Hay Fever: Specialists & Information

In hay fever, allergens enter the body primarily through the mucous membranes of the nose and throat. The body therefore produces antibodies at these sites. This leads to the development of the symptoms typical of allergic rhinitis. It is, therefore, an immune response by the body.

Allergic rhinitis rarely occurs on its own. It is often accompanied by other respiratory conditions, such as sinusitis or asthma. In addition, the allergens can enter the eyes and trigger conjunctivitis.

Like 90 percent of all allergic reactions, grass allergy is a Type 1 allergy, also known as an immediate-type reaction.

Grass pollen allergy involves an overreaction of the immune system to certain grasses. The immune system’s job is to fight off pathogens. In pollen allergies, the immune system classifies the proteins in flower pollen—which are harmless in themselves—as dangerous and attacks them. As a result, specific inflammatory mediators—histamines and leukotrienes—trigger an inflammatory reaction.

The allergy is thus caused by a malfunction of the so-called IgE antibodies. People with grass allergies have higher levels of these antibodies, which are located on mast cells and react to contact with pollen. The IgE antibodies stimulate the mast cells to release histamine and other inflammatory mediators.

This leads to the development of typical immediate allergic reactions within a few minutes.

For most people with grass allergies, the condition begins in early childhood and persists for decades. Why the immune system reacts so strongly to pollen that is actually harmless has not yet been conclusively determined.

A genetic predisposition appears to play a role in many cases. For example, children of people with allergies often develop an allergy to grasses as well.

Excessive hygiene measures during childhood can also negatively affect the immune system.

However, external factors can also contribute to the development of the condition. These include, for example, air pollution in cities and increasing exposure to pollutants.

Allergies occur particularly in highly developed industrialized countries and are therefore also classified as lifestyle-related diseases. Researchers predict that the frequency and severity of allergic rhinitis will continue to increase in the future as a result of global warming.

As people age, cross-allergies also play a role. In these cases, IgE antibodies respond not only to their specific grass allergen but also to allergens from other sources. For example, people with a grass pollen intolerance often also have allergic reactions to

• various types of grains,
• peppermint,
• peanuts,
• potatoes,
• tomatoes,
• kiwis, or
• melons.

In Europe, most people with pollen allergies react to:

• meadow foxtail,
• common bromegrass,
• German ryegrass,
• meadow fescue,
• meadow foxtail.

Pollen calendars provide hay fever sufferers with precise information about when certain types of pollen are most prevalent in the air.

Hay fever symptoms occur depending on the season: mainly in the spring, when pollen begins to spread. However, there may be exceptions during the winter months of December and January when temperatures remain mild. In such cases, for example, alders may already begin to bloom, and their pollen may start circulating earlier.

In addition, many sufferers are very sensitive to other irritants. These include, above all, scents such as

• perfume,
• dust, and
• tobacco smoke, as well as
• changes in temperature.

Experience shows that dry days and strong winds worsen symptoms. Periods of rain, on the other hand, help alleviate them.

Similar patterns characterize house dust mite allergy. The condition is triggered by inhaling the feces of house dust mites. Here, too, the immune system fights the allergen (the feces).

An allergy to grasses can manifest in various ways. At first, many patients mistake the allergy for a cold, as the symptoms are sometimes very similar.

Due to allergy-induced inflammation of the nasal mucosa, affected individuals suffer from an irritated and itchy nose. During pollen season, the nose is constantly stuffy and runs. At the same time, the nasal mucous membranes dry out very quickly.

Many allergy sufferers experience severe sneezing fits several times a day. The symptoms of grass allergy can also spread to the eyes, throat, pharynx, and lungs. Irritation of the conjunctiva of the eyes leads to watery, burning, and itchy eyes. Conjunctivitis, with severely reddened and painful eyes, is also possible.

The characteristic signs of hay fever are:

• a tingling, itchy, or stuffy nose,
• a runny nose,
• difficulty breathing through the nose,
• dry nasal mucosa,
• frequent sneezing,
• impaired sense of smell and taste,
• a scratchy feeling in the throat,
• a burning sensation in the throat and a sore throat,
• cough,
• sore throat,
• red and watery eyes,
• swollen eyelids,
• Itchy skin,
• disturbed sleep at night and daytime fatigue,
• flu-like symptoms, such as fatigue and body aches.

In severe cases, those affected may experience shortness of breath or asthma attacks. The transition from hay fever to allergic asthma is also referred to as a “change of level.” An allergic reaction causes swelling of the respiratory tract mucosa and a simultaneous contraction of the bronchial muscles, resulting in a typical asthma attack with

• coughing,
• shortness of breath, and
• chest tightness.

A dry, wheezing sound is audible during exhalation. Exhalation is very prolonged and causes great difficulty for those affected. As the attack progresses, a distressing cough develops with thick mucus that is difficult to cough up. The attack is accompanied by restlessness and anxiety.

The typical symptoms of allergic rhinitis vary in severity among those affected. They depend primarily on the amount of pollen in the air.

In the case of a dust mite allergy, symptoms occur year-round. Dust mites—and therefore their feces—are found primarily in mattresses, but also in upholstered furniture.

With both types of allergies, various symptoms often occur simultaneously. In such cases, the chronic condition can pose a significant psychological burden over time. The quality of life for those affected is severely impaired over an extended period.

First, the doctor uses an allergy test to determine the exact trigger of the allergic rhinitis. Treatment should then begin as early as possible. Otherwise, there is a risk that other conditions, such as asthma, may develop.

Ideally, the pollen causing the allergy should be avoided as much as possible. However, since grass pollen is now present almost year-round, this can be quite difficult.

Treatment for grass allergies is generally divided into two categories:

1. Drug Therapy
2. Specific immunotherapy

Medication for Hay Fever

The first pillar of allergy treatment is medication. Antihistamines are primarily used for this purpose. They prevent the inflammatory mediator histamine from taking effect. In this way, antihistamines can block the receptors to which histamine binds in the body. Antihistamines can be administered topically as nasal sprays or systemically in tablet form.

First-generation antihistamines often cause significant drowsiness. This unwanted side effect generally no longer occurs with newer-generation antihistamines. In addition, these medications have the advantage that they often take effect within just one hour. Antihistamines are available over the counter at pharmacies.

Cromones, such as cromoglicic acid, are also effective when used topically. These medications can stabilize mast cells and thus inhibit the release of histamine. However, they take time to take effect, so cromones must be used at least one week before the pollen season begins.

For very severe symptoms, the body’s own hormone, cortisone, is used. Cortisone is many times more effective at reducing inflammation than antihistamines. Glucocorticoids are the most effective form of medication for treating nasal congestion. They are typically administered topically.

Systemic corticosteroids should only be administered for a limited time due to the risk of side effects.

Decongestant nasal sprays or drops do relieve nasal congestion, but they should also be used only for a short time. Otherwise, prolonged use can lead to medication-induced inflammation of the nasal mucosa.

Another treatment option for allergic rhinitis is nasal irrigation. Compared to nasal sprays, it has the advantage of not drying out the nasal mucosa.

Specific Immunotherapies

Specific immunotherapies, such as hyposensitization, are another option for treating hay fever.

In this process, the treating physician administers the grass allergen to the patient in gradually increasing doses. The goal is for the body to become accustomed to the allergen over time and no longer classify it as a potential threat.

Specific immunotherapy can be divided into subcutaneous and sublingual forms:

• Subcutaneous immunotherapy is administered by a doctor through controlled injections.
• In sublingual immunotherapy, the patient takes the allergens in the form of drops or tablets.

The treatment duration for both methods is up to three years and is intended to provide long-term relief.

Proven alternative methods can also help with hay fever. Acupuncture can alleviate the unpleasant symptoms associated with hay fever and noticeably improve quality of life. This often makes it possible to reduce the use of medication.

Since 2015, studies on laser acupuncture therapy have also been underway at Dresden University Hospital. Initial research has shown that this pain-free treatment has a longer-lasting effect than the traditional form of acupuncture.

For allergic rhinitis, there are several immediate measures that can at least help reduce allergic symptoms.

At the start of pollen season, it’s advisable to install a protective screen in front of the bedroom window. During this time, patients should sleep with the window closed whenever possible. It’s best to ventilate the room in the early morning hours when it’s cooler and there’s less pollen in the air.

Vacuum cleaners with HEPA filters, which trap even the smallest pollen particles, have proven effective for cleaning carpets.

To reduce pollen exposure while driving, ventilation systems and air conditioners can be equipped with a pollen filter. When planning a vacation, it’s best to choose regions with low pollen counts. These include, above all, high mountain ranges and islands where there are no birch trees, whose pollen most commonly triggers hay fever.

The symptoms of a dust mite allergy can be alleviated by regularly changing your bedding. Wash the linens at 60°. It’s also helpful to cover mattresses with a special protective encasing. This prevents you from coming into contact with the mites and their droppings.

To reduce the mites’ ability to survive, lowering the humidity in the bedroom has proven effective.