to an end. At least she'll have a few months of respite before it all begins again. But the millions for whom the annual battle with pollen is a wearying one can at least console themselves that the most successful cure for hay fever is time. Hang on in there; it should start to fade when you reach middle age.

What happens when you have hay fever?

Pollen grains in the air land on the inside of the nose, which is lined with mast cells. These cells have a "trigger" antibody, which in some people is directed against pollen. The allergic reaction causes the cells to release histamine, a chemical which prompts the sneezing and itching impulse. Blood also flows to the nose, which causes blockage, and the mucus producing glands may also be activated.

How do I know what type of pollen I am allergic to?

Doctors can carry out a simple test. It may also help to keep a diary of your symptoms and compare this to published pollen counts.

How should I treat it?

It depends on the type and severity of your allergy, but the main treatments fall into four types:

These can be very effective for occasional symptoms, and are taken by mouth or by nasal spray. It is important to use the spray properly - nasal cavities go backwards not upwards! Newer drugs are non-drowsy: some of the older brands like Piriton can cause serious drowsiness equivalent to having a couple of pints and so should not be used before driving.

Corticosteroid nasal spray.
For those with severe symptoms, or if the main problem is blockage. This works by suppressing the mast cells themselves, but should ideally be taken before symptoms start, and takes a few days to work. It is important to use the spray regularly - intermittent use is ineffective.

The "anti-hay fever" injection
A one-off injection given at the start of the pollen season into the bottom, many doctors have significant reservations about this treatment. It works by giving a large and uncontrolled dose of steroids at once, and can cause a sunken area at the site of the injection. Has also been associated with psychological problems such as irritability and depression.

This is the most effective form of long-term treatment, but is extremely labour-intensive. Small doses of pollen extract are injected weekly for 12 weeks and then monthly for three years. But the results are impressive - a 50-60% reduction in symptoms and an 80% reduction in medication. The effects are also long-lasting - this is the closest thing we have to a "cure" for hay fever.

• For more information you should consult your GP or pharmacist. The Royal Brompton hospital is keen to see patients with hay fever to help with their research into the disease. Call 0207 351 8994 if you want to help.

Thanks to guardian.co.uk who have provided this article. View the original here.


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