Spring into action

With spring in full swing, many of us are looking forward to longer days, warmer weather and more chances to enjoy the great outdoors.

Unfortunately, for millions of hayfever sufferers across the nation, it can be hard to feel full of the joys of the season if your eyes are itchy and you can’t stop sneezing.

“Hayfever is a very common allergy affecting around one in four adults and one in 10 children in the UK,” says Margaret Kelman, acting head of clinical services at Allergy UK. “The number of people affected has trebled in the last 30 years. The condition is becoming more common, partly due to better diagnosis but also due to climate change, with warmer temperatures causing pollen seasons to start earlier and last longer.”

Pharmacy staff may also sometimes hear the condition referred to as ‘allergic rhinitis’. “They’re used interchangeably, for sure,” says professor Stephen Till, an allergy specialist and a spokesperson for the British Society for Allergy & Clinical Immunology (BSACI). “The thing about allergic rhinitis is that just refers to the nasal symptoms, whereas hayfever encompasses the wider symptoms.”

These might also include:

• Red, itchy or watering eyes
• Itching of the throat, mouth and ears
• Headache
• Tiredness
• Loss of smell.

Anyone can be affected by hayfever, according to Margaret, but it’s more common in young adults. “Allergic rhinitis is more likely to occur when there is an immediate family history of atopy (i.e., one or more of asthma, allergic rhinitis, eczema, etc). Often there is a seasonal pattern to symptoms that can be linked to a particular pollen group,” she explains.

“Allergies can develop at any age, although as we go into our senior years the immune system becomes less reactive, and so allergies are not as common as when we are younger. People with known atopy are more likely to develop other allergic conditions – for example, asthma and allergic rhinitis.”

Taking its toll

While some hayfever patients experience mild discomfort, for others it can mean months of misery. “Hayfever can have a huge impact on quality of life if it is not treated or well managed,” explains Margaret. “Having severe hayfever can affect someone’s ability to participate in outdoor activities, affect their mental health and even have a detrimental impact on careers, especially for someone who works outdoors. It can lead to increased irritability, lack of sleep, and affect someone’s ability to concentrate at work or school and to carry out simple tasks.”

Margaret adds that 90 per cent of people with asthma have allergic rhinitis. “In people with asthma, there is an increased risk of worsening asthma symptoms and hospitalisation with poorly treated hayfever. This can also lead to recurrent sinus infections and the development of asthma, especially in children.”

There are people with hayfever who also develop seasonal asthma symptoms, says professor Till. “Sometimes these are patients who don’t have asthma at any other time of the year. On certain days when the pollen count is really high, and perhaps they’re outdoors or something like that, people do develop asthma attacks in summer or tree pollen season. That’s something we see fairly commonly. If patients with hayfever develop wheezing or chest tightness or difficulty breathing, they really need to seek medical attention as they may need treatment for asthma for that period of the year. Sometimes patients can even end up needing care in A&E.”

Common triggers

So what are the main hayfever culprits – and how do they vary by season? “Grass pollen is the most common allergen, but tree and weed pollens can also cause the allergic reaction we know as hayfever, especially birch pollen,” says Margaret. “Typically, hayfever triggered by grass pollen will start to affect people during May and June, but hayfever can start as early as February/March if you are allergic to tree pollen. While some people with hayfever react to one type of pollen during the ‘season’ and then feel better later in the year, it is also possible to be affected by more than one type, leading to many months of allergic rhinitis symptoms.”

In some cases, you may encounter customers whose hayfever has been triggered for the first time. But what causes some patients to suddenly experience symptoms when they’ve never done so before?

“I suspect that some of these individuals may have already been sensitised to the pollen – in other words, they already had the antibodies that react to it – but possibly the tendency for pollen counts to become higher for longer has unmasked the allergy,” says professor Till. “It has been proposed that higher pollen counts could possibly be linked with climate change.”

Having been involved with allergy since the early 90s, professor Till says we’re seeing many more people now who are allergic to tree pollen, such as from silver birch trees. “Why exactly tree pollen allergy has increased is not well understood. There are various theories – about local authorities planting more birch trees around, possibly also a climate element too – but it’s very difficult to tie down these factors.”

“It is worth noting that after a person has become sensitised to a pollen, then on subsequent seasonal exposures their symptoms may become worse, especially if the symptoms aren’t treated adequately,” adds Margaret. Allergy UK has a handy pollen calendar on its website, identifying the different strains and when they are at their peak.