Hay fever, or allergic rhinosinusitis, is characterised by an overreaction of the immune system to allergens such as:
- pollen
- dust
- pet dander
leading to inflamed and swollen nasal passages and sinus cavities.
The condition presents with symptoms including:
- nose congestion
- runny nose
- sneezing
- and often, eye irritation.
These symptoms result from the body’s release of chemical messengers that cause inflammation (histamines and other inflammatory mediators), which aim to attack the perceived threat. This in turn, irritates the lining of the nose and sinuses.
Treatment
The goal of treating hay fever is not only to relieve symptoms but also to manage inflammation and prevent recurrent flare-ups. This involves a multi-pronged approach, often starting with all of the available treatments before narrowing down based on response.
Steroid Nasal Sprays
These are the key in treating hay fever due to their anti-inflammatory properties. They work by reducing the sensitivity of the nasal and sinus tissues to allergens, thus decreasing inflammation.
It’s essential to use these sprays correctly for maximum benefit. Users should block one nostril and insert the nasal applicator into the other, directing the spray towards the outer wall of the nostril, and inhale slowly while pressing the applicator.
In New Zealand, examples of steroid nasal sprays include Beclometasone (Becloclear®, Beconase®), Budesonide (SteroClear®), and Fluticasone (Flixonase®). They’re available in different strengths, with lower strength options purchasable without a prescription and higher strengths requiring one.
Regular use is necessary for maintaining symptom control.
What about decongestant sprays?
It’s worth noting that nasal decongestant sprays like Otrivin and Sudafed should be avoided for hay fever. You can get what we call rebound nasal congestion, due to how the sprays work (down-regulation of alpha-adrenergic receptors).
It typically happens after three to seven days of use and can lead to a cycle of congestion both caused by and temporarily relieved by the medication(s), resulting in increasing use and eventual dependency.
Antihistamines
Antihistamines are usually taken in tablet or liquid form and they work by blocking the histamine reaction reducing itching, sneezing, and runny nosoe (rhinorrhoea). They are effective ways to control symptoms in the short term but are less effective for nasal congestion and maintenance therapy compared with glucocorticoid sprays.
In New Zealand options include loratadine and cetirizine and these second generation medicines are less sedating compared to their first generation cousins which are now rarely used.
Sinus rinses
Rinses with larger volumes of saline (salt water) can wash away materials that can cause allergies (allergens) from the nasal passages. Saline can be used alone for mild symptoms or just before other topical medications, so that the lining is freshly cleansed when the medications are applied.
Nose rinses with saline can be performed as needed only, daily at baseline, or twice daily for increased symptoms.
Eye Drops
For individuals experiencing eye symptoms, ophthalmic antihistamine drops, such as olopatadine, are effective in providing relief.
These drops work locally in the eyes to decrease itching, redness, and watering and work better than using antihistamine tablets.
Management Approach
For optimal results, we would start a full treatment protocol at the first sign of symptoms, using steroid nasal sprays, antihistamines, sinus rinses, and eye drops if necessary. Once symptoms improve, reduce treatments but continue using the nasal spray for long-term protection, adjusting the frequency from daily to as infrequently as weekly based on symptom control.
Allergen Immunotherapy
This is an option for individuals who do not experience sufficient relief from medications or those who prefer a long-term solution. Allergy injections work by gradually desensitising the immune system to the offending allergens, eventually leading to decreased sensitivity and fewer symptoms over time. This is provided by an allergy specialist.
Conclusion
Hay fever, medically known as allergic rhinitis, is manageable with the right strategy. A strong treatment plan, including steroid nasal sprays, antihistamines, sinus rinses, and potentially allergen immunotherapy, can provide a significant relief. Starting with a comprehensive approach and tapering based on symptom control is effective. Consistency, informed decision-making, and proactive management are crucial to handling this disruptive condition.
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