Why what’s making you sneeze may NOT be hay fever

The hay fever season is well under way and the air is alive with the sound of sneezing. With up to one in ten Britons affected, this year could be particularly challenging as the long, cold winter has triggered an especially high pollen count, say experts from the Royal Horticultural Society.

This is because plants that didn’t bloom earlier in the spring are likely to do so at the same time as the later bloomers, creating a ‘flower bomb’ effect.

Grass pollen is the most common cause of reactions and tends to affect sufferers between May and July. Tree pollens tend to be most active from March to May, weed pollens from early spring to early autumn.

Allergy symptoms occur when the immune system over-reacts to substances that should be harmless — in the case of hay fever, triggering sneezing, which may be accompanied by runny eyes and an itchy throat.

Yet there are other factors which can cause sneezing, and it’s important to get a correct diagnosis. Taking medication unnecessarily could have side-effects (some antihistamines can cause heartburn).

And not treating the real cause can mean prolonged misery with the symptoms when there may be a simple solution.

Indeed your ‘hay fever’ could be something else, as some of the people here discovered after they underwent allergy blood tests at the Spire Hospital in Manchester.

Each was tested for allergy to grass, weeds, and tree pollen, as well as other common allergens — cat and dog fur, house dust mites, mold and foods including milk, eggs, fish, peanuts and soya.

The blood tests checked for IgE antibodies, which are produced by the immune system in response to allergens and are responsible for mounting an allergic reaction. Their results were assessed by Jay Goswamy, a consultant ear, nose and throat surgeon and specialist in allergy from Wythenshawe Hospital.

And the message for the rest of us? If you think you have hay fever, don’t self-diagnose and medicate; talk to your doctor or pharmacist for the best approach.

My ‘colds’ were caused by milk

Graeme Warner, 60, a company director thought he had hay fever, but was in fact allergic to milk

Graeme Warner, 60, a company director thought he had hay fever, but was in fact allergic to milk

Graeme Warner, 60, a company director thought he had hay fever, but was in fact allergic to milk

Graeme Warner, 60, a company director, lives in Manchester with his wife, Jan, 56, a PA. The couple have three grown-up children. Graeme has suffered from seasonal sneezing for the past ten years. He says:

I started having periodic bouts of sneezing — at least once a week lasting several minutes — about ten years ago. I didn’t feel unwell but my eyes felt gritty and my nose would stream.

I assumed it was hay fever and went to the pharmacist who suggested antihistamines, which didn’t make any difference. The only thing that helped was using the steam room at the gym.

Sometimes it would make me feel off-colour so I’d take paracetamol. Although it was worse in summer, it seemed to happen all year round. I didn’t actually do much about it because I’m in pretty good health, although I do seem to get quite a few colds throughout the year — more so than my family do.

VERDICT: Allergic to milk.

EXPERT COMMENT: Graeme does not have hay fever — he has a mild allergy to milk. Usually this would cause gut symptoms rather than just sneezing. But we know that dairy intake can be associated with increased nasal secretions.

So when Graeme says he has a cold, the symptoms of sneezing, a runny nose and feeling a bit groggy may have been his allergy.

Anecdotally, I’ve seen patients who, after completely cutting out milk and dairy foods, have seen an improvement in their ‘hay fever’ symptoms. It’s good Graeme has found out about his allergy as he can treat his symptoms effectively rather than waste his time with antihistamines.

Graeme says: I’m astonished — I was convinced I had hay fever. I don’t eat meat, but I do have quite a lot of milk and cheese to make up for its absence. I’m going to try to cut it out for a while to see if it makes a difference.

Hidden problem with CAT fur

Danielle Ayres, 35, an employment lawyer at Gorvins Solicitors, is allergic to cats and grass pollen

Danielle Ayres, 35, an employment lawyer at Gorvins Solicitors, is allergic to cats and grass pollen

Danielle Ayres, 35, an employment lawyer at Gorvins Solicitors, is allergic to cats and grass pollen

Danielle Ayres, 35, an employment lawyer at Gorvins Solicitors, lives in Bury, Greater Manchester, with her husband Mike, 34, a recruitment consultant, and their children Jake, seven, and Oliver, five. She started experiencing ‘summer’ sneezing when she was 16. She says:

Although I just try to get on with it I do dread this time of year as the children want to do things like play football outside, and just watching them play in the park can be an ordeal.

I’ve tried taking antihistamines but the drugs leave me exhausted by the end of the day. I’m not sure the pills help anyway. I have sometimes wondered if it is in fact hay fever as I sneeze in the office, even though we don’t have the windows open.

I can get a bit of a cough, though I wonder if that’s a hangover from childhood asthma.

VERDICT: Allergic to cats and grass pollen.

EXPERT COMMENT: Danielle had moderate allergies to cats and grass pollen. Having asthma as a child makes Danielle a candidate for hay fever as the two are closely connected, not surprisingly given that both are the result of hypersensitivity in the airway.

Her asthma treatment — a steroid inhaler — would have suppressed her hay fever hypersensitivity too.

Antihistamines are the best way to treat grass pollen allergy — I recommend fexofenadine, a prescription-only antihistamine which is usually non-drowsy, though it still makes some people sleepy.

A lot of allergy sufferers use over-the-counter decongestants such as Otrivine, which contains xylometazoline hydrochloride to open up and clear nasal passages by reducing swollen blood vessels.

But a word of caution: these types of drug work very quickly but if overused — say after four to six days — they stop working and the user gets a rebound effect, known as rhinitis medicamentosa. The lining of the inside of the nose becomes swollen and inflamed, which is difficult to treat.

Otherwise, the most effective way for Danielle to control her hay fever would be to avoid exposure to pollen. She could try applying a small amount of Vaseline around the nostrils to trap pollen grains, using a saline nasal spray to rinse her nose, and a daily antihistamine eye drop.

Since Danielle’s eyes are especially affected it may also help to wear wraparound sunglasses outdoors. Taking a shower and changing clothes after being outdoors can help.

If Danielle finds that she has exhausted all treatment and feels she really can’t put up with her problem then for grass pollen, she could try immunotherapy, where patients are given a low but increasing dose of grass pollen vaccine either as a monthly injection or as a daily pill placed under the tongue.

Although highly effective, grass pollen immunotherapy needs to be given for three years for long-term remission. In terms of her cat allergy, it’s a case of being forewarned, say if visiting relatives or friends who have a cat.

Danielle says: I’m really surprised about the cat allergy. We don’t have any pets and I never really come into contact with cats, though we did have one when I was young, and I’m wondering if that had anything to do with triggering my asthma.

Even though the sneezing is really bad, I don’t think I’m ready to try immunotherapy as it’s quite a commitment: I’m going to try to manage by avoiding pollen.

SNEEZES FROM FIVE ALLERGENS

Hadassah Walker, 46, a designer, lives in Salford with her husband Adam, 48, a businessman, and their four children aged ten to 18. She’s suffered from hay fever for more than 40 years

Hadassah Walker, 46, a designer, lives in Salford with her husband Adam, 48, a businessman, and their four children aged ten to 18. She’s suffered from hay fever for more than 40 years

Hadassah Walker, 46, a designer, lives in Salford with her husband Adam, 48, a businessman, and their four children aged ten to 18. She’s suffered from hay fever for more than 40 years

Hadassah Walker, 46, a designer, lives in Salford with her husband Adam, 48, a businessman, and their four children aged ten to 18. She’s suffered from hay fever for more than 40 years. She says:

Anything from going into an old building to smelling strong perfume or just being outside can set me off. And it can happen all year round, which is difficult for work since I’m often designing intricate pieces — hard to do with a streaming nose.

I presumed it was hay fever and I’ve tried taking antihistamines. But they don’t work.

I can sneeze unpredictably at any time. Big hearty sneezes about 50 times a day, and six to ten sneezes in one bout. It’s exhausting.

In December I had a really bad cold which left me with no sense of smell or taste. It’s been really awful since I literally can’t taste a thing. My GP referred me to an ear, nose and throat surgeon who has ruled out blocked sinuses and polyps — growths — in my nose. Strangely, I wasn’t tested for allergies.

I had a course of oral steroids but those didn’t help. So I’m waiting for another appointment to see the specialist again.

The only plus side has been that since I lost my senses of taste and smell, I don’t seem to be sneezing anything like as much as before. But it’s a high price to pay.

VERDICT: Allergic to house dust mites, cat and dog fur, grass and tree pollen.

EXPERT COMMENT: Unfortunately Hadassah seems to have a range of allergies, not just hay fever — her allergies to house dust and cat fur are especially strong, while the tree pollen, grass pollen and dog fur are moderate.

She is a hyper-allergic person, so her treatment needs to be general rather than targeted as there are just too many. She may be relieved to know that all her allergies are likely to stay at the same level: only things like reactions to peanuts and insect stings can get worse over time.

She may think she is suffering from a lot of colds but having a runny nose, sneezing and feeling groggy can just as easily be treated as allergic rhinitis.

As well as trying to reduce her exposure to pollen — by showering after she has been outside and trying to avoid being out in the middle of open grassy spaces during the day — she should use a nasal steroid two to four weeks before her hayfever season. In a sense this is the easiest allergy to treat.

For the dust mites I’d suggest Hadassah vacuums her house every day and the pillows and duvets once a week. Bedding should be washed weekly above 60c. Having an ioniser in the bedroom will remove dust from the air while she is sleeping. It could also help if she has a pollen filter put in her car and regularly changed.

It may be that despite these allergies Hadassah has an especially sensitive nose, which is why she sneezes such a lot.

Loss of smell can occur when nerves are damaged by infection: this can be treated with oral steroids, but this doesn’t always work, as in Hadassah’s case. Often it gets better over time — but it can take up to a year.

Hadassah says: I can’t believe how many different things I’m allergic to and hay fever is almost the least of them. We did have a cat a few years ago, and thinking back I sneezed a lot more then. I’m going to take up suggestions about the dust. As for my sense of smell, all I can do is pray it comes back.

JUST AN OVER- SENSITIVE NOSE

Chava Erlanger, 42, an artist, has three children, aged between 15 and 23

Chava Erlanger, 42, an artist, has three children, aged between 15 and 23

Chava Erlanger, 42, an artist, has three children, aged between 15 and 23

Chava Erlanger, 42, an artist, has three children, aged between 15 and 23. She has suffered from summer sneezing for the past 15 years. She says:

At times my sneezing is so bad it affects my ability to work, and in the past my GP has given me a steroid inhaler as well as steroid tablets for about six days at a time. (I don’t take antihistamines because they make me so sleepy.)

I usually start sneezing around April, although this year, it hasn’t been that bad, which is strange considering this is meant to be a bad year for hay fever.

I never had a problem until I moved to the UK from my native Belgium, 15 years ago. I lived in Antwerp which is quite a bare, concrete place with few trees.

I have tried buying locally-sourced honey: I thought that if I exposed myself to local pollen it might boost my immunity, so I have a spoonful in my porridge every day. I can’t say it has made much of a difference.

VERDICT: No allergies, but a sensitive nose.

EXPERT COMMENT: Chava scored a grade zero for all the tests, but since she sneezes all the time, it may be that she has hypersensitive nasal mucosa — the tissue that lines the nasal cavity. She may be sensitive to changes in surroundings, which could even include walking into a warm room.

Even though she doesn’t have an allergy, it may help Chava to use a steroid spray, as it will act as an anti-inflammatory and reduce the impact of environmental triggers which may cause her to sneeze.

However, choosing the right nasal spray is important. Many that can be bought over the counter have high rates of systemic absorption — meaning the steroid gets into the bloodstream and can adversely affect other parts of the body, causing insomnia among other issues. So don’t use one for more than three months at most.

As for the honey, some patients tell me that having local honey, which contains pollen from local trees, seems to help but in Chava’s case this won’t make a difference.

Chava says: I’m really surprised by the results as I was sure I’d be allergic to something. But the advice is really helpful as I still need to manage my sneezing.

The risk of self-diagnosis 

Aaron Seitler, 19, a student, lives in Manchester. He first experienced hay fever sneezing three years ago

Aaron Seitler, 19, a student, lives in Manchester. He first experienced hay fever sneezing three years ago

Aaron Seitler, 19, a student, lives in Manchester. He first experienced hay fever sneezing three years ago

Aaron Seitler, 19, a student, lives in Manchester. He first experienced hay fever sneezing three years ago. He says:

I started having problems with sneezing fits when I was about 16 during my GCSEs and it was really difficult. My eyes were sore, my nose was streaming and it was so hard to concentrate.

The sneezing tends to start around May and the episodes don’t tail off until late August, so I always assumed it was hay fever. Though I didn’t let it stop me doing anything, it can be so bad I get nosebleeds.

I now know to take cotton wool into exams to stop the mess. I have tried taking over-the-counter antihistamine products such as Piriton but it doesn’t really help.

Are you using your nasal spray properly? 

 Many patients don’t use nasal sprays correctly, says Jay Goswamy, a consultant ENT surgeon and specialist in allergy at the Spire Hospital in Manchester and Wythenshawe Hospital.

When you insert the nozzle into your nostril, point it towards that cheek and away from the midline (the bit of cartilage between the nostrils at the bottom of the nose, also called the cartilaginous septum). Then sniff gently. This will ensure the treatment gets into the mucosa, the nasal lining, and into the openings of the sinuses, where the majority of nasal secretions originate.

Lean forward as you apply the spray to help the treatment remain within the nose. Pointing the nozzle towards the midline blows away the mucus, drying out the septum, and can cause bleeding; sniffing too hard also means the particles of the spray bypass the nasal cavity and end up straight in the throat.

The best time of day to use steroids or antihistamines is first thing in the morning — though a steroid spray should be used again at night. (Taking antihistamines in the morning means they can work all day).

The strange thing was that I went to Italy about two years ago right in the middle of August and I didn’t sneeze at all.

VERDICT: Allergy to grass pollen.

EXPERT COMMENT: Aaron has a grade three allergy to grass pollen (grade six is the highest level), also known as seasonal allergic rhinitis, and has all the classic symptoms.

Taking a steroid nasal spray will help. I would advise against self-medicating — it is better to get advice from a GP or pharmacist on this as some people self-diagnose and just assume the immediate route is antihistamines and the problem with that is you might not get the most effective one for you.

But it’s important to start a month before the hay fever season kicks in, since it takes two to four weeks for the spray to take effect.

Antihistamines seem to be most effective against grass pollen allergy but I prefer types such as fexofenadine, which are prescription-only and which you won’t get if you self-diagnose. A lot of allergy sufferers use nasal decongestants such as Otrivine. However, they can’t be used long term because they cause a rebound effect.

Aaron has nosebleeds which can happen due to inflammation within the nose but are often caused in hay fever by nose-blowing or by incorrect nasal spray use.

Aaron says: I’m glad my suspicions that it was hay fever have been confirmed and now I know I should cut back on over-the-counter decongestants to avoid the rebound effect. I think the thing to focus on is prevention.

 

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