Allergies, Asthma & Hayfever

Please find our Allergy, Asthma & Hayfever related health tips below.

Diagnosis & Symptoms

Hayfever is an allergic reaction to pollen grains, of which grass pollen is the most common type. Sneezing, a runny nose (rhinitis), nasal congestion and watery eyes are the most common symptoms but wheezing and coughing can also be a problem for a significant proportion.

The higher the pollen count level in the atmosphere, the worse the effects, with symptoms often being at their worst in the early morning and late evening. It is estimated that between May and August 2% to 10% of the population suffer from hayfever and those who suffer allergies such as asthma are more likely to suffer from hayfever also.

Hayfever is most common in those aged between 16 and 34.

Preventative Measures

• Avoid freshly cut grass and get somebody else to mow the lawn.
• Stay indoors with the windows closed.
• Do not sleep with an open window.
  
• Keep car windows closed. Some cars now have pollen filters.
  
• Wear sunglasses to prevent pollen grains getting in your eyes.
  
• Wash your hands regularly and do not touch your eyes with your hands.
  
• Apply Vaseline to the nose, which can trap the pollen and prevent it travelling further up the nasal passage.
  
• As coastal areas have lower pollen levels, go to the coast when the pollen counts are high.
  
• Do not smoke and avoid smokey atmospheres.
  
• It is recommended that if there is a history of pollen allergy in a family, newborn babies should be kept away from high pollen concentrations.
  
• Take appropriate preventative medicine (See below)

Non-prescription treatments

A number of oral antihistamines, nasal sprays and eye drops are available without prescription.

Antihistamines are taken to prevent and treat the allergy directly. Older, oral antihistamines such as PIRITON will reduce symptoms but can cause drowsiness. The sedating anti-histamines need to be taken a number of times in the day and interact with some other medicines.

PHENERGAN elixir, may be used in children from 2 years with dosage dependent on age. PHENERGAN elixir can also cause drowsiness and at high doses may cause photosensitivity thus increasing the risk of being sunburnt.

The newer antihistamines such as Cetirizine (available in such brands as ZIRTEK or CETIRELIEF) and Loratadine (available in such brands as CLARITYN or CLAREEZE) are considered to cause much less drowsiness.

Zirtek is regarded as usually non-sedative but in very sensitive people (less than 10% of patients) some drowsiness has been reported.

For children from 2 years of age, ZIRTEK oral solution is available without prescription. Dosage is dependent on weight.

As oral antihistamines alone are not effective in treating nasal congestion, they are combined with a decongestant in ACTIFED, which is available as a tablet or as a liquid that can be administered to children over the age of 6.

Nasal Congestion can be treated using nasal corticosteroid sprays such as BECONASE HAYFEVER Nasal Spray or FLIXONASE ALLERGY RELIEF. The manufacturers of BECONASE HAYFEVER recommend regular usage is essential for full therapeutic benefit. However, if there is no response after 14 days of treatment, medical advice should be sought. It should not be used continuously for longer than 3 months without consulting your doctor.

For FLIXONASE onset of action in the treatment of allergic rhinitis has been observed as early as 2-4 hours after use, with most users achieving symptomatic relief within 12 hours of treatment. Maximum benefit may require 3-4 days of continuous treatment in some people. If there is no improvement within 7 days, you should consult your doctor.

Where symptoms of a runny nose (rhinitis) and watering eyes are particularly bad, and cannot be controlled by oral antihistamines alone, nasal sprays such as VIVIDRIN and eye drops such as HAY-CROM, OPTICROM and VIVIDRIN can be used. These preventative medicines can be administered up to four times daily and should be started a week or two before the pollen season commences. Where the sufferers experience severe eye symptoms, the use of combined antihistamine/sympathomimetic eye drops, OTRIVINE-ANTISTIN are sometimes recommended.

At the end of the hayfever season, the prescription and non-prescription medications used should be reviewed and plans made for the following hayfever season.

Further Information on the medicines listed above including dosage is available at www.medicines.ie

What is a pollen count?

The pollen count is the number of pollen grains per cubic metre (m3) of air, recorded over 24 hours. The results are sometimes stated as low, moderate, high or very high.

The pollen count will be at its highest on a perfect summer day; clear sky, no rain and gentle breezes.

Factors Which Influence Pollen Counts

• Amount of sunlight: Higher counts are found on sunny days as pollen spreads and transfers from one flower to another, while the lower counts are associated with overcast and cloudy days. 
• Wind Effects: Higher counts are produced when winds are light, below Force 4.
• Time of the day: Counts are usually lower early in the day. The peak level is reached in the late afternoon and evening, while there are morning peaks also. Lowest levels are usually around midday.
• Location: Pollen counts in rural grassy areas are much higher than urban areas. However, research has shown that a higher percentage of children in urban areas suffer from hayfever than in rural areas. This is thought to be due to increased traffic pollution.
• Time of the year: Flowers produce most pollen in the summer months. Pollen counts reach the highest in the months of June and July. In March to May, the temperatures are usually quite low resulting in low counts.
• Rainfall: Rain will wash the pollen out of the air, especially rain in the early morning.

Spanish Scientists have reported that severe asthma attacks are associated with high grass pollen levels rather than pollution. The Madrid study reported in the journal Thorax (July 2003) found a correlation between times of high pollen counts and an increase in the number of emergency admissions associated with severe asthma attacks. The study was based on pollen counts and pollution data collected over three years and on data on 5,000 hospital emergency admissions for respiratory illness during that time.

The study reported that there was a statistically significant association between the grass pollens from Panacea and Plantago, which are commonly found in Europe. The study reported that hospital admissions rose by 17% three days after an increase in Poaceae pollen and by 16% two days after Plantago pollen levels peaked.

This increase was found to be independent of air pollution. During periods when the pollen count was low very few admissions were associated with asthma. This research highlights the importance of pollen forecasts not just for hayfever sufferers but also for asthmas. During such times asthmatics and hayfever sufferers may need to take preventive measures and/or adjust their medications requirements.

The full report is in found in Thorax, Short term effects of airborne pollen concentrations on asthma epidemic A Tobías, I Galán, J R Banegas and E Aránguez Thorax 2003;58:708-710

According to a US study, carried out by Penn State College of Medicine researchers found that families who have dogs and cats are putting their health at risk if they suffer from asthma. The study evaluated the effect of allergens from pets, insects and plants on asthma sufferers. The study reported that while more asthmatics were allergic to allergens from cats, dog allergens were found to cause greater disturbances in lung function measurements for asthmatics.

Asthma Severity Increased by Airborne Moulds rather than Pollens.

A European-wide study reported that severe adults asthma may be associated with sensitivity to the airborne fungal or mould spores rather than to seasonal allergens such as pollens.

Reported in the British Medical Journal, the French study of over one thousand adult asthmatics linked the severity of their asthma more closely with sensitisation to airborne moulds rather than allergens traditionally associated with asthma such as cats or pollens. Indeed the research team did not find any link between the severity of asthma and sensitisation to pollens or cats.

The researchers believe that because fungal spores are much smaller in size than pollens, they can reach travel to lowers areas of the lungs and thus increase the severity of asthma. In addition, the authors argue that as moulds can occur both indoors and outdoors, exposure to moulds could potentially be greater, as we spend most of our time indoors.

Fungal spores are a in the atmosphere at all times of the year. Indeed some types, such as Cladosporium Alternaria, often associated with allergies, can increase during months of July and August.

To avoid fungal spores indoors, damp conditions which promote the growth of moulds should be avoided.

Read the British Medical Journal article

Diagnosis & Symptoms

Hives (Urticaria) are characterised by itching, redness and the development of welts or smooth raised red patches, of varying sizes. Scratching the hives can cause them to break and a scab may be formed. Hives and scabies can often be confused; scabies appear as tiny red marks or dots on the skin, while hives are usually more diffuse and broader is size. Hives are an allergic reaction. The allergy could be to foods, such as shellfish, tomatoes, strawberries, animals, perfumes, deodorants, etc.

To specifically identify the cause at the time can often be difficult, but all recent changes to diet and lifestyle should be investigated as a source of the allergy. Hives can often appear and disappear within a number of days.

Those who suffer from persistent, recurrence of the problem should seek specialist advice.

Preventative measures

If the cause of the hives is known then this agent should obviously be avoided. Hives can often come and go in a number of days with only minor discomfort, even without finding the actual cause of the problem. If the causative agent cannot be found, a further investigation of diet and lifestyle should be taken with a doctor or specialist in order that the agent can be avoided and further outbreaks prevented.

Non-prescription Treatments

It is advisable to treat hives, especially if they are very itchy, as persistent itching may cause marking of the area and in some cases a secondary infection. Anti-itching products such as EURAX cream or lotion or CALAMINE LOTION are useful in preventing itching and should be applied to the affected area twice to three times daily, providing relief for 6-10 hours. For children under 3 years, once daily application only is required.

Hydrocortisone creams such as HC45, HYDROCORTISYL or CORTOPIN are also useful in reducing the itch of bites and stings, but can only be applied sparingly to small areas. For adults and children over 10 years only, application is once or twice daily to a maximum of 7 days. EURAX HC contains both anti-itching and hydrocortisone actives and is applied to the area twice daily. Alterrnatively topical anti-histamines such as ANTHISAN cream can be applied to reduce the allergic reaction.

Oral anti-histamines can be used in conjunction with topical antihistamines or on their own, depending on the severity of the hives. The older oral antihistamine products such as PIRITON will reduce symptoms but can cause drowsiness, need to be taken a number of times in the day and can interact with a number of medicines.

From the age of 2 years, children can take PHENERGAN elixir. As it causes drowsiness, it is usually administered at night, the quantity dependent on the age of the child. Children over 6 years of age can take PIRITON.

The newer oral antihistamines ZIRTEK, CLARITYN do not cause drowsiness, are only taken once daily and do not interact with as many medicines as the older antihistamines. They cannot be taken by children under 12 years.

For pain, paracetamol is recommended. The adult dose is two tablets up to four times daily, while the children s dosage depends on age.

Your Pharmacist will be able to advise you on the specific products and dosages that are suitable for you and your condition.

Further Information on the medicines listed above including dosage is available at www.medicines.ie