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Hay Fever

Pollenosis

Hay fever or allergic rhinitis is an allergic inflammation of the nasal membranes that is characterized by rhinorrhea, sneezing, nasal congestion and pruritus.


Presentation

The main symptoms of allergic rhinitis are rhinorrhea (increase in nasal secretion), pruritus, sneezing fits, obstruction and congestion of the nasal pathway [7]. Other characteristic physical findings include conjuctival swelling and erythema, eyelid swelling, lower eyelid venous stasis and effusion from the middle ear.

Cervical Lymphadenopathy
  • This was accompanied by painful anterior cervical lymphadenopathy. The condition responded well to an oral cephalosporin and increased fluid intake along with an analgesic agent. The patient recovered without sequelae.[ncbi.nlm.nih.gov]
Sneezing
  • RESULTS: Significant reductions in severity of symptom scores were found for sneezing, running nose, running eyes and itchy mouth/palate (p or 0.05).[ncbi.nlm.nih.gov]
  • Abstract This case concerns bilateral parotitis apparently caused by increased intraoral pressure generated by sneezing and forceful clearing of the nares during an attack of hay fever.[ncbi.nlm.nih.gov]
  • “It’s like a grenade going off in your nose; within 30 seconds you’re sneezing” Advertisement In most people, these harmless proteins are ignored, but those with allergies are not so lucky.[newscientist.com]
  • Hay fever, also called allergic rhinitis, seasonally recurrent bouts of sneezing, nasal congestion, and tearing and itching of the eyes caused by allergy to the pollen of certain plants, chiefly those depending upon the wind for cross-fertilization, such[britannica.com]
  • It is characterised by cold-like symptoms that may include a runny nose, itchy eyes, sneezing and nasal congestion or blockage.[ncbi.nlm.nih.gov]
Cough
  • Indicators of home dampness were strongly and significantly associated with dry cough, wheeze, and rhinitis symptoms.[ncbi.nlm.nih.gov]
  • Asthma symptoms include: tight chest shortness of breath coughing wheezing.[healthdirect.gov.au]
  • […] you have asthma, you might also: have a tight feeling in your chest be short of breath wheeze and cough Hay fever will last for weeks or months, unlike a cold, which usually goes away after 1 to 2 weeks.[nhs.uk]
Nasal Congestion
  • Hay fever, also called allergic rhinitis, seasonally recurrent bouts of sneezing, nasal congestion, and tearing and itching of the eyes caused by allergy to the pollen of certain plants, chiefly those depending upon the wind for cross-fertilization, such[britannica.com]
  • It is characterised by cold-like symptoms that may include a runny nose, itchy eyes, sneezing and nasal congestion or blockage.[ncbi.nlm.nih.gov]
  • The study would have been improved if compliance was monitored electronically and if nasal congestion was monitored by report. The mode of action is unclear. The study does not consider long-term implications of the therapy.[ncbi.nlm.nih.gov]
Sore Throat
  • Hay fever can cause runny noses, streaming eyes and sore throats. Sadly, many treatments for this distressing condition are not recommended during pregnancy because of fears surrounding the effect on the unborn child.[ncbi.nlm.nih.gov]
  • Stinging eyes, severe sniffles and sore throats are plaguing the poor hay fever sufferers of the UK this summer Credit: Media for Medical / Contributor/gettyimages.com L ast week's heatwave may have relented, but there's no respite for the UK's itchy-eyed[telegraph.co.uk]
  • Symptoms can include: Sneezing Coughing Itching (mostly eyes, nose, mouth, throat, and skin) Runny nose Stuffy nose Headache Sore throat Watery, red, or swollen eyes Dark circles under your eyes Trouble smelling How does hay fever differ from a cold or[aafp.org]
  • Itching of the eyes with redness and watering, headache, intermittent ear plugging, chronic cough, wheezing, intermittent hoarseness, sore throat, and fatigue can also be experienced.[care.american-rhinologic.org]
  • In some cases, hay fever can also: make asthma more difficult to control increase the chance of sinus infections affect your child's learning and performance lead to bad breath, a husky voice and/or a sore throat cause more frequent eye infections because[rch.org.au]
Nasal Discharge
  • Colds will typically last 7-10 days and are often accompanied by yellow or green nasal discharge. Allergic rhinitis, however, is typically associated with clear nasal discharge.[clarityallergycenter.com]
  • Symptoms: Eczema Watery nasal discharge Sneezing Itchy nose and eyes Breathing difficulties Suggestions: Limit outside exposure during hay fever season.[himalayawellness.com]
  • General allergy symptoms include: sneezing clear, watery nasal discharge and congestion itchy eyes, nose, and throat watery eyes[pollen.com]
  • An inflammation of the mucous membrane lining of the nose, usually associated with a nasal discharge; it may be caused by a viral infection, as in the common cold; or by allergic reaction, as in hay fever; also called coryza.[curlie.org]
  • discharge Inflammation of the mucous membrane of the nose 472.0 Excludes Applies To Ozena Rhinitis: NOS atrophic granulomatous hypertrophic obstructive purulent ulcerative ICD-9-CM Volume 2 Index entries containing back-references to 472.0 :[icd9data.com]
Urticaria
  • Rhinoconjunctival syndrome was diagnosed in 180 (97.8%) patients, pollen induced bronchial asthma in 76 (41.3%) and pollen induced urticaria in 35 (19.0%) patients.[ncbi.nlm.nih.gov]
  • […] pustules rarely reaction resemble scalp scaly scarlatiniform scars scleroderma scratch seborrheic dermatitis sensitization serum skin sometimes subcutaneous surface symptoms syndrome Syph syphilis therapy thickening tion toxic treatment tumors ulcers urticaria[books.google.com]
  • Claratyne Tablets provide non-drowsy, rapid 24 hour relief from the symptoms of hayfever, year round allergies and chronic urticaria (hives). One daily dose provides relief from: - Sneezing - Runny nose - Watery, itchy eyes - Itchy rash[bayer.com.au]
  • Martin Metz and Marcus Maurer, Rupatadine for the treatment of allergic rhinitis and urticaria, Expert Review of Clinical Immunology, 7, 1, (15), (2011). Z. A. Randriamanantany, I. Annesi‐Maesano, D. Moreau, C. Raherison, D. Charpin, C.[doi.org]
Epistaxis
  • APARATO RESPIRATORIO R01 Dolor atribuido al aparato respiratorio R02 Fatiga respiratoria/disnea R03 Respiración jadeante/sibilante R04 Otros problemas de la respiración R05 Tos R06 Epistaxis/hemorragia nasal R07 Estornudos/congestión nasal R08 Otros signos[iqb.es]
  • , leading to release of various inflammatory mediators that cause the symptoms we recognize as AR, including sneezing; nasal congestion; stuffiness; rhinorrhea (runny nose); cough; itching of the nose, eyes, and throat; sinus pressure; headache; and epistaxis[emedicine.com]
Kidney Failure
  • For the control condition of kidney failure/weakening, the standardized regression coefficient with air quality was very small (range-0.001-0.004).[ncbi.nlm.nih.gov]

Workup

Allergy testing often shows what allergens an individual is sensitive to. The most common form of allergy testing is skin testing [8]. This often involves a patch test to see what particular substances are causing the condition. In less common situations, the suspected allergen is dissolved and dropped onto the lower eyelid as a means of testing for allergies. The lower eyelid test may be harmful when done improperly. When it is established that an individual cannot undergo skin testing, the RAST blood test is helpful in determining specific allergen sensitivity. In a differential leukocyte count, peripheral eosinophilia is seen.

Alternaria
  • High levels of the mold Alternaria have been associated with severe asthma in the late summer in the upper Midwest of the United States. Aspergillus, another type of mold, is associated with a severe and chronic form of asthma.[web.archive.org]
  • A nasal allergen provocation test with multiple aeroallergens (NAPT‐M), including Dermatophagoides pteronyssinus, pollens, alternaria, and dog epithelia, was performed in patients with negative SPT and serum sIgE.[doi.org]
  • Caillaud, Alternaria sensitization and allergic rhinitis with or without asthma in the French Six Cities study, Allergy, 65, 3, (368-375), (2009). L. Van Den Nieuwenhof, T. Schermer, Y. Bosch, J. Bousquet, Y. Heijdra, H. Bor, W. Van Den Bosch and C.[doi.org]

Treatment

The main goal of treatment is to prevent or reduce the symptoms that are brought about with the inflammation of the affected tissues [9]. Measures that have been proven effective include avoiding the allergen. When medications are required, intranasal corticosteroids are the preferred treatment. Other options can be used when these turn out to be ineffective. Antihistamines and steroids are also effective.

Prognosis

Prognosis is very positive because in many cases, hay fever is successfully managed by minimising exposure to the allergens and treatment with one or more medications [6]. Without medical treatment, many people with hay fever find their symptoms diminish as they get older.

Etiology

Allergic rhinitis is triggered by the pollens of specific seasonal plants. It is known as hay fever because its prevalence is highest during the haying season. The condition however, can affect people round the year [2]. The causative pollen agent varies amongst individuals and also from region to region but in general, the pollens of wind-pollinated plants are the main cause. Pollens of insect pollinated plants cannot cause allergic rhinitis because they are not able to remain airborne for long and do not carry any risks [3]. Below are some plants that have been implicated as etiologic factors for allergic rhinitis.

  • Trees: Olive, linden/lime, plane, poplar, willow, horse chestnut, horn beam, hazel, cedar, alder, birch and pine.
  • Grasses: Family Poaceae (mostly ryegrass (Lolium sp.) and timothy (Phelum pratense)). An estimated 90% of hay fever sufferers are allergic to grass pollen. 
  • Weeds: Ragweed, plantain, nettle, mugwort, fat hen and sorrel/dock. 

The Balsam of Peru, which is seen in fragrances and other products, may also cause allergic rhinitis.

Epidemiology

In the United States, allergic rhinitis affects an estimated 40 million people. Recent figures also suggest a cumulative prevalence rate of 20% [4].

Internationally, the prevalence may vary within and among different countries. In Scandinavia, studies points to a 15% prevalence rate in men and 14% prevalence rate in women. This may be due to geographic differences in the types as well as potency of the overall aeroallergen burden.

Sex distribution
Age distribution

Pathophysiology

Allergic rhinitis is basically an inflammation of the mucous membranes of the nose, eyes, sinuses, pharynx, middle ear and Eustachian tubes [5]. Inflammation of the mucous membranes is characterized by a complex interaction of inflammatory mediators but it is chiefly triggered by a response to an extrinsic protein triggered by an immunoglobulin E (IgE).

The ability to develop allergic or IgE mediated reactions following exposure to extrinsic allergens has a genetic composition. In individuals who are susceptible, exposure to any of the foreign proteins brings about allergic sensitisation. This is characterized by the production of specific IgE directed against these proteins.

This specific IgE coats the surface of the mast cell seen in the nasal mucosa. Following inhalation of a specific pollen grain, it binds to IgE on the mast cells and this leads to the immediate or delayed release some mediators such as histamine, tryptase, chymase, kinins, and heparin. These mediators following various interactions bring about the symptoms consistent with allergic rhinitis.

Prevention

There is no clear prevention path to avoid getting hay fever. A few suggestions point to the avoidance of exposure to allergy inducing substances such as dust mites and animal dander but there is no clear evidence on this yet as susceptible people still develops hay fever even with careful avoidance.

For people with hay fever, the best thing to do is to take steps to lessen the exposure to the allergens that cause the symptoms [10] and taking allergy medications before exposure to allergens as directed by medical personnel.

Summary

Hay fever is a condition more correctly known as allergic rhinitis. It is seen when an allergen like pollen, dust or particles off an animal such as hair or shed skin gets inhaled by an individual who has a susceptible immune system [1]. In these individuals, the allergen triggers the production of the immunoglobin E (IgE) which binds to mast cells and basophils containing histamine.

When allergic rhinitis is caused by pollens from plants, it is known as pollinosis and when it is caused by grass pollens, it is known as hay fever.

Although symptoms resembling a cold or flu can be produced following hay fever, it doesn’t bring about a fever. The disease was erroneously linked with hay because it was believed at the time that symptoms were triggered by coumarin (smell of new hay).

Patient Information

Hay fever or allergic rhinitis is a condition that causes symptoms that bear close resemblance to cold-like signs and symptoms such as runny nose, itchy eyes, congestion and sneezing. Unlike a cold though, hay fever is not caused by a virus. It is instead caused by an allergic response to outdoor or indoor pollens like pollen and dust mites.

Hay fever is a troublesome condition as it can affect performance at work or school and also interfere with leisure activities. In most cases, avoiding triggers and taken the right medication is the best way to manage the condition.

References

Article

  1. May JR, Smith PH. (2008). Allergic Rhinitis. In DiPiro JT, Talbert RL, Yee GC, Matzke G, Wells B, Posey LM. Pharmacotherapy: A Pathophysiologic Approach (7th ed.). New York: McGraw-Hill. pp. 1565–75.
  2. Yamamoto T, Asakura K, Shirasaki H, Himi T, Ogasawara H, Narita S, Kataura A. [Relationship between pollen allergy and oral allergy syndrome]. Nippon Jibiinkoka Gakkai Kaiho 2005 108 (10): 971–9.
  3. Baroody FM, Brown D, Gavanescu L, Detineo M, Naclerio RM. Oxymetazoline adds to the effectiveness of fluticasone furoate in the treatment of perennial allergic rhinitis. The Journal of Allergy and Clinical Immunology 2011 127 (4): 927–34.
  4. Passalacqua G, Bousquet PJ, Carlsen KH, Kemp J, Lockey RF, Niggemann B, Pawankar R, Price D, Bousquet J. ARIA update: I—Systematic review of complementary and alternative medicine for rhinitis and asthma. The Journal of Allergy and Clinical Immunology 2006 117 (5): 1054–62.
  5. Rondón C, Fernandez J, Canto G, Blanca M. Local allergic rhinitis: Concept, clinical manifestations, and diagnostic approach. Journal of investigational allergology & clinical immunology 2010 20 (5): 364–71;
  6. Dykewicz MS, Fineman S, Skoner DP, et al. Diagnosis and management of rhinitis: complete guidelines of the Joint Task Force on Practice Parameters in Allergy, Asthma and Immunology. American Academy of Allergy, Asthma, and Immunology. Ann Allergy Asthma Immunol 1998; 81:478.
  7. Wallace DV, Dykewicz MS, Bernstein DI, et al. The diagnosis and management of rhinitis: an updated practice parameter. J Allergy Clin Immunol 2008; 122:S1.
  8. van Cauwenberge P, Bachert C, Passalacqua G, et al. Consensus statement on the treatment of allergic rhinitis. European Academy of Allergology and Clinical Immunology. Allergy 2000; 55:116.
  9. Bousquet J, Khaltaev N, Cruz AA, et al. Allergic Rhinitis and its Impact on Asthma (ARIA) 2008 update (in collaboration with the World Health Organization, GA(2)LEN and AllerGen). Allergy 2008; 63 Suppl 86:8.
  10. Bousquet J, van Cauwenberge P, Aït Khaled N, et al. Pharmacologic and anti-IgE treatment of allergic rhinitis ARIA update (in collaboration with GA2LEN). Allergy 2006; 61:1086.

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Last updated: 2017-08-09 17:58