hayfever For thousands of children and young people, seasonal allergic rhinitis causes misery and stress and may adversely affect everyday life, both at school and leisure. Allergy UK’s deputy CEO Lindsay McManus and JFHC editor Penny Hosie suggest ways to relieve some symptoms.

The UK has one of the highest prevalence rates of hay fever or ‘seasonal allergic rhinitis’ anywhere in the world, with the overall rate for the population being about 25% (Mullol et al, 2007) rising to 38% in teenagers (Björkstén et al, 2008).

Common symptoms include a blocked or itchy nose, sneezing, headaches and a general feeling of lethargy.Some sufferers also experience ‘post-nasal drip’, where mucus runs down the back of the throat. Grass pollen is the most common allergen, which affects sufferers at the specific times of the year when grass pollen is released (May to July). However, some people become allergic to tree or weed and shrub pollens, and will therefore be affected at different times of the year (February to June for trees; September and October for weeds). This knowledge can be helpful for forward planning in terms of treatment.

Professor Jean Emberlin, an allergy specialist and scientific director of Allergy UK, says that children who suffer rhinitis are also at increased risk of developing asthma (Emberlin et al, 2007), which is why it is important for good management plans to be followed. She also advises that asthmatics who also suffer rhinitis have less severe asthma and less A&E and hospital admissions if their rhinitis is treated effectively.

Allergy UK’s survey in 2012 revealed that for the 38% of young people who suffer from hay fever, exams couldn’t come at a worse time.

The consumer research revealed that 30% of children with hay fever admitted the condition makes their school life difficult. The national charity surveyed parents of children with the allergy and 31% said their child felt unable to concentrate because of their hay fever, while nearly a quarter (22%) said it makes their child’s life a misery.

Not a trivial condition

‘Hay fever is often perceived as a trivial condition, but the reality is far different,’ explains Lindsey McManus, Allergy UK’s Deputy CEO. ‘Seasonal allergic rhinitis brings with it a great deal of suffering for months at a time. Studies have shown that 40% of children can actually drop a grade between mocks and final exams because of their hay fever and 43% of children find it difficult to sleep, which inevitably has a detrimental effect on their school work.’
The effects of hay fever on performance

‘We want people to understand what a debilitating condition hay fever is, and the affect it has on children, particularly during the exam period,’ she adds.

Certainly the combined effects of sleep deprivation and headaches caused by the congested airways and blocked noses can significantly drain energy levels and performance, greatly increasing a young person’s anxiety and stress levels.

However, it’s often the length of suffering that adds to the misery, whatever the child’s age. Allergy UK’s survey also revealed that 65% of children suffer for two months or more each year, with three in ten suffering for more than three months. Over one in ten (12%) of children don’t even like leaving the house when they are suffering.

Oral Allergy Syndrome

Unfortunately some children with pollen allergy (especially allergy to tree pollens) may also be affected by cross-reactions between their pollen allergy and certain foods. They may find that when eating certain fruits and vegetables, especially raw, they get an itchy mouth or throat. Allergy UK has a useful factsheet on this.

Treatment and referral

There are a wide range of suitable medications available both over the counter and on prescription. The best known over the counter remedies include antihistamines such as Chlorphenamine (Piriton). However, this causes drowsiness in most people so although this side effect can be useful when taken at night and can help children to sleep, it is best avoided during the day. Non-sedating antihistamines such as Loratidine or Cetirizine, are advisable for those taking exams, etc. There are various brands of medication available and when one is not effective trying another is worthwhile.

As we went to press, promising new research revealed how using a new powder treatment, sprayed up the nose, halved hay fever symptoms. What’s more, the trials had shown ‘complete absence of significant adverse effects’, according to Dr Jean Emberlin, co-author of the research.

The fine powder, made of cellulose, the main component of plant cell walls, contains proteins that can trigger the production of histamine, a chemical in the body that causes the nose, eyes, throat and sinuses to become swollen, irritated and inflamed. The treatment is delivered by a puffer device into the nostrils. Once there, it reacts with moisture in the lining and forms a protective gel layer. This stops the inhaled allergens coming into contact with cells in the nose.

The cellulose powder used in the trial is already available over the counter as Care Allergy Defence and Nasaleze For this new study, involving 108 people, some of the volunteers were given the cellulose powder while the others were given a placebo with the same appearance and minty taste, to use three times a day. According to the results, reported in the International Archives of Allergy and Immunology, those on the cellulose powder had a significant drop in their symptoms, while those with the placebo had virtually no change.

Dr Emberlin says that the treatment is not like traditional barrier treatments, such as placing Vaseline around the nostrils which just catch some of the pollen grains. Experiments done on the cellulose gel have shown that it actually stops the allergens going through it so it protects the nasal mucosa. Also, the powder coats a much larger area inside of the nose – not just around the nostrils. At the start of the four-week trial, the average symptom score was seven: by the end, the score in the cellulose group had dropped to four, while for the placebo group it was 6.5.

Dr Pamela Ewan, consultant allergist at Cambridge University Hospitals NHS Foundation Trust, said: ‘This sounds like an interesting study, and certainly an improvement on the old-fashioned remedy of Vaseline.’

However, she cautions that the powder may not be effective against streaming eyes. ‘In the patients in the study the hay fever symptoms were very mild, and the focus was on reducing symptoms in the nose. It is thus not clear if this would help itchy, gritty eyes.’

If a child’s symptoms are severe, a referral to an allergy specialist for a form of treatment called immunotherapy which is extremely effective in treating hay fever. If this option is considered, the treatment needs to be started outside of hay fever season so forward planning is key.

‘We would urge school nurses that where this treatment is appropriate, ensure young people are aware of this as an option and advise that planning should ideally start ahead of time for exams and to talk to their school if they are concerned. With a good management programme, hay fever can be kept under control.’

What is immunotherapy?

According to Allergy UK, desensitisation (also called immunotherapy) is a treatment where an allergic person is exposed to very small doses of an allergen on a regular basis. It can be a very successful treatment for severe allergic rhinitis, as it causes the body to develop ‘regulatory’ immune cells which control the allergic reaction and results in tolerance to the allergen.

Desensitisation is available in two main forms, either as injections or as a tablet which dissolves under the tongue (sublingual therapy). To date, the most effective treatment is a course of injection immunotherapy, which can have long lasting benefits. Injection therapy is available for allergy to grass pollens, tree pollens, house dust mite allergy and allergy to pets. The tablet form of immunotherapy is currently only available for grass pollen allergy.

As immunotherapy is so intensive and time consuming, it is only those with extreme symptoms uncontrolled by normal medications who receive this therapy. In order to be considered for desensitisation you will need to be referred to a specialist allergy clinic by your GP.

Teaching about allergy to young children

Research has shown that children with asthma and allergies often react to triggers in the classroom or nursery environment, so it is sensible to take account of any childhood allergies when planning lessons. Nursery nurses, teachers and school nurses can work together to make sure that any information is appropriate for the age of the children in the group.

Children are naturally inquisitive and will want to know why a child has to avoid certain things, so it is easier to be open and discuss any issues surrounding the allergy that the children should be aware of. Circle time is a good environment in which to introduce the subject of allergies to other children and to talk about how to help an allergic child deal with their allergy. They may also not understand why some children cannot take part in activities, such as sport, and it can be helpful for teachers to explain this to classmates, even quickly, when starting an activity where one child cannot take part for medical reasons.

The school environment

The school environment can exacerbate hay fever symptoms, but reducing exposure to allergens can help. Dr Glenis Scadding, Honorary Senior Lecturer at UCL and based at the Royal National, Throat, Nose and Ear Hospital in London offers this advice:

●Potential allergens should be considered, both inside and outside the classroom (activity lessons, school trips, games and physical education).
●A child with hay fever should sit away from open windows during the summer
●If a child has an asthma inhaler or an auto-injector adrenaline pen, ensure that these are taken to any sporting area or fixture.
●Do not let a child with asthma, eczema or house dust mite allergy sit on dusty carpets.
●Take care when creating nature tables, or pet corners with animal foods and touching of pets.

Sensitisation to grass pollen leads to more exercise related airway symptoms – and there is some evidence that exercising in unfavourable environmental conditions – cold, pollution – can increase the likelihood of developing allergy. Competitive swimmers tend to have allergies and chlorinated pool attendance by children is associated with increased risk of both hay fever and asthma.