Hay Fever Causes

Symptoms

Possible symptoms of hay fever include:

  • Allergic rhinitis: itchy, runny or stuffy nose, sneezing.
  • Allergic conjunctivitis: red, itchy, watery eyes.
  • Cough, mucus formation
  • Itching in the mouth
  • Swollen, blue discolored skin under the eyes
  • Fatigue
  • Sleep disturbance due to the discomfort

Hay fever is often accompanied by other inflammatory diseases of the mucous membranes. These include allergic conjunctivitis, urticaria, bronchial asthma with cough, a middle ear infection and sinusitis. In particular, there is a close relationship with asthma, and people with hay fever often also have perennial allergic rhinitis, such as cat allergy. It is estimated that over 400 million people worldwide are affected by allergic rhinitis and this is mainly in industrialized nations (see also under hygiene hypothesis). Hay fever has a significant negative impact on quality of life and development.

Causes

The cause of the disease is hypersensitivity to pollen, which leads to an inflammatory reaction in the nasal mucosa and the formation of specific IgE antibodies. Binding of the antigen in the nose leads to the release of histamine and other inflammatory mediators from mast cells, which causes symptoms and promotes the infiltration of inflammatory cells into the tissues.

Diagnosis

Diagnosis is made under medical treatment based on patient history, clinical symptoms, skin, blood, and provocation tests, among other factors. Numerous other possible causes must be excluded. These include, for example, common cold, vasomotor rhinitis, rhinitis medicamentosa, medications, and pregnancy rhinitis. Furthermore, it should be noted that a positive epicutaneous test against certain pollens does not prove that the hay fever is actually caused by that allergen.

Nonpharmacologic treatment

For prevention, it is advised to avoid the triggering allergens as much as possible. However, this is often difficult in practice. Hay fever tips:

  • Washing the hair before going to bed.
  • Change the bed linen regularly.
  • Put clothes worn outdoors in the laundry and do not store them in the bedroom.
  • Do not dry the laundry outdoors.
  • Do not vacuum yourself.
  • Do not open the window at night.
  • Keep the lawn in the garden short by mowing regularly.
  • In spring and summer rather avoid jogging and cycling. Water sports are usually a good alternative.
  • Wear sunglasses.
  • During the hay fever season, travel to a place with less exposure.
  • Rinse the nose with saline solution.
  • Observe the pollen prognosis.

Drug systemic treatment

2nd-generation antihistamines such as cetirizine (Zyrtec, generics), loratadine (Claritine, generics), fexofenadine (Telfast, TelfastinAllergo, generics), and levocetirizine (Xyzal, generics) abolish the effects of histamine and are partially mast cell stabilizing. They are well effective but have an inadequate effect against nasal congestion. Usually, once-daily administration is sufficient. Because of the possible adverse effects, the use of 1st generation agents should be avoided (see under antihistamines). The newer antihistamines may also cause drowsiness. Leukotriene antagonists such as montelukast (Singulair, generics) are approved for the treatment of hay fever in addition to asthma. They cancel out the effects of pro-inflammatory leukotrienes. However, they are considered to be less effective than antihistamines. Mast cell stabilizers such as cromoglicic acid and ketotifen (Zaditen) inhibit the release of inflammatory mediators. Systemic glucocorticoids such as betamethasone, prednisolone, and prednisone may be considered in a severe course but have an unfavorable side effect profile in the longer term. Specific immunotherapy or hyposensitization involves administration of allergens subcutaneously and sublingually (e.g., Grazax, Oralair), among others. In contrast to all other agents, immunotherapy is not only effective against the symptoms, but causally and can bring about a complete or partial cure.Disadvantages are the long duration of therapy, frequent visits to the doctor for subcutaneous administration and the risk of anaphylaxis. Phytopharmaceuticals: Butterbur extracts are approved in many countries for the symptomatic treatment of hay fever (Tesalin), see Butterbur for hay fever. Black cumin is also used (e.g., Alpinamed, Phytopharma).

Drug topical treatment

Glucocorticoid nasal sprays: Nasally administered glucocorticoids (“cortisone nasal sprays”) have local anti-inflammatory and anti-allergic effects. They should preferably be used regularly, as the maximum effects are delayed. Glucocorticoid nasal sprays are much better tolerated than oral glucocorticoids and are well effective against nasal congestion. Adverse effects include local reactions such as nosebleeds and sneezing. The risk for systemic side effects is considered low.

Glucocorticoid eye drops are eye drops with anti-inflammatory, anti-allergic and immunosuppressive properties. They are used for local and short-term treatment of the anterior segment of the eye. Possible adverse effects include an increase in intraocular pressure, infections, and cataracts, especially with prolonged therapy. Its use is controversial.

  • Dexamethasone (Maxidex, Spersadex mono).
  • Fluorometholone (FML Liquifilm)
  • Prednisolone (Pred forte)
  • Rimexolone (Vexol, out of trade)

Antihistamine nasal sprays with active ingredients such as azelastine (Allergodil) and levocabastine (Livostin) have antihistamine, antiallergic and partially mast cell stabilizing properties. They are applied in the morning and evening and up to a maximum of 4 times daily. Possible adverse effects include nasal discomfort and rarely fatigue. They are less effective against nasal congestion than glucocorticoids. Antihistamine eye drops are eye drops with antihistamine, antiallergic, and partial mast cell stabilizing effects. They are usually given into the eyes two to a maximum of four times daily. Possible adverse effects include local reactions to the eye such as redness and burning. Systemic side effects, on the other hand, are rare.

  • Azelastine (Allergodil).
  • Emedastine (Emadine)
  • Epinastine (Relestat)
  • Levocabastine (Livostin)
  • Olopatadine (Opatanol)

Decongestant nasal sprays with active ingredients such as xylometazoline (Otrivin, generics) and oxymetazoline (Nasivin) should, in our view, rather not be used against hay fever, because they are not directly effective against the causative mediators and can lead to rhinitis medicamentosa. Sympathomimetics such as tetryzoline (Visine), for example, are also not the 1st choice agents for hay fever in our view. Mast cell stabilizers such as cromoglicic acid (generics) and ketotifen eye drops (Zaditen Ophtha) inhibit the release of inflammatory mediators in the nose or eye and are mainly used preventively. They must be administered frequently and regularly. Nasal rinses with seawater or saline solution help remove pollen from the nose and moisturize and nourish the nasal mucosa. Eye baths such as Optrex are available for the eyes. See also under Moisturizing nasal sprays. Ectoin (Triofan Hay Fever) is a natural substance made from salt-loving bacteria with cell-protecting, anti-inflammatory and moisturizing properties. It is administered in the form of a nasal spray and as eye drops for the treatment of hay fever. Antihistamines, antipruriginous agents such as menthol and local anesthetics, glucocorticoids and thermal water are among the drugs available for the treatment of allergic skin reactions.

Alternative medicine (selection)

  • Boiron Euphrasia officinalis; Allium cepa.
  • Ceres Urtica-Sambucus comp., Euphrasia mother tincture
  • Rhinallergy
  • Similasan hay fever
  • Luffa comp. Heel nasal spray
  • Luffa-Lobelia comp. Heel tablets
  • Minerals
  • Black currant ( Ribes nigrum oral spray, gemmotherapy).
  • Similasan eye drops No. 2
  • Spenglersan Staphylococcus comp. D13-K
  • Oculoheel eye drops
  • Probiotics (eg Burgerstein)
  • Vitamin B complex, vitamin C, zinc
  • Weleda Gencydo (Germany: Weleda hay fever spray).