HAYFEVER HAYFEVER
“Grim News for Vitim’s of Hayfever”, “Five Moths of Misery”, and “Pollen Counts Set to Soar”.1-3
These are
just some of the headlines making national newspapers in Scotland and throughout the UK last year. The age- old problem of hayfever appears not to be going away, and in fact media sources are convinced it is getting worse. Even for Scotland and more northern countries, where prevalence is traditionally lower the prevalence is on the rise. So what is hayfever? And why does it cause so many problems, for so many people?
Seasonal Allergic Rhinitis, more commonly known as hayfever, is a common condition characterised by infl ammation of the nasal mucosa following exposure of the patient to various allergens. This condition is extremely prevalent throughout the developed world and the effects of which are most noticeable at certain times of the year, usually throughout the spring and summer months.
There are two main categories of rhinitis namely: Seasonal allergic rhinitis (hayfever), which occurs at certain times of the year, and Perennial Rhinitis (persistent), which occurs throughout the year. Hayfever is extremely prevalent in the UK with an estimated 20% of the population suffering from its effects, with the vast majority of patients identifi ed under the age of 30 years.4
Peak incidence
of hayfever appears in the childhood and adolescent years.5
Interestingly,
children of school age and adolescents are more likely to suffer from seasonal symptoms, where as adults are more likely to suffer from persistent allergic rhinitis. 6
The exact prevalence of
hayfever in UK population is unknown, as a signifi cant proportion of people tend to self-medicate, as a result these patients remain unreported. The prevalence of hayfever is however on the increase, particularly in European
14 - SCOTTISH PHARMACIST
countries and one possible cause is an extended pollen season with the earlier onset of spring, possibly as a result of recent signifi cant climate shifts.
Hayfever is predominantly an infl ammatory response, driven mostly by an immunoglobulin E (IgE) reaction. Stimulation of the IgE cascade results in the release of mediators and chemical factors from mast cells in the nasal mucosa, most notably histamine. As a direct result, epithelial permeability increases and this prompts migration of infl ammatory cells to the mucosal sight – leading to the symptoms experienced by so many people throughout the country. There are two stages of response to pollen:
The acute response will occur within minutes – sneezing is a major component and is due to stimulation of afferent nerves, increase in nasal secretions follow, peaking at 15-20 minutes post exposure.
The late-phase response can occur up to 6-12 hours post exposure and is characterised by obstruction of the nasal passageway, in many cases some of the acute symptoms persist.
WHAT CAUSES HAYFEVER? A number of factors have been identifi ed as causative, or at least linked to developing an increased risk of allergic conditions. These include, most notably genetic variation, and environmental exposure to pollens. There has been some evidence to suggest that other allergic conditions may be closely linked to the aetiology of hayfever including: sinusitis, nasal polyps, and conjunctivitis. 6
Patients
who have a history of eczema, a history of recurrent rhinitis, and perhaps more strangely, are fi rst-born are more likely to suffer from hayfever, either in childhood or further into adult life. 7
HAYFEVER SEASONS? Different people will be affected by hayfever at different stages throughout the year; this is primarily due to individual sensitivities to different types of pollen. Understandably then, as these particular plants become more active, releasing pollen, then we see an increase in patient suffering. There are fi ve main hayfever seasons including:
• Tree – This is when trees such as Hazel, Yew, Birch, and Oak release their pollen, and this typically occurs from the beginning of March to the end of July.
• Grass – Common grasses such as Rye, Timothy and Crocks foot release pollen from mid April to the end of August.
• Crops – Oil seed rape is the most common source of crop-based pollen throughout the UK however, due to shifting wind conditions people from across the Isles can be affected by this type of pollen. It is most prevalent from the end of April to the beginning of June.
• Weeds – Dock, Nettle, and Plantain are most apparent during the summer months, from the beginning of May through to the beginning of September.
• Fungi – Fungal spores can also be an allergenic trigger for many hayfever sufferers and these become most active in the later Summer/Autumn months, usually August into later September or even early October.
WHAT ARE THE SYMPTOMS? The characteristic symptoms of hayfever are frequent sneezing and bilateral rhinnorrheoa. This can often be accompanied by conjunctival involvement and also ear involvement. Itchy, red or watery eyes are common, as is an itchy mouth, nose or ears. Many patients also suffer from a
persistent cough caused by post-nasal drip.
Talking to patients about their conditions or symptoms will usually indicate hayfever, as their description of symptoms will correlate with expected trends in hayfever seasons. Often patients can be sensitive to more than one type of pollen and this will ultimately result in the patient experience prolonged symptoms. Discussing duration, frequency, seasonal or perennial, trigger factors, or occupational reasons will usually point to hayfever assuming no other red fl ag or warning symptoms are present. Rhinorrheal nasal congestion, if green in colour can often indicate viral or bacterial infection and is usually self-limiting. If the discharge is tainted pink or red and the patient feels this is not due to over use of tissues, then a referral here may be appropriate. Similarly unilateral discharge from the nasal mucosa can be an indicator that hayfever is not the causative problem here, warranting a referral.
Other more serious problems that can display similar signs and symptoms to hayfever include adenoidal hypertrophy, cystic fi brosis, and Kartagener’s syndrome. In these cases many other factors can present, however it is worth noting that not all hayfever symptoms are as a direct result of seasonal allergic rhinitis.
In young children it is particularly important to rule out nasal obstruction from a foreign body, as untreated this can cause secondary infections, signifi cant pain and discomfort, and even impacts on growth and developmental changes.
Although many people can manage their symptoms of hayfever by using over-the-counter preparations, a third of adults have said that it affects
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