Hayfever in Allergy
Hayfever in Allergy
Foxtall grasses release their pollen - a potential source of hayfever symptoms.
`I gradually recognised that it was not an ordinary cold and that the symptoms were much worse on the
golf course or even during a nice day rowing on Loch Lomond.’ Dr John Morrison Smith, then a medical
student, began suffering from hayfever in the late 1930s. ‘At first I did not know what I had, and
neither did any other doctor I encountered in the next two or three years…’
All the classical allergic diseases (see box on p. 11) seem to be increasing, but none has exploded
quite so dramatically as hayfever. The physicians of Ancient Greece described asthma and food allergy,
and the Romans recorded allergy to horses, but there were no reports of hayfever. The only account –
and it is a doubtful one – comes from Persia in AD 925. Two hundred years ago, hayfever was unknown –
and careful research by medical historians has shown that this was not a case of it simply being
ignored, or misinterpreted as a cold.
The first case was reported in 1819, but even in the 1930s it was so rare that a succession of Scottish
doctors and medical students were baffled by Dr Morrison Smith’s symptoms. Today everyone knows what
hayfever is, since huge numbers of people sneeze and snuffle their way through the pollen season. There
are no certain explanations for this meteoric rise, but greater hygiene (21) may be an important
factor.
Symptoms of hayfever
The common symptoms of hayfever are well known:
• itchiness of the nose, mouth, throat and eyes – often the first sign
• a streaming and/or blocked nose
• frequent sneezing
• red, watery eyes (very rarely, hayfever affects the eyes only, with no symptoms in the nose).
Less commonly, there may be:
• dryness of the throat if the nasal blockage results in constant breathing through the mouth
• no sense of smell due to a blocked nose (but nasal polyps can also cause this – 30)
• a feverish sweaty feeling (but the body temperature is usually normal)
• swelling and inflammation of the eyelids, sometimes leading to blistering and ulceration: there
is a risk of blindness if this is not treated promptly
• recurrent sinusitis (30)
• earache, itching or a stuffy feeling in the ears, or ‘glue ear’ (29)
Some sufferers also experience:
• Oral Allergy Syndrome (an itchy tingling mouth) from certain fruits, nuts and vegetables (see
box on p. 63)
• a skin rash from pollen falling on the skin, direct contact with the leaves of the offending
plants, or with droplets of moisture from them – as when mowing a lawn or using a strimmer. If the skin
is cut or grazed, anaphylaxis can (rarely) result from direct contact with the plant (see pp. 58-9).
Even more rarely there can be:
• stomach upsets or even colitis (inflammation of the bowel) possibly due to pollen swallowed
with food or in the saliva
• irritation in the vagina
• migraine
• kidney inflammation (nephritis), leading to puffiness of the face and hands, and possibly other
symptoms
• joint pains.
The last two are probably caused by pollen allergens bound to their antibodies and carried in the blood
(13).
Diagnosis
The standard diagnostic tool here is the skin-prick test (see lo, 91). In diagnosing hayfever there are
three separate questions:
1 Is it actually hayfever?
2 Which pollen or pollens are responsible?
3 Are allergens other than pollen also involved?
Don’t be surprised if none of these questions is asked. In most countries, if you have hayfever-like
symptoms during the pollen season (i.e. when most hayfever sufferers have symptoms), the doctor will
conclude that you have hayfever - and that will be the end of that.
If hayfever seems plausible to you, and you respond to drug treatment, or manage well on pollen
avoidance (126), then -here is probably no reason to go further. Should you want a more thorough
investigation, you will need to be persistent. These are good reasons for requesting a full diagnosis:
• Your symptoms are worse in the pollen season, but they never really go away, suggesting that
you may be allergic to year-round allergens, such as house-dust mite or moulds, as well. It is worth
knowing which ones, so that you can avoid them. If you live in an area that is always warm (such as
California or Southern Australia) it may be that your culprit pollen is in the air all year round -
even so, knowing which pollen it is can help with avoidance. Around the Mediterranean, the pollen from
cypresses can keep hayfever going through the winter (or cause symptoms in winter only).
• Your symptoms are sometimes worse when they should be better, and vice versa. If you are
consistently worse indoors with the windows closed this could indicate that a seasonal indoor allergen
is the culprit - mould spores or cockroach perhaps (cockroach is often seasonal in regions with cold
winters - 118).
• Your symptoms begin before the pollen season begins, or go on long afterwards. Or the severity
of your symptoms does not match the daily pollen count for your suspect pollen. In Britain, the mould
Cladosporium herbarum produces spores in June, roughly coinciding with the grass-pollen season. Allergy
to this mould can easily be mistaken for grass-pollen allergy. You would need skin-prick tests for both
Cladosporium and grasses.
• You are much worse near home than elsewhere. It could just be a garden plant or tree. As one
California resident observed, ‘The worst offender was an olive tree on our front lawn. It’s been
removed.’
• You want to plan holidays free from the culprit pollen.
Moving house - especially to a region with different vegetation
- can be a spur to finding out exactly what your allergens are. If you are going for a full diagnosis
make sure it is done correctly. Don’t accept testing with ‘mixed tree and shrub pollens’ for example,
or ‘weed pollens’. The result tells you very little. Ask for tests with specific pollens.
Treatment
Too many people allow hayfever to spoil the summer months because they are anxious about taking drugs,
or feel that it is nobler to suffer. This book is not in any way complacent about the dangers from
drugs (see Chapter 5), but when it comes to hayfever there really is very little cause for concern. The
risks with drugs used for hayfever are absolutely minimal, and it is such a waste to miss out on the
best time of year.
Most hayfever responds very well to treatment with antihistamines (138). If they make you sleepy,
persist for a while, because this side effect often wears off - or ask for one of the new non-sedating
forms. The sleepiness is annoying, but it is only a minor side effect, and not an indication of the
drug causing any serious harm.
Cromoglycate drops (for the eyes or nose) do not work for everyone, but if they work for you, go for
them. These are absolutely the safest of the anti-allergy drugs. Steroid drops for the nose (144) are
also recommended. The dose of steroid involved is small, and very little gets into the bloodstream, so
there is no risk of serious side effects. If you suffer stinging, burning or dryness, it might be due
to preservatives in the drops, not the drug itself (see box on p. 33). Steroid drops for the eyes
should be used cautiously (144). Don’t use over-the-counter decongestant drops for more than three days
(29).
Immunotherapy is standard treatment for hayfever in many countries, but in Britain you will have a
struggle to get it (see pp. 164-8). Some hayfever sufferers feel they do well with homeopathy (215) or
acupuncture (214).
Pollen asthma
Some people with hayfever also have pollen asthma. Their asthma is worse in the pollen season but it
usually persists all year round (either because there are other allergens or irritants involved, or
just because the inflammation of the airways is self-perpetuating) whereas hayfever itself clears up.
Treating the hayfever fully with antihistamines helps considerably with the asthma symptoms.
In medical terms, this article covers a lot of ground.
First there are the classical allergic diseases
such as hayfever and immediate food allergy, which are caused by the allergy
antibody, IgE .
Then there is non-IgE immune sensitivity, a category which includes a number of quite different
diseases, caused in a great variety of ways. They also vary in severity - there are serious lifelong
problems such as coeliac disease and minor short-lived problems such as contact dermatitis from garden
plants.
Finally the chapter looks at diseases where the immune system seems not to be involved, or
plays only a minor role: the intolerance reactions to food and synthetic chemicals. These are diverse
and rather mysterious in origin. They would not be described as ‘allergies’ by most doctors, though
they often are by complementary therapists (6).
These categories are not nearly as neat and tidy as they might sound. Some problems refuse to fit
anywhere, such as atopic eczema caused by food. A percentage of children with this problem have IgE to
the food concerned, while others do not - so where does it belong?
If you were expecting an answer to that question, you will be disappointed. Nor, quite often, are there
any certain and honest answers to questions such as ‘Has my baby really got asthma?’ or ‘Can you be
sure it’s irritable bowel syndrome?’ There are no answers to
such questions because most diseases do not exist in neat compartments, and the words we use to
describe them really denote rather abstract concepts.
This does not mean that the terms used to describe diseases are invalid - doctors and medical
researchers invent them to try to make sense of a complex, confusing and largely foggy reality. They
also argue over them, split them, unite them and redefine them. There is a constant desire to get the
medical picture of that foggy reality more precise and accurate (although medical politics gets
involved too - 7 -which is unfortunate).
Over time, thanks to huge amounts of research effort, things gradually get clearer. You’ll no longer
hear a doctor talk about ‘rheumatism’ or ‘arthritis’, because it was long since realised that these
categories were useless - they included a number of diverse diseases. And while doctors might say ‘food
poisoning’ or ‘heart attack’ or ’skin cancer’ to a patient, they use much narrower and more precise
terms when talking among themselves, and when ordering tests or prescribing treatment. Each of these
categories has been split into several well-defined sub-categories.
Ideally, this process of splitting continues until each disease category has a set of well-defined
symptoms (this set is known as a syndrome), plus a few simple and definitive diagnostic tests. This
will probably depend on the cause of the disease (the mechanism in medical jargon) being clearly
understood. Once the mechanism is clear, then a disease category is a truly satisfactory tool for
diagnosis and treatment.
Of the disease categories mentioned in this book only a few, such as coeliac disease and hayfever, have
reached that happy state. The majority are still somewhat arbitrary and debatable.
Some disease terms describe a set of symptoms with no clear underlying cause, for example, ‘irritable
bowel syndrome’. Others describe a well-defined response by the body, that can be caused in many
different ways - an endpoint that can be reached by various routes. This is true of ‘asthma’ or
‘urticaria’.
A third type describes a much less well-defined cluster of symptoms. Idiopathic food intolerance,
chemical intolerance and yeast overgrowth all come into this category. A few doctors don’t even see
some of these clusters as real diseases because the symptoms involved are so vague and so widely
encountered. Some of the arguments used to dismiss idiopathic food intolerance are dissected on pp.
74-7. A key point made against these diseases is that the symptoms they produce are non-specific -
common symptoms such as headache, fatigue and diarrhoea, which can arise in a great variety of ways.
Ever since Pasteur and the germ theory, medicine has been based on the idea of each disease having
specific symptoms and specific causes, and it has roared ahead on the basis of this assumption. This is
the prevailing paradigm of modern medicine, and like all
paradigms it blinds people to facts that don’t fit. Evidence is accumulating that there are diseases
which have multiple, non-specific and variable symptoms. Chronic Fatigue Syndrome (CFS - see box on p.
85) is one of these, and its recent transformation from a doubtful diagnosis to a reputable disease
recognised by conventional medicine suggests that the paradigm might be starting to crack.
To sum up, the business of identifying and naming diseases is a complex and uncertain process, in which
the concept of most diseases is only ever that - a concept, subject to change and refinement. This does
not make it worthless - quite the opposite. These concepts are the best we can do at the present time,
and accurate diagnosis is the key to getting the best treatment available now.
As regards both diagnosis and treatment, this book covers a very wide spectrum of medical opinion, from
the entirely orthodox to the frankly whacky. I have tried to give an objective view of these different
opinions and approaches, using the evidence currently available, in the hope that it will help readers
to improve their health while wasting as little as possible of their time or money. In using this
information, you should always try to work closely with your doctor (96), respecting the depth and
breadth of knowledge that conventional medicine has to offer.