Millions suffer from hay fever, and many will be acutely aware that the time of sneezes, itchy eyes and runny noses is upon us.
With warnings that the hay fever season is getting longer and worsening — and concerns about the confusing similarity between hay fever and Covid symptoms — here, experts explain everything you need to know….
Is this the worst ever year for hay fever?
The pollen season so far has been a bad one, thanks to the recent dry weather.
Normally, rain dissipates pollen, but in dry conditions it blows straight into the air, where it can then easily get into the eyes and nose.
As last month was one of the driest Aprils on record in England and Wales, this has led to high levels of circulating pollen.
‘I have been seeing more people than usual seek help — and those who do are really struggling with their hay fever,’ says Dr Adrian Morris, a specialist based at the Surrey Allergy Clinic.
But whether this is going to be a record-breaking year for pollen depends on the summer, says Dr Harsha Kariyawasam, a consultant allergist and lead physician for hay fever at the Royal National Throat, Nose and Ear Hospital in London.
As last month was one of the driest Aprils on record in England and Wales, this has led to high levels of circulating pollen
‘We are at the mercy of the summer weather. If it is wet, the pollen will get washed away and it won’t be such a bad hay fever year.’
So far, although it has got off to a bad start, 2021’s hay fever season seems not to be as bad as last year’s, which was worse at this stage, explains Sultan Dajani, a pharmacist in Hampshire. ‘We have not seen as much demand for remedies as we had last year,’ he says.
This is possibly because we haven’t yet had particularly hot weather. And because of lockdown, there have been fewer cars on the roads and so less pollution, which can otherwise add to the discomfort caused by hay fever, he says.
What we do know for sure is that pollen seasons are getting longer. A U.S. study published in February found that the pollen season extended by 30 days between 1990 and 2018.
So instead of starting in March and ending in September, it is now starting in late February, and continuing into October.
Why are symptoms worse sometimes?
Hay fever symptoms tend to be worst around 11am and 6pm, and this is because pollen is at nose level, says Dr Morris.
‘Pollen starts off on the ground at the beginning of the day, so at 8am the pollen is all sitting on the grass. As the day warms up and the grass warms up, the pollen particles are shed and rise up in the air. At about 11am, they’re at nose level — 5 ft off the ground.
During the course of the day, the pollen then goes very high up into the atmosphere and then, as it cools down during the course of the day, the pollen grains come down to earth again and at about 6pm they tend to be back at nose level.
‘That’s why there are two times of the day when people tend to be particularly vulnerable.’
Watch the weather forecast. Gentle rain can ease symptoms because it washes the pollen out of the air and on to the ground out of harm’s way, says Dr Morris. But during a thunderstorm, the pollen grains can explode into smaller particles, which can penetrate deeper into the airways and so exacerbate symptoms.
Gentle rain followed by still, sunny weather creates the perfect condition for a pollen ‘bomb’ (a massive surge of pollen), explains Dr Morris. The rain feeds the production of pollen, the warm weather triggers its release and the lack of wind keeps it hanging in the air. A hot, sunny day with little wind can also be a problem because pollen stays airborne for longer.
Can adults develop it, too?
A recent survey by Allergy UK found nearly half (49 per cent) of people questioned said they had suffered hay fever for the first time in the past five years. While it usually starts in childhood, adults can suddenly be affected, says Dr Kariyawasam: ‘Most commonly, those who are genetically prone to allergies start with eczema in infanthood, with hay fever then following in adolescence.’
It takes time for the immune system to become sensitive to pollen, so most people aren’t struck down with hay fever for the first time until they are between 18 and 25, explains Professor Adam Fox, a consultant in allergies at Evelina London Children’s Hospital.
It’s still possible to develop hay fever in your 30s or 40s but it would be unusual to be a first-time sufferer in your 60s or 70s because the immune response wanes with age.
Dr Kariyawsam adds: ‘However, it can present in anyone who has the genetic tendency. What happens is that something in your environment (we aren’t sure exactly what that is) turns on the genetic switch.’
Is it hay fever- or do I have covid?
There is some crossover with the symptoms of Covid and hay fever, says Dr Kariyawasam. ‘With both you can get flu-like symptoms — and as a result some people with hay fever feel they just want to go to bed, just as those with Covid may.’
But while a high temperature is one of the defining symptoms of catching coronavirus, hay fever does not cause a fever, adds Dr Morris.
Whereas the immune response to a virus generates chemicals that cause a fever, a different part of the immune system is triggered with allergies and this does not include fever-generating chemicals.
‘With hay fever you are also not going to have a sore throat or any aberration of your sense of taste and smell,’ says Dr Morris. ‘You’re more likely to have an itchy nose, sneezing and itchy, swollen eyes.’
If your symptoms get worse after being outside, ‘that’s a strong indicator that it is hay fever’, says Dr Kariyawasam.
The good news is that some allergy-related medication may protect against Covid.
‘Pollen can go to the chest and trigger asthma,’ says Dr Kariyawasam. ‘It can trigger a cough and wheeze and bring on the asthma. If you take the steroid budesonide, it can improve your outcome with Covid,’ he says.
A study published in The Lancet last month reported that the ‘administration of inhaled budesonide reduced the likelihood of needing urgent medical care’ and reduced recovery time after Covid.
‘It seems to protect your airway from the damage that can be done by Covid — possibly as the steroid reduces inflammation [which is what causes much of the damage of Covid],’ says Dr Kariyawasam.
But a high pollen count may be something we should all be wary of because, hay fever sufferer or not, it raises your risk of Covid, according to a University of Utah School of Biological Sciences study. Researchers looked at data from 130 collection points in 31 countries and found that Covid infection rates went up as pollen levels in the air rose.
Writing in the journal Proceedings of the National Academy of Sciences in February, they suggested this was because inhaled pollen reduced the airways’ inflammatory immune response to viruses including coronavirus, so they were able to take hold more easily.
Your pet can get hay fever too
‘Dogs and cats can get hay fever when exposed to grass and tree pollen, just like their owners,’ says Daniella Dos Santos, senior vice president of the British Veterinary Association and a small-animal vet in Buckinghamshire.
‘Their symptoms tend to be different: the main symptom is itchy skin. Dogs with hay fever are also prone to ear infections.’
Treatments for pets include medicated drops for ear infections and medicated shampoos, antibiotics and anti-fungal treatments for skin infections from scratching, as well as medication to prevent itchiness.
Immunotherapy — giving the animal regular injections of small amounts of the pollen it is allergic to — can provide longer-term relief from itchiness.
To help you and your pet, the animal charity Blue Cross suggests wiping your dog’s fur, skin and paws with a damp cloth to remove pollen after a walk, washing bedding regularly and keeping your lawn well-mown (short grass releases less pollen).
‘Dogs and cats can get hay fever when exposed to grass and tree pollen, just like their owners,’ says Daniella Dos Santos, senior vice president of the British Veterinary Association and a small-animal vet in Buckinghamshire
Should we blame rapeseed farmers?
While many people blame the increasing growth of rapeseed for their hay fever symptoms, it is a myth, says Dr Morris.
‘Rapeseed produces a heavy, sticky pollen that drops to the ground and the pollen is spread by bees, not by wind, so it’s not an issue with hay fever,’ he says.
‘We don’t even test for it when we check what people’s hay fever may be triggered by — but people see these huge fields of rapeseed and think it must be their trigger, when actually it’s probably the less conspicuous grass.’
However, certain tree pollen allergies do seem to have become more common — birch tree, for example, says Dr Morris. ‘Birch grows very quickly and looks very pretty and so is increasingly used in residential areas. As a result, the number of people experiencing hay fever owing to birch pollen is increasing.’
Is it worse in the country?
This is another myth, says Dr Morris. ‘Many people don’t realise there is a higher proportion of hay fever sufferers in cities than in the countryside.’ Increased air pollution may be to blame, especially particulates (microscopic particles) from diesel fumes, for triggering the condition and exacerbating hay fever in those who have it.
‘Someone who lives in the city near a park will have worse hay fever than someone in the quiet countryside where there are not many cars around,’ says Dr Morris.
‘The diesel particulates seem to stick to the pollen grains in the air and they form an aggregate that either gets deeper into the airways or it may be that the pollen becomes more allergy-provoking.’
A study published last year in the Journal of Allergy and Clinical Immunology found that people who live in areas of higher pollution are more likely to have more severe nasal symptoms.
However, this seemed to occur only when levels of particulate matter rose — specifically, PM 2.5; particulate matter measuring less than a 50th of the diameter of a human hair, which comes from numerous sources including diesel fumes and wood smoke but also brake pads, tyres and road dust.
People who already have allergies are likely to have worse symptoms if they are in a polluted environment, says Professor Sir Malcolm Green, founder of the British Lung Foundation. ‘There is also evidence that people who would not normally develop allergies are tipped over into becoming allergic because of mucosal irritation caused by pollutants,’ he adds.
Pollution may make plants grow faster and produce more pollen. A study from Germany, published in the journal Plant, Cell & Environment in 2015, found that ragweed plants exposed to high levels of nitrogen oxide, a pollutant emitted from power stations and vehicles, produced more potent pollen that led to more severe reactions.
When should I start taking medication?
If you know you suffer from hay fever, take action in advance, says pharmacist Sultan Dajani. ‘It can take a few days for antihistamines to take effect, so start them around three days before you expect symptoms to begin.
‘In the meantime, you can use corticosteroid nasal sprays, such as mometasone furoate [brand name Nasonex] or fluticasone propionate [Flonase], available over the counter, to override some of the symptoms until the antihistamine start working properly.’
These reduce local inflammation and are different from decongestants, which can help relieve stuffiness but need to be stopped after three days because they can cause ‘rebound rhinitis’.
‘If you keep taking them, you become tolerant, the medication doesn’t work any more and you get the symptoms back but worse than before.’
(It is thought that nasal decongestants cause the nasal receptors that respond to them to reduce in number temporarily.)
Creams containing an antihistamine can help reduce urticaria (skin rashes) caused by hay fever. Eye drops containing sodium cromoglicate (such as Optrex) can help with red, itchy eyes by reducing the release of histamine and can be used up to four times a day.
Why do I get drowsy on antihistamines?
Antihistamines attach to histamine receptors and block the chemical histamine, which is released as part of an allergic response and causes itchy eyes and sneezing. Medicines such as chlorphenamine can cause drowsiness because they cross into the brain, where they affect sleep and wakefulness, says Sultan Dajani.
‘Newer antihistamines such as cetirizine, loratadine and fexofenadine don’t cross into the brain and so don’t cause drowsiness — although, as a result, they may be slightly less effective.’
How diet may help with symptoms
There is some preliminary research suggesting that probiotics (live, ‘friendly’ bacteria) may help alleviate hay fever symptoms.
Professor Adam Fox, a consultant in allergies at Evelina London Children’s Hospital, says: ‘The thinking is that the way that our immune system responds to the outside world is quite significantly influenced by the microbiome, the bacteria that colonise our gut.
‘So if you have a “healthy” microbiome, it skews your immune system to more appropriate responses and less allergic responses, whereas if you have an “unhealthy” microbiome it can skew you the other way. But it’s early days and there are no clinically relevant randomised trials to show probiotics may help.’
However, some dietary strategies may help. Dietitian Carrie Ruxton says: ‘A way of helping to calm the immune response is by having more omega-3 fats as these are anti-inflammatory. Good sources are salmon, trout, mackerel and prawns.
‘Studies suggest eating local honey every day during hay fever season may lessen symptoms.’
Should I put vaseline around my nostrils?
Sultan Dajani suggests ignoring the common advice to smear petroleum jelly around your nose to ‘catch’ the pollen grains before their enter your nose: ‘It is breathing in pollen that’s the problem and this won’t stop this. It will just make a sticky mess.’
But there can be some benefit, says Dr Morris. ‘When someone has hay fever, the nose can be very itchy and irritated from constant sneezing. Rubbing on a layer of petroleum jelly can protect against this.’
More useful is a face mask and wraparound sunglasses. ‘Ordinary [surgery-style] blue masks will act as a barrier and reduce the number of pollen grains entering your nose and mouth — although not completely as the pollen particles are very small,’ says Sultan Dajani.
‘Even on a shady day there can be a lot of pollen in the air, so keep eye glasses on whenever you go outside during the pollen season. Keep car windows closed and use the air conditioning on the “recycle air” setting.’
Will I grow out of hay fever?
Yes you can — symptoms typically start to improve from the age of 40 onwards, says Dr Kariyawasam.
That’s because symptoms begin when immune cells called B lymphocytes mistakenly identify the proteins on pollen as a threat and make antibodies in response. These antibodies (known as IgE) bind to mast cells, triggering the release of histamine, which tries to rid the body of the threat, causing symptoms such as sneezing and watering eyes.
‘However, as we get older we produce less IgE,’ says Dr Kariyawasam. ‘I always say 40 is a turning point for this, but for most people symptoms significantly improve after 60.’
Allergy-busting gadgets not to be sneezed at
There is no shortage of products claiming to help banish the symptoms of allergic reactions, triggered by everything from pollen to pet hair and house dust mites.
Pat Hagan asked Adam Frosh, an ear, nose and throat surgeon at the Lister Hospital in Hertfordshire, to assess a selection. We then rated them.
Henry Allergy, £159.98, myhenry.co.uk (below)
Claim: This vacuum cleaner is designed to remove pollen, dust and pet-related allergens from carpets and upholstery. It has a special filter that, it is claimed, traps particles ‘up to 800 times smaller in width than a human hair’. It comes with bags with a self-seal tab to ‘lock dust inside’.
Expert verdict: This is potentially useful for getting rid of house dust mite droppings, a common trigger for asthma symptoms. It will also remove pollen on surfaces. If you have bad allergies, consider wearing a face mask (preferably with an allergy or pollen filter) when emptying the cleaner. It only claims to help with pet allergies, not specifically cat allergen particles — which are much smaller and an asthma trigger.
Anti-pollen nose filter
Nasal AirGuard, £11.95 for six, allergybestbuys.co.uk
Claim: A tiny cellulose filter sits inside each nostril to trap particulates such as pollen and house dust mite fragments, while carbon granules in the filter absorb pollutants such as exhaust fume particles.
Expert verdict: These are useful because they provide a physical barrier to pollen and other allergens. They obviously won’t protect against other hay fever symptoms such as streaming eyes.
Necklace to ‘clean’ air
Minimate Ionic Personal Air Purifier
Minimate Ionic Personal Air Purifier, £69.95, allergybestbuys.co.uk
Claim: Worn round the neck, this matchbox-sized device is said to protect against pollen and other allergens and viruses by purifying surrounding air. It generates an electrical field that disrupts the electrical charge of particles such as pollen.
Expert verdict: In theory, air purifiers could protect against allergens getting into the airway, but there’s very little research to prove they work. I haven’t seen any studies proving this technology works, as it claims, to help ‘vaporise’ pollen. And it’s not cheap.
Neat Steam Cleaner, £144.99, dupray.co.uk
Claim: This produces a jet of steam at around 100c (212f) that kills 99.9 per cent of bacteria and viruses, and eliminates mould spores, dust mites and allergens from bedding, furniture, carpets, toys and car interiors, it is claimed.
Expert verdict: Steam cleaners are much more effective at getting rid of allergens and house dust mites than vacuum cleaners with special filters because the steam heat can kill dust mites.
But steam cleaners can’t penetrate far enough to kill dust mites deep inside a mattress, so replace your mattress every seven to ten years.
Neat Steam Cleaner
Kleenex Allergy Comfort Wipes, £1.50 for 40, wilko.com
Claim: These chemical-free pads are infused with water to wipe away allergens from skin surrounding the eyes.
Expert verdict: There’s no evidence these are any better than using a damp cloth, but they are more convenient if you are out. Wiping your face frequently or showering when you come home can reduce pollen particles.
Kleenex Allergy Comfort Wipes
Allergy reliever, £19.99, lloydspharmacy.com
Claim: A gadget that’s placed in the nostrils, this emits a red light that, it is claimed, will suppress inflammation — slowing down the release of histamine.
Expert verdict: There is some evidence to support phototherapy devices like this.
A recent study found regular use of light therapy reduced hay fever symptoms — such as runny and watery eyes — by more than a third, reported the Brazilian Journal of Otorhinolaryngology. It’s worth a try.