It’s never too early to prepare for the hayfever season. For many hayfever sufferers, the most common symptoms – itchy eyes, a blocked or runny nose and constant sneezing – strike during the late spring and summer months. But this year, the first hayfever symptoms appeared in early March, with an unexpected wave of warm weather increasing the demand for suitable over-thecounter products and advice.
Around one in four people in the UK are affected by hayfever – one of the highest prevalence rates in Europe.
According to pollen expert Dr Jean Emberlin, the number of hayfever sufferers in the UK is set to more than double to 31.8 million by 2030 and will rise by a third to 20 million sufferers in just two years’ time. Milder temperatures in recent years may be partly to blame. “Climate change in the next few decades will have a notable impact on people’s health, especially for hayfever sufferers,” says Dr Emberlin, who wrote a report on hayfever and climate change on behalf of the hayfever eye drops brand Opticrom. “Evidence has shown that the timings of pollen seasons have been changing in the UK and across Europe over the last few decades,” explains Dr Emberlin. “Climate change is causing pollen seasons to start earlier, last longer, and become more severe.” All of which is bad news for sufferers.
People living in cities and towns are now just as likely to ask for hayfever advice as those in rural areas. There is some evidence to suggest that air pollution, such as car exhaust fumes, is making hayfever symptoms worse.
“There are now more diesel cars on the road,” says Dr Adrian Morris, a Surrey-based allergy consultant. “Pollen binds to diesel exhaust particles so that these are more likely to trigger allergy symptoms. This may be why hayfever is becoming more common in urban communities.”
The number of hayfever sufferers in the UK is set to more than double to 31.8 million by 2030 and will rise by a third to 20 million sufferers in just two years’ time
Most hayfever sufferers experience some or all of the following symptoms: explosive sneezing, a runny or stuffy nose, intensely itchy eyes, throat and/or ears, skin rashes and red, watery, puffy eyes (allergic conjunctivitis). Some people also develop ‘post-nasal drip’, when mucus runs down the back of the throat.
In people with severe symptoms, hayfever can also trigger sleeping problems, fatigue, irritability and poor concentration.
Research also shows that teenagers suffering from hayfever can drop a grade between their mocks and final exams, particularly if they are taking sedating antihistamines.
People often confuse the symptoms of a summer cold with hayfever. But there are ways to distinguish between the two. “Hayfever is often misdiagnosed as a cold,” says Stuart White, marketing manager for Omega Pharma’s hayfever portfolio. “Using the why, what, how, action, medication (WWHAM) approach will help pharmacy teams to identify hayfever symptoms.”
A cold causes a runny nose with a cough, slight headache, sore throat and tiredness. The nasal discharge tends to start off clear and watery, but soon turns thick and colourful (yellow or green). If a runny or blocked nose lasts for more than a couple of weeks, it is more likely to be caused by hayfever. With hayfever, the nasal discharge remains watery and clear.
There are around 30 different types of pollen that can trigger hayfever and it is possible to be allergic to more than one type. Most hayfever sufferers are allergic to grass pollen, which is released from mid-May to July. However, some people are also allergic to tree, weed and shrub pollens or outdoor moulds, so they experience symptoms from February to October.
If hayfever symptoms continue all year, they are more likely to be caused by perennial allergic rhinitis, which is triggered by indoor allergens. “House dust mites and pet allergies tend to cause a wider range of symptoms than hayfever,” says Dr Morris. “These patients are often misdiagnosed as having a ‘permanent’ cold and receive inappropriate treatment with antibiotics. Their symptoms can be very subtle and include constant nasal blockage, snoring at night, watery post-nasal discharge, a loss of taste and smell sensation and sneezing only on waking in the morning.”
Some people who are allergic to tree, grass or weed pollens experience an allergic reaction when they eat certain fruits, vegetables or tree nuts, especially if they’re raw. Called ‘oral allergy syndrome’, the symptoms occur because the proteins in the pollen are very similar to those in specific foods and the immune system can’t distinguish between them.
“Oral allergy syndrome is very common in people who have tree pollen allergy,” says Dr Morris. “They experience local itching of the mouth and eyes, usually within minutes of contact with the food. This is usually not serious, improves on taking an antihistamine and never leads to anaphylaxis.”
The pollen count is usually given as part of the weather forecast during the spring and summer months. It is calculated as the number of pollen grains in one cubic metre of air. Air samples are collected in traps set on buildings two or three storeys high. The pollen grains are collected on either sticky tape or microscope slides so that they can be counted.
“Most people start experiencing symptoms at a count of 50 grains per cubicmetre of air,” says Beverley Adams-Groom, chief palynologist at the National Pollen and Aerobiology Research Unit in Worcester. “However, some sufferers will experience symptoms at lower counts because they have a lower threshold of response.”
Pollen grains travel for miles in the wind and spread easily, making them difficult to avoid. However, many people do benefit from self-help measures, such as washing their hair and clothes after being outdoors and using a pollen barrier to prevent allergens from entering their nose or a saline nasal spray to wash them away.
“Customers should keep an eye on the pollen count and avoid going deep into the countryside and city in the middle of day,” says Maureen Jenkins, director of clinical services at Allergy UK. “Close the house and car windows in the morning. Wrap-around sunglasses are also very important, as most people experience eye symptoms.”
Over-the-counter (OTC) antihistamine tablets (or liquids for children) are usually the first approach for mild to moderate symptoms. It is important that customers use a daily, nonsedating antihistamine such as cetirizine or loratadine to control their symptoms. Antihistamines are usually effective at treating itching, sneezing and watery eyes, but they may not relieve a blocked nose.
If hayfever symptoms persist or are moderate to severe, or a blocked nose is the main symptom, using a corticosteroid nasal spray will help to reduce the underlying inflammation. Ideally, sufferers should start to use these sprays a week or two before the hayfever symptoms usually begin and they work best when used regularly. It’s important that customers follow the instructions carefully to limit possible side effects, such as nasal irritation, bleeding or dryness. Decongestant nasal sprays may be useful when the congestion is particularly severe, but shouldn’t be used for longer than seven days consecutively, as they can make symptoms worse.
If customers experience eye symptoms, they should try sodium cromoglicate eye drops. Like corticosteroid nasal sprays, these eye drops need to be started before the hayfever season begins and then used regularly throughout.
For some, the symptoms of hayfever can have a considerable impact on their ability to function during the peak pollen season
Hayfever can severely affect a person’s quality of life, interfering with their work, relationships and social lives. “Common allergies like hayfever are often trivialised, but for some, the symptoms can have a considerable impact on their ability to function during the peak pollen season,” says allergy consultant Dr Adam Fox at Guy’s and St Thomas’ Hospital in London.
Pollen is a well-known asthma trigger, causing tightness of the chest, wheezing and coughing in susceptible people. If a customer has asthma and knows that hayfever aggravates their symptoms, it’s important that they consult their GP or asthma nurse for a medication review well before the hayfever season. Sinusitis and middle ear infections are also possible complications.
Pharmacies are an essential source of allergy products and advice. Here are some top tips to make the most of the hayfever season: