Hay Fever: Immunotherapy

By Allergy Ireland
Thursday, 8th July 2021
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Allergy Ireland's Dr Iseult Sheehan talks about Immunotherapy in That's Farming magazine in July 2021. 

That's Farming: Immunotherapy for Hay Fever

Catherina Cunnane, editor of That’s Farming, speaks to Dr Iseult Sheehan, allergy doctor and clinical director at Allergy Ireland, Slievemore Clinic, Stillorgan, Co. Dublin. They discuss the prevention and treatment of hay fever. 

TF: What is hay fever?

Dr Iseult Sheehan: Hay fever refers to those who have an allergy to grass or tree pollen. It is the overreaction of your immune system on inhaling pollen, resulting in inflammation of the lining of the nose and eyes. The symptoms characteristically include a runny or congested nose, sneezing and an itchy nose or throat.

If the sinuses are affected, you may experience sinus pressure and headaches, a postnasal drip and a reduced sense of smell. Additionally, symptoms can often include watery, itchy eyes and dark rings under the eyes.

Hay fever sufferers often have difficulty sleeping, with snoring and mouth breathing being a common feature. They can experience fatigue, low energy and concentration and a feeling of a ‘fuzzy’ head.

Hay fever can even worsen asthma and eczema symptoms. Overall, it can be very debilitating and can reduce your ability to work or study, play sports or attend social activities.

How common is hay fever in Ireland?

Dr Iseult Sheehan: Hay fever is very common in Ireland, with approximately 1 in 4 people suffering. There are, in fact, many different allergic triggers that can cause hay fever symptoms including grass and tree pollen, dust mites, animal dander and mould.

It is estimated that hay fever affects at least 400 million people worldwide. The UK has a prevalence of 26%, and Ireland is likely to be similar to this.

TF: Who can suffer from hay fever?

Dr Iseult Sheehan: Genetic predisposition plays a part, and as a result, hay fever can be seen to run in families. If you have hay fever and work outdoors, this increases your exposure, and it can be a daily battle during peak season.

Symptoms may be more pronounced in inland areas with high pollen counts compared to being close to the sea, where pollen can be blown away.

Pollution can play a role, too, as some pollution particles are known to bind to pollen to create a ‘super pollen’ so to speak.

It is known that symptoms can often be more pronounced when the body is undergoing hormonal changes such as in puberty, pregnancy or menopause.

TF: How could someone find out if they are suffering from hay fever?

Dr Iseult Sheehan: Skin prick testing is the gold standard for allergy testing. It can be done to exclude many other potential allergic triggers, including animal dander or dust mites.

Sometimes blood tests are used in addition to skin prick testing. It is important that these tests are done by the appropriate medical specialist, as the correct interpretation of the results is as important as the tests themselves.

TF: How can farmers ease their hay fever symptoms?

Dr Iseult Sheehan: The first thing to do is to try to limit your exposure to pollen. Wearing wraparound sunglasses while out will reduce the amount of pollen landing in your eyes.

Facemasks reduce the amount of pollen inhaled but can be difficult to wear during heavy work.

After working outside, have a shower and change your clothes so that the pollen sitting on your skin and clothes is washed away.

I would recommend keeping your bedroom window closed during the day to reduce the amount of pollen that ends up on your bedsheets and ensure that you do not have clothes drying outdoors on high pollen count days.

Where possible, avoid cutting grass on high pollen count days also.

TF: What should farmers not do if they suffer from hay fever?

Dr Iseult Sheehan: Do not smoke – apart from causing cancer and lung disease – smoking (even passive smoking) also worsens hay fever symptoms.

TF: What is the best way to treat hay fever?

Dr Iseult Sheehan: The last few years have seen some very effective new treatments become available for hay fever. However, a stepwise approach to treatment is still used.

Saltwater nasal rinses are very effective at cleaning out pollen and excessive phlegm from the nose.

Antihistamine tablets will work well for some people. They are particularly effective for reducing sneezing and itching. 

If these do not work, a steroid nasal spray will usually help. Your doctor can prescribe a suitable one for you.

Your pharmacist can recommend eye drops to prevent eye dryness and ease the itching and irritation. Otherwise, you may require a prescribed eye drop to control these symptoms.

If your nose becomes very blocked, you can use a decongestant spray as a rescue medication. However, it is important that you do not use decongestants for more than five days as they can result in rebound or worsening of your symptoms.

Immunotherapy and Rhinolight: If your hay fever symptoms are on the more severe side or are causing a significant disruption to your life, then several new treatments are available at specialist centres (such as Allergy Ireland) which are highly effective.

Immunotherapy is like taking a vaccine against pollen. It involves taking a tiny dose of grass pollen daily for a period of 3 years to provide long-term protection.
Rhinolight: Phototherapy (Light Therapy) uses visible light and a certain safe range of UV light to reverse the allergic inflammation within the nose. It is effective at preventing and treating hay fever symptoms, whatever the cause.

TF: When should hay fever sufferers start their treatments?

Dr Iseult Sheehan: In general, all treatments are more effective when started a few weeks early. If you suffer from tree pollen hay fever, your symptoms will usually start in March. Meanwhile, with grass pollen hay fever, your symptoms will usually start in May.

It is important to start your medication treatments at least 4-6 weeks before the start of the hay fever season.

TF: What are some natural remedies that farmers could try?

Dr Iseult Sheehan: As previously mentioned, saltwater nasal rinses daily help to remove pollen from the inside of the nose and sinuses.

A fifteen-minute cold compress with a wet towel is useful for suppressing badly itchy eyes or skin.

On high pollen count days, applying a layer of Vaseline to the inside of each nostril can act as a barrier and reduce symptoms.

TF: A Garlic clove hay fever hack went viral on social media in recent weeks. What are your views on this?

Dr Iseult Sheehan: I would not recommend it! The garlic could act as an irritant and make things worse.

Also, getting a garlic clove lodged up your nose could end up with an embarrassing trip to your local emergency department!

TF: When should farmers seek advice from their GP?

Dr Iseult Sheehan: It is important to see your doctor if over the counter treatments do not control your symptoms.

In particular, I would recommend that you see your doctor if your symptoms impact your work, sleep, energy and quality of life.

There are many effective treatments for hay fever sufferers. It is important to ask for advice and not to struggle through your summers feeling miserable!