How to make sure your hay fever doesn't drive you haywire
Ireland’s grass pollen season begins the day after St Patrick’s Day and runs until the end of August, making it one of the longest grass pollen seasons in the world. Picture: iStock
An itchy, runny nose, streaming eyes, and sneezing. As we enter peak grass pollen season, these are all common symptoms for the one in four Irish people who have hay fever.
Ireland’s grass pollen season begins the day after St Patrick’s Day and runs until the end of August, making it one of the longest grass pollen seasons in the world.
Experts advise starting hay fever medication before the season begins, ahead of symptom onset. That preparation is critical, says Dr Iseult Sheehan, clinical director at Allergy Ireland, because for people with hay fever, pollen can trigger inflammation in the nasal cavity, and this inflammation “is harder to control and manage once it starts”.
“If you’re allergic to pollen, on a high pollen-count day, what’s happening is your immune system misinterprets pollen as a threat, and it reacts to that threat. So, when you’re exposed to pollen and breathe it in, it can cause a runny nose, sneezing, or a blocked nose, which can then block your sinuses and cause pressure headaches. And then you can also experience symptoms such as itchy, swollen, red or watery eyes. With those symptoms, you’ll often have a lot of daytime fatigue and not sleep properly at night, which means it can be difficult to perform your normal daily job or attend school,” says Sheehan.
The combination of these symptoms can often cause hay fever sufferers to miss school and work. And for young people taking exams, this can be problematic, as exams are often held in the middle of peak grass pollen season.
“For those with mild hay fever, that means starting to take their over-the-counter antihistamines, which are effective for itching, sneezing and for drying up the nose a little bit,” says Sheehan.
Those with mild to moderate hay fever may opt for nasal steroid sprays, but Sheehan reminds us that these are a “long-term treatment” and not an instant fix. “Some people will often stop using their nasal spray because they feel they’re not getting immediate relief from it. But if they continue to use it on a regular basis, then it will make a difference during the hay fever season.”
Using antihistamines with a nasal spray will be more effective than antihistamines on their own, says Dr Juan Trujillo, consultant paediatric allergist at Cork University Hospital. “Nasal sprays that are prescribed by GPs work to decrease the inflammation of the nose, and they can help you to breathe better than with antihistamines alone.”
In these cases, allergy experts often recommend transformative sublingual immunotherapy.
“This treatment tries to train your own body to fight an allergen, in the case of hay fever — that’s tree or grass pollen. While it doesn’t cure you, it greatly reduces the symptoms in those with moderate to severe hay fever,” Trujillo says.
The treatment works by exposing a person’s immune system to small, gradually increasing doses of an allergen — grass pollen, tree pollen, or dust mites — which boosts tolerance and reduces the need for allergy medication.
Sublingual immunotherapy has been available in Ireland for around 10 years, but in the last five years it has become more popular as a treatment, says Trujillo.
“It must be diagnosed and started by an allergy specialist or a GP who is familiar with the treatment. You can’t start it by yourself.”
In addition to medication, people with hay fever can take practical steps to minimise their exposure to pollen. Keeping windows closed on days with a high pollen count, and staying away from grassy areas on those days, is a good start, says Trujillo.
“If you have been exposed during the day, make sure that when you come home, you shower, wash your hair, change your clothes, and rinse out your eyes. We would recommend saline irrigation of the nose as well; salty water into the nose is very effective in the evening to clear out the pollen load from the day,” he says.
It’s about being proactive, says Sheehan, and understanding how to reduce your contact with pollen. “A lot of this advice is common sense, and most hay fever sufferers will know these maintenance tactics, like not hanging clothes outside to dry on days of high pollen count.
“One thing that people may not think of, but for people who have pets, particularly pets with long hair, they can also carry pollen on their dander, so just to make sure that they are groomed frequently and wiped down with a damp cloth if they’ve been outside during high pollen days.”
Hay fever tends to begin in childhood, says Trujillo, with symptoms typically starting around school age.
“If a child is young, six months or a year old, they’re probably not allergic to grass pollen yet. But when they get older, and they’re outside in the world and exposed more to grass pollen, that’s when you may see the allergy taking hold. By the age of seven or eight, parents may begin to see symptoms.
“As the child gets older, we can sit down with them and ask for a quick clinical history of symptoms. This is to help us distinguish between mucus or nasal problems that could be because of a viral infection and allergic rhinitis.”
The standout symptoms experts look for are an itchy nose, nasal congestion, itchy eyes, and the need to repeatedly clear the throat. If these symptoms show up every time your child goes to the park or at specific seasons, the diagnosis is likely to be hay fever, says Trujillo.
The most common refrain he says he hears from parents is, ‘My kid is perfect from October to February, and then in March, April, May, June, July they get so much worse’. “That means the symptoms are seasonal, and it most likely is hay fever.”
Once parents know their child has hay fever, they should focus on everyday management and on stepping up treatment as needed. If their symptoms are mild, Trujillo suggests parents talk to their GP about antihistamines and basic measures.
“If symptoms are still significant — they are impacting sleep, school, and outdoor activities despite nasal sprays — ask your GP if a referral for allergy assessment and possible sublingual immunotherapy is appropriate.”
“Asthma and hay fever are very closely linked. I always say they’re like sisters. What’s going on in the lungs is what’s going on in the sinuses - we call it the one airway disease, because it literally is. Asthma starts in the nose, not just down in your lungs,” explains Ruth Morrow, respiratory nurse specialist with Asthma Ireland.
With such close links, Morrow says management is key. “If you don’t control the hay fever, it will impact the asthma and make it worse.”
She warns that for most asthma patients, hay fever isn’t a side issue, it’s a major trigger. That’s why good hay fever control plays a key role in preventing serious and potentially life-threatening asthma attacks.
Knowing your asthma baseline and establishing your asthma action plan ahead of the hay fever season are good starting points, explains Morrow. “Know how to recognise your symptoms, and when they change, this will alert you to the fact that you may have moved from the green zone, where you feel OK, into the orange zone, where you might need to take some action. Don’t wait to get to the red zone.”
Taking action may involve increasing the dosage of your control medication (a preventative inhaler) or discussing beginning hay fever medication with your doctor.
“Understand what’s working and what’s triggering your asthma and know that you might need to make adjustments to your plan or speak with your GP.”
Simple housekeeping steps, such as ensuring you have enough reliever inhalers, are also vital ahead of the hay fever season. Morrow also advises students facing summer exams not to delay putting a plan in place.
“For people who are doing exams, now is the time to go and have that conversation with the GP, because you want to get your asthma and hay fever controlled. Two weeks before the exam is a bit late in the day. Have that conversation now and get on to the right treatment that gets you through. We always say to exam students to have a conversation with the exam co-ordinator from the school to ensure their chair isn’t right beside an open window, or alert them that you might need breaks if symptoms flare up.”
Proactivity, diligence, and maintenance are key when it comes to hay fever and related chronic diseases such as asthma. Available treatments are effective, and when combined with a common-sense approach to minimising pollen exposure, hay fever sufferers can often reduce the impact of this chronic disease on their daily lives.
- For more information and resources on living with asthma, visit asthma.ie
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