Dr Deirdre Peake - Consultant Paediatric Neurologist talks to us about Hayfever

24th, June 2014

While most of us are enjoying the current heat wave, 12 million hayfever sufferers are rubbing their eyes and blowing their noses in misery.

Pollen Beware... Don't Let Hayfever Spoil Your Summer


3fivetwo Group


While most of us are enjoying the current heat wave, 12 million hayfever sufferers are rubbing their eyes and blowing their noses in misery. 

 What is Hayfever?


 Hayfever is medically known as seasonal allergic rhinitis. “Seasonal” because in only occurs for a “part” of the year, “allergic” due to  our own  bodies  makes allergic antibodies (IgE) to a substance  e.g. pollen (these are known as allergens). Rhinitis because in people sensitive to these allergens, exposure causes the release of chemicals from cells in the nasal passages, eyes or airways. This results in inflammation and irritation to the lining of the eyes, nose and throat.

Grass pollen is the most common allergen, which affects sufferers at the specific times of the year when grass pollen is released (May–July). However some children are allergic to tree, grass and weed pollens and therefore they may suffer a very prolonged 'hay fever' season. 


Does it happen to children and how common is it?


We don’t know the exact prevalence in children but an estimated 20% of the population are affected by allergic rhinitis .The prevalence of diagnosed allergic rhinitis and  eczema in children have both trebled over the last three decades

10% of children and adults under the age of 45 have 2 or more allergies 


How does this present?


  • Sneezing, itchy nose and palate
  • Rhinorrhoea (watery, runny nose)
  • itchy, red, swollen eyes
  • Cough, wheeze, shortness of breath

In people sensitive to these allergens, exposure causes the release of chemicals from cells in the nasal passages, eyes or airways. This results in inflammation and irritation to the lining of the eyes, nose and throat.


What other ways can this affect our children?


Asthma: The majority of people with asthma have rhinitis (~78%) and a significant number of people with rhinitis have asthma.

Grass pollen is more associated with asthma attacks than tree pollen. But if you are tree pollen allergic, your immune system can’t really tell the difference between them.

We know that pollution and pollutants increase the inflammatory response within the respiratory system e.g lungs of asthma suffers. This then lowers the threshold at which people respond to the pollen in the air therefore causing a decreased threshold for hayfever sufferers.


 Quality of Life


It may affect quality of life, performance and attendance at school . Although the majority of cases of rhinitis are benign, short-lasting and self-limiting, the symptoms can be severe and debilitating at the time. 


 Does my child need special tests?


No routine blood tests are required however blood tests may be indicated depending on clinical suggestions arising from the history

  • Blood tests are available to identify IgE-mediated disease, although these are not commonly used.
  • Skin prick tests are often not sensitive or specific enough in many cases and need to be interpreted in light of the specific history and if the child is on other medication (it can be suppressed by antihistamines). However if the skin prick test is negative then the child is highly unlikely to be sensitised to that allergen.

 In the case of “hayfever” confirmation of grass or tree pollens as a trigger allows initiation of effective treatment pre-seasonally which is likely to result in better symptom control. Also confirmation that an allergen trigger is NOT the cause may prevent unnecessary lifestyle changes and discourage further allergy investigations

Allergy testing kits are now available to buy over-the counter, although patients should be advised that results need to be interpreted in the light of their clinical history and therefore clinical expertise is required. 


Treatment


The majority of children respond to non-sedating antihistamines, topical nasal corticosteroids or anti-histamines and anti-inflammatory eye drops. A combination of these can be used depending upon symptoms and severity


Saline irrigation (nasal douching)


  • during the pollen season this may improve symptoms

Nasal Steroids


• Useful for nasal congestion and obstruction

Second line treatments

• For nasal congestion the combination of corticosteroid and nasal drops and a topical decongestant can be useful for short term use only (less than 14 days.)

• In severe seasonal allergic rhinitis, particularly before exams or other important events, a short course (25mg/day for 5-7 days) of oral steroids can be very effective (in children 2mg/kg/day up to 25mg)

•Other  more specialised treatments are available in difficult to control cases ( e.g ipratropium bromide 0.03%, Leukotriene receptor antagonists in concomitant rhinitis/asthma and  Immunotherapy (IT) is effective and sublingual IT is now available for children as well as adults.


References:


BSACI  (British Society for Allergy and Clinical Immunology  Standards of Care Committee guideline)


If you would like to book an appointment with Dr Deirdre Peak please call our dedicated team on 0845 60 06 352

Dr Deirdre Peake

Dr Deirdre Peake

General Paediatrics & Paediatric Neurology

Click here to view Dr Peakes Consultant Profile


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