Hay Fever Therapy: What Helps?

Hay fever therapy: Symptomatic treatment

Hay fever is not a trifle, but a disease that can severely affect those affected. For example, schoolchildren with an untreated pollen allergy are 40 percent more likely to drop an entire grade during the pollen season.

Allergy sufferers should therefore not simply accept the annoying and often severe symptoms of hay fever. In most cases, they can be effectively alleviated with the help of medication. The preparations used target the inflammatory messengers histamine and leukotrienes. These are released by special immune cells (mast cells) as part of the allergic reaction and trigger the hay fever symptoms.

Hay fever medications block the effect or release of the inflammatory messengers. The following medications are used – sometimes in combination – in symptomatic hay fever therapy:

Antihistamines

Antihistamines block the docking sites (receptors) of the inflammatory messenger histamine on the surface of body cells. This prevents it from exerting its effect. The drugs take effect very quickly, usually after about an hour.

In the past, antihistamines often made people tired, which was very dangerous, especially in traffic. The so-called second- and third-generation antihistamines, however, have little or no such side effects. Their effect usually lasts for about 24 hours.

Cortisone

Cortisone is an endogenous hormone that performs numerous tasks in the body. Its strong anti-inflammatory effect is also used in hay fever therapy: Substances similar to cortisone (glucocorticoids) are used.

Glucocorticoids are usually used locally for hay fever (as nasal sprays), and less frequently systemically (as tablets). With the locally acting cortisone preparations (such as beclometasone – or budesonide nasal spray), hardly any side effects are to be expected.

Cortisone nasal sprays are the first choice for treating moderate to severe hay fever symptoms. The combination of cortisone and the antihistamine azelastine in a nasal spray is considered particularly effective.

The symptoms are moderate to severe if they lead to disturbed sleep, lack of concentration at school or work, impairments in everyday life or other disturbing complaints. However, allergy sufferers can also use cortisone sprays as an alternative to antihistamines even for mild symptoms.

Leukotriene receptor antagonists

Decongestant nasal sprays and nasal rinses

Decongestant nasal sprays provide quick relief from hay fever when the nose is swollen shut. However, they should be used for a maximum of one week. Otherwise, there is a risk that the nasal mucous membranes dry out, which can worsen the allergic reactions. In addition, decongestant preparations themselves can trigger inflammation (rhinitis medicamentosa).

Nasal rinses are also part of symptomatic hay fever therapy: they clear the nasal mucosa of pollen.

During the day, nasal sprays with saline solution are very convenient. However, rinsing the nose with a nasal douche, such as those available in drugstores and pharmacies, is much more effective. The allergic symptoms can often be significantly alleviated with this.

To care for irritated nasal (mucus) skin, sufferers can apply an ointment containing dexpanthenol.

Mast cell stabilizers (cromones)

The so-called cromones (such as cromoglizic acid, nedocromil) “stabilize” the mast cells so that they no longer release inflammatory messenger substances. Because of their low efficacy, mast cell stabilizers are not part of the standard therapy for hay fever and are used in exceptional cases at most.

Cromones are available in various forms (nasal spray, eye drops, metered-dose inhalers, capsules for ingestion). They act only locally – this also applies to cromoglizic acid, which is available in capsule form. This only exerts its effect on the mucous membrane in the intestine, but is not absorbed into the body.

Hay fever therapy: Specific immunotherapy (SIT, “desensitization”)

Specific immunotherapy (SIT) is currently the only option for hay fever treatment that mitigates the mechanism of origin of the symptoms – the excessive immune reaction. Doctors therefore also speak of causal hay fever therapy. The procedure itself, specific immunotherapy, is also called allergen-specific immunotherapy (AIT). In the case of pollen allergy, one also speaks of hay fever hyposensitization, hay fever desensitization or hay fever vaccination.

In this treatment method, the immune system is gradually accustomed to the actually harmless allergens (pollen proteins) so that it ultimately reacts less “sensitively” to them.

The effect of desensitization is very good, especially with hay fever, as several large scientific studies have shown.
In the case of hay fever, it is difficult to avoid the allergy-causing substance (allergy clearance), since the pollen often flies hundreds of kilometers through the air and those affected can hardly protect themselves from it. Desensitization can therefore enormously improve the quality of life of allergy sufferers.
In many cases, hay fever turns into allergic asthma after some time. Successful hay fever desensitization can prevent this so-called change of stage.

Desensitization for hay fever: How does it work?

The principle of hay fever desensitization is to introduce the allergy-causing substance (allergen) into the body in increasing doses. In this way, the immune system is supposed to get used to it, so to speak, and eventually no longer fight the allergen. Exactly how this habituation occurs has not yet been clarified with certainty. However, the success of desensitization for hay fever is undisputed.

Who performs desensitization for hay fever?

Hay fever desensitization is performed by physicians specially trained for this purpose. These are usually dermatologists, ear, nose and throat (ENT) doctors or internists specializing in pulmonary medicine. They usually carry out the treatment on an outpatient basis in the doctor’s office. However, in the case of particularly severe allergies or for short-term treatment (see below), an inpatient stay may be necessary.

Since specific immunotherapy can lead to life-threatening allergic reactions (anaphylactic reactions) in very rare cases, the physician must have the appropriate knowledge and medication to treat such an emergency.

When and for how long is desensitization performed?

Exactly when to start hyposensitization depends on which type of pollen the patient being treated is allergic to. Different plants release their pollen at different times of the year, which the doctor has to take into account in this form of hay fever therapy.

Normally, hay fever desensitization is started a few months before the beginning of the “personal” allergen season and therefore usually already in autumn.

For whom is desensitization for hay fever suitable?

Desensitization as a hay fever therapy is in principle possible at any age. In children, however, it is usually only used from the age of five. One of the reasons for this is that there is little systematic data available for younger children, and anaphylactic reactions that can occur as a result of the therapy are much more difficult to recognize here.

In principle, hay fever desensitization in childhood is very effective. However, some people do not develop hay fever until they are older. There is no strict upper age limit for hay fever desensitization. What is important is a good general physical condition. In case of doubt, your doctor will tell you whether specific immunotherapy is possible in your case or not.

For whom is hay fever desensitization not suitable?

Hay fever desensitization is not advisable in those cases where the potential risks of treatment exceed the expected benefits. These cases include, for example:

current cancer
severe diseases of the immune system (autoimmune diseases or acquired immune disorders caused by drugs or diseases such as AIDS)
uncontrolled asthma
severe psychiatric illnesses

Women should not start hyposensitization during pregnancy. However, AIT for pollen allergy that has already been started can be continued if it is well tolerated.

Desensitization for hay fever: How does it work exactly?

Before desensitization for hay fever is even considered, two things must be ensured: First, that the complaints are really allergic. Secondly, which pollen triggers them. You can read more about this under Hay fever: Examinations and diagnosis.

Before desensitization begins, an explanatory consultation is held: The doctor informs the patient about the procedure as well as the possible risks and side effects of the causal hay fever therapy. Even though desensitization is a low-risk procedure, an allergic overreaction (anaphylactic reaction) can occur in very rare cases.

During the explanatory consultation, the doctor will also ask the patient about his medical history (anamnesis). This helps him to assess whether desensitization for hay fever therapy is safe in the specific case. After the interview, the patient must sign a form – to confirm that the doctor has informed him about the treatment and its possible side effects.

Subcutaneous immunotherapy (SCIT).

In SCIT, the physician uses a syringe with a very fine needle (26G needle). After disinfecting the skin area, the physician injects the allergen into a fold of skin on the back of the upper arm. The puncture hurts only very briefly; during the injection, the patient feels at most a slight sensation of pressure.

For safety reasons, the patient must remain in the office for at least 30 minutes after the injection in case of an allergic overreaction. Local redness and swelling at the injection site are normal. However, anyone who feels noticeably uncomfortable should tell the doctor or medical staff immediately.

At the end of the 30 minutes, the doctor will check the injection site again before the patient is allowed to go home. These injections are usually given about once a week for several months. The total number of injections required depends on the preparation used.

Sublingual immunotherapy (SLIT)

In SLIT, the physician places the allergen in the form of drops or tablets under the patient’s tongue. It remains there for two to three minutes if possible, which means that the patient should not swallow for that long. After that, he should not drink anything for at least five minutes. The first application is done under the supervision of the doctor. Subsequently, the patient can perform SLIT on his own.

Subcutaneous immunotherapy (SCIT).

At the end of the 30 minutes, the doctor will check the injection site again before the patient is allowed to go home. These injections are usually given about once a week for several months. The total number of injections required depends on the preparation used.

Sublingual immunotherapy (SLIT)

In SLIT, the physician places the allergen in the form of drops or tablets under the patient’s tongue. It remains there for two to three minutes if possible, which means that the patient should not swallow for that long. After that, he should not drink anything for at least five minutes. The first application is done under the supervision of the doctor. Subsequently, the patient can perform SLIT on his own.

There have been numerous studies on the effectiveness of homeopathy for hay fever in recent decades. In most cases, however, these studies did not include objective target values; instead, the subjects merely stated their subjective perception of the efficacy of homeopathy – and this is hardly verifiable and depends on a wide variety of influencing factors.

A different approach was therefore taken in a study from India (Gosh et al., 2013). It was able to discover verifiable changes in laboratory values as a result of homeopathy treatment: A one-year hay fever therapy with various homeopathic remedies (including Natrium muriaticum, Allium cepa and Euphrasia officinalis) decreased the concentration of so-called IgE antibodies and eosinophilic granulocytes (a subgroup of white blood cells) in the blood of the subjects. These parameters are usually elevated in allergic diseases such as hay fever.

However, the study was very small with 34 subjects. More scientific studies with a larger number of subjects are needed to prove the effectiveness of homeopathy in hay fever.

Organotropic homeopathy

Some doctors see hay fever therapy as a suitable field of application for so-called organotropic homeopathy (indication-based homeopathy).

On the one hand, the treatment is thus much less individually tailored to the respective patient. On the other hand, this direction of homeopathy allows a quick treatment. Self-treatment is also more likely to be possible.

In principle, however, you should not use homeopathy for hay fever without the advice of a doctor or homeopath.

Homeopathy for hay fever: frequently used preparations

Field of application	Application area
Galphimia glauca	For watery, itchy eyes and violent sneezing attacks. Can also be taken as a preventative – starting six to eight weeks before pollen season.
Allium cepa (kitchen onion)	Complaints especially at the nose: burning, watery runny nose
Euphrasia (Eyebright)	Complaints especially at the eyes: burning, watering eyes
Wyethia helenoides	Itching in the throat or deep in the neck
Arundo mauritanica (water pipe)	Itching in the ears

These homeopathic remedies are usually used in the potency D6 or D12. Patients should take five globules each about three to five times a day. If the complaints are very strong, the patient can take five globules every hour for six to ten hours. From the second day he then reduces the dosage back to the usual level (three to five times a day each five globules).