Hay fever Classification and external resources
Pollen grains from a variety of common plants can cause hay fever. Pollen is a fine to coarse powder consisting of microgametophytes ( pollen grains) which produce the male Gametes (sperm cells of
ICD-10	J30.1
ICD-9	477
OMIM	607154
DiseasesDB	31140
MedlinePlus	000813
eMedicine	ent/194  med/104 ped/2560
MeSH	D006255

Allergic rhinitis, known as hay fever, is caused by pollens of specific seasonal plants, airborne chemicals and dust particles in people who are allergic to these substances. Pollen is a fine to coarse powder consisting of microgametophytes ( pollen grains) which produce the male Gametes (sperm cells of Allergy is a disorder of the Immune system often also referred to as Atopy. It is characterised by sneezing, runny nose and itching eyes. This seasonal allergic rhinitis is commonly known as 'hay fever', because it is most prevalent during haying season. Rhinitis is the medical term describing irritation and inflammation of some internal areas of the Nose. Hay is a generic term for grass or Legumes that have been cut dried and stored for use as animal feed, particularly for grazing animals like It is particularly prevalent from late May to the end of June (in the Northern Hemisphere). However it is possible to suffer from hay fever throughout the year.

Contents 1 Causes 2 Signs and tests 3 Prevention 4 Treatment 4.1 Medication 4.1.1 Systemic therapy 4.1.2 Topical therapy 4.1.2.1 Nasal treatments 4.1.2.2 Eye treatments 4.2 Preventative 4.3 Herbal treatments 4.4 Allergy immunotherapy 4.5 Homeopathy 4.6 Acupuncture 4.7 Honey 5 Expectations 5.1 Complications 6 References 7 External links

Causes

As noted above, hay fever involves an allergic reaction to pollen. Allergy is a disorder of the Immune system often also referred to as Atopy. Pollen is a fine to coarse powder consisting of microgametophytes ( pollen grains) which produce the male Gametes (sperm cells of A virtually identical reaction occurs with allergy to mold, animal dander, dust and similar inhaled allergens. Dander is material shed from the body of various animals similar to Dandruff or pet pollen Particulate matter in polluted air and chemicals such as chlorine and detergents, which can normally be tolerated, can greatly aggravate the condition.

The pollens that cause hay fever vary from person to person and from region to region; generally speaking, the tiny, hardly visible pollens of wind-pollinated plants are the predominant cause. See also Pollination syndrome Anemophily or wind pollination is a form of Pollination whereby Pollen is distributed by Wind Plants are living Organisms belonging to the kingdom Plantae. Pollens of insect-pollinated plants are too large to remain airborne and pose no risk. See also Pollination syndrome Entomophily is a form of pollination whereby Pollen is distributed by Insects particularly Bees Examples of plants commonly responsible for hay fever include:

• Trees: such as birch (Betula), alder (Alnus), hazel (Corylus), hornbeam (Carpinus), horse chestnut (Aesculus), willow (Salix), poplar (Populus), plane (Platanus), linden/lime (Tilia) and olive (Olea). Birch is the name of any Tree of the genus Betula ( Bé-tu-la) in the family Betulaceae, closely related to the Alder is the common name of a Genus of Flowering plants ( Alnus) belonging to the Birch family (Family Betulaceae) The hazels ( Corylus) are a genus of Deciduous Trees and large Shrubs native to the temperate northern hemisphere Plants in the genus Carpinus ( Cár-pi-nus) are commonly called Hornbeams. For the South African Thoroughbred racehorse see Horse Chestnut (horse. Willows, sallows and osiers form the Genus Salix, around 400 species of Deciduous Trees and Shrubs found primarily Populus is a genus of between 25–35 species of Flowering plants in the family Salicaceae, native to most of the Northern Hemisphere. Platanus is a small genus of Trees native to the Northern Hemisphere. Tilia is a Genus of about 30 species of Trees native throughout most of the temperate Northern Hemisphere, in Asia (where the greatest Olea is a Genus of about 20 species in the family Oleaceae, native to warm temperate and tropical regions of southern Europe, Africa In northern latitudes birch is considered to be the most important allergenic tree pollen, with an estimated 15–20% of hay fever sufferers sensitive to birch pollen grains. Olive pollen is most predominant in Mediterranean regions.
• Grasses (Family Poaceae): especially ryegrass (Lolium sp. Poaceae or Gramineae is a family in the Class Liliopsida of the flowering plants. Ryegrass ( Lolium) is a genus of nine species of tufted Grasses family Poaceae. ) and timothy (Phleum pratense). Timothy-Bailey ( Phleum pratense) is an abundant perennial grass native to most of Europe except for the Mediterranean region An estimated 90% of hay fever sufferers are allergic to grass pollen.
• Weeds: ragweed (Ambrosia), plantain (Plantago), nettle/parietaria (Urticaceae), mugwort (Artemisia), Fat hen (Chenopodium) and sorrel/dock (Rumex)

In addition to individual sensitivity and geographic differences in local plant populations, the amount of pollen in the air can be a factor in whether hay fever symptoms develop. Ragweeds ( Ambrosia) also called bitterweeds and bloodweeds, are a Genus of flowering Plants from the sunflower Plantago is a Genus of about 200 species of small inconspicuous plants commonly called plantains. Nettle is the common name for between 30-45 species of Flowering plants of the genus Urtica in the family Urticaceae, with a cosmopolitan though Urticaceae, or the nettle family is a family of Flowering plants The family name comes from the genus Urtica (nettles Artemisia vulgaris ( mugwort or common wormwood) is one of several species in the genus Artemisia with names containing mugwort "Goosefoot" redirects here The unrelated Smearwort ( Aristolochia rotunda) is sometimes called "Mercury Goosefoot" Common sorrel ( Rumex acetosa) also known as spinach dock, is a perennial herb that is cultivated as a garden Herb or The docks and sorrels, Genus Rumex L, are a genus of about 200 species of annual, biennial and perennial Hot, dry, windy days are more likely to have increased amounts of pollen in the air than cool, damp, rainy days when most pollen is washed to the ground.

The time of year at which hay fever symptoms manifest themselves varies greatly depending on the types of pollen to which an allergic reaction is produced. The pollen count, in general, is highest from mid-spring to early summer. As most pollens are produced at fixed periods in the year, a long-term hay fever sufferer may also be able to anticipate when the symptoms are most likely to begin and end, although this may be complicated by an allergy to dust particles.

When an allergen such as pollen or dust is inhaled by a person with a sensitized immune system, it triggers antibody production. Antibodies (also known as immunoglobulins, abbreviated Ig) are Gamma globulin Proteins that are found in Blood or other Bodily These antibodies mostly bind to mast cells, which contain histamine. A mast cell (or mastocyte) is a resident cell of several types of tissues and contains many granules rich in Histamine and Heparin Histamine is a Biogenic amine involved in local immune responses as well as regulating physiological function in the gut and acting as a Neurotransmitter When the mast cells are stimulated by pollen and dust, histamine (and other chemicals) are released. This causes itching, swelling, and mucus production. In vertebrates mucus is a slippery secretion produced by and covering Mucous membranes It is a viscous Colloid containing Antiseptic enzymes (such as Symptoms vary in severity from person to person. Very sensitive individuals can experience hives or other rashes. A rash is a change of the Skin which affects its color appearance or Texture.

Some disorders may be associated with allergies. These include eczema and asthma, among others. Eczema (from Greek έκζεμα) is a form of Dermatitis, or Inflammation of the Epidermis. Asthma is a chronic Condition involving the Respiratory system in which the airways occasionally constrict become inflamed, and are

Allergies are common. Heredity and environmental exposures may contribute to a predisposition to allergies. It is roughly estimated that one in three people have an active allergy at any given time and at least three in four people develop an allergic reaction at least once in their lives.

The two categories of allergic rhinitis include:

• seasonal - occurs particularly during pollen seasons. Seasonal allergic rhinitis does not usually develop until after 6 years of age.
• perennial - occurs throughout the year. This type of allergic rhinitis is commonly seen in younger children. ^[1]

Signs and tests

The history of the person's symptoms is important in diagnosing allergic rhinitis, including whether the symptoms vary according to time of day or the season, exposure to pets or other allergens, and diet changes. Rhinitis is the medical term describing irritation and inflammation of some internal areas of the Nose. This article is primarily about the human diet For a discussion of animal diets see List of feeding behaviours.

Allergy testing may reveal the specific allergens the person is reacting to. Skin testing is the most common method of allergy testing. This may include intradermal, scratch, patch, or other tests. Less commonly, the suspected allergen is dissolved and dropped onto the lower eyelid as a means of testing for allergies. (This test should only be done by a physician, never the patient, since it can be harmful if done improperly. )

In some individuals who cannot undergo skin testing (as determined by the doctor), the RAST blood test may be helpful in determining specific allergen sensitivity. A RAST test (short for radioallergosorbent test) is a blood test used to determine what a person is allergic to

Sufferers might also find that cross-reactivity occurs. Oral allergy syndrome or OAS is an Allergic reaction to certain (usually fresh Fruits, nuts, and Vegetables that develops in ^[2] For example, someone allergic to birch pollen may also find that they have an allergic reaction to the skin of apples or potatoes. ^[3] A clear sign of this is the occurrence of an itchy throat after eating an apple or sneezing when peeling potatoes or apples. This occurs because of similarities in the proteins of the pollen and the food. ^[4] There are many cross-reacting substances.

Prevention

Avoiding exposure to pollen is the best way to decrease allergic symptoms. ^{[5] [6]}

• Remain indoors in the morning and evening when outdoor pollen levels are highest.
• Take antihistamine drugs
• Wear face masks designed to filter out pollen if you must be outdoors. A histamine antagonist is an agent which serves to inhibit the release or action of Histamine.
• Keep windows closed and use the air conditioner if possible in the house and car. An air conditioner is an Appliance, System, or mechanism designed to extract Heat from an area via a Refrigeration cycle
• Do not dry clothes outdoors.
• Avoid unnecessary exposure to other environmental irritants such as insect sprays, tobacco smoke, air pollution, and fresh tar or paint. Tobacco is an Agricultural product recognized as an addictive drug processed from the fresh Leaves of plants in the genus Nicotiana. Air pollution is the human introduction into the atmosphere of Chemicals Particulate matter, or Biological materials that cause harm or discomfort
• Avoid mowing the grass or doing other outdoor work, if possible. Avoid fields and large areas of grassland.
• Regular hand and face-washing removes pollen from areas where it is likely to enter the nose.
• Regular hair washing before going to bed removes pollen so it doesn't get stuck onto the pillow.
• A small amount of petroleum jelly around the eyes and nostrils will stop some pollen from entering the areas that cause a reaction
• A pollen filter can be fitted to cars.
• If cycling or walking, a filter mask may help.
• Wear wrap-around sunglasses, which reduce the amount of pollen entering the eyes. Wear hypo-allergenic eye makeup and avoid rubbing the eyes. Wear goggles while swimming.
• Take a shower before going to bed and change bed linen often to avoid extra exposure during the night
• Try to avoid trips to rural areas. Trips to the seaside may be better as the sea breeze blows pollen inland.

Treatment

The goal of treatment is to reduce allergy symptoms caused by the inflammation of affected tissues. The best "treatment" is to avoid what causes your allergic symptoms in the first place.

Medication

The most appropriate medication depends on the type and severity of symptoms. Specific illnesses that are caused by allergies (such as asthma and eczema) may require other treatments.

Options include the following:

Systemic therapy

Therapies that have an overall effect on a person's body and therefore thay may help for all of the symptoms include:

Antihistamines

these are taken by mouth and may relieve mild to moderate symptoms. A histamine antagonist is an agent which serves to inhibit the release or action of Histamine. The first-generation (non-selective or classical) antihistamines such as chlorphenamine and promethazine are perhaps the most effective, but their sedative side effects limits their usefulness compared to the newer second-generation and third-generation (selective, non-sedating) antihistamines such as loratadine and cetirizine. An H1 antagonist is a Histamine antagonist of the H1 receptor that serves to reduce or eliminate effects mediated by Histamine Chlorphenamine ( INN) or chlorpheniramine ( USAN, former BAN) commonly marketed as its salt chlorphenamine Maleate (CPM Promethazine is a first-generation H1 receptor antagonist Antihistamine and Antiemetic medication An H1 antagonist is a Histamine antagonist of the H1 receptor that serves to reduce or eliminate effects mediated by Histamine Loratadine is a drug used to treat allergies, and marketed for its non-sedating properties Cetirizine hydrochloride, an Antihistamine, (sɛˈtɪrɨziːn is a major Metabolite of Hydroxyzine, and a Racemic selective H1 Most of these antihistamines are available as over-the-counter drugs. Over-the-counter (OTC drugs are medicines that may be sold without a prescription, in contrast to Prescription drugs The name "over-the-counter"

Glucocorticoids

Corticosteroids administered to the whole body, such as Triamcinolone (Kenalog) by intramuscular injection, are also effective, but their use is limited by their short duration of effect, lasting a few weeks, and the side effects of prolonged steroid therapy. Glucocorticoids (GC are a class of Steroid hormones characterised by an ability to bind with the glucocorticoid receptor ( GR) and trigger similar effects Corticosteroids are a class of Steroid hormones that are produced in the Adrenal cortex. Triamcinolone (trade names Kenalog Aristocort Nasacort Tri-Nasal Triderm Azmacort Trilone Volon A Tristoject, Fougera, Tricortone, Triesence Intramuscular injection is the injection of a substance directly into a Muscle.

Leukotriene receptor antagonists

these newer products, such as montelukast (Singulair) and zafirlukast (Accolate), have proven very effective in dealing with allergic rhinitis, without the common side-effects of the first-generation antihistamines, such as drowsiness. Leukotrienes are naturally produced Eicosanoid lipid mediators, which may be responsible for the effects of an inflammatory response Montelukast (trade name Singulair) is a Leukotriene receptor antagonist (LTRA used for the maintenance treatment of Asthma and to relieve symptoms of seasonal Zafirlukast is an oral Leukotriene receptor antagonist These medicines are also long-acting and are taken once-daily.

Topical therapy

Localised treatments may give more effective relief of eye or nasal symptoms.

Nasal treatments

Steroid nasal sprays

are effective and safe, and may be effective without oral antihistamines. Nasal sprays, or nasal mists, are used for the nasal delivery of a drug or drugs generally to alleviate cold or Allergy symptoms such as Nasal congestion These medications include, in order of potency: beclomethasone (Beconase), budesonide (Rhinocort), flunisolide (Syntaris),mometasone (Nasonex), fluticasone (Flonase, Flixonase), triamcinolone (Nasacort AQ). Beclometasone dipropionate ( INN modified or beclomethasone dipropionate ( USAN, former BAN) also referred to as beclometasone (INN Budesonide is a Glucocorticoid Steroid for the treatment of Asthma, non-infectious Rhinitis (including Hay fever and other allergies Flunisolide (marketed as AeroBid, Nasalide, Nasarel) is a Corticosteroid often prescribed as treatment for Allergic rhinitis. Mometasone furoate (also referred to as Mometasone) is a moderately potent Glucocorticoid Steroid used in the treatment of inflammatory skin disorders Fluticasone is a potent synthetic Corticosteroid often prescribed as treatment for Asthma and Allergic rhinitis. Triamcinolone (trade names Kenalog Aristocort Nasacort Tri-Nasal Triderm Azmacort Trilone Volon A Tristoject, Fougera, Tricortone, Triesence They take several days to act and so need be taken continually for several weeks as their therapeutic effect builds up with time.

Cromoglicate

is a drug that stabilizes mast cells and prevent their degranulation and subsequent release of histamine. A mast cell (or mastocyte) is a resident cell of several types of tissues and contains many granules rich in Histamine and Heparin It is available as a nasal spray (Nasalcrom) for treating hay fever, although generally less effective than the nasal steroid sprays.

Antihistamine

Azelastine (Astelin) is the only antihistamine available as a nasal spray. Azelastine is an Antihistamine and Mast cell stabilizer available as a nasal spray (Astelin for Hay fever and as Eye drops (Optivar for

Topical decongestants

may also be helpful in reducing symptoms such as nasal congestion, but should not be used for long periods as stopping them after protracted use can lead to a rebound nasal congestion (Rhinitis medicamentosa). Topical decongestants are Decongestants applied directly to the Nasal cavity. Rhinitis medicamentosa (or RM) is a condition of rebound Nasal congestion brought on by extended use of Topical decongestants ( e

Saltwater sprays, rinses or steam

this removes dust, secretions and allergenic molecules from the mucosa, as they are all instant water soluble. A suitable solution is 2-3 spoonful of salt dissolved in one litre of lukewarm water. ^[7]

Eye treatments

Cromoglicate

is also used as eye drops (Crolom in US and Opticrom in UK being best known brands). Nedocromil is a newer variant of cromoglycate and has essentially the same activity. Nedocromil sodium is a Medication used to prevent wheezing shortness of breath and other breathing problems caused by Asthma.

Preventative

"Allergy shots" (Hyposensibilization, immunotherapy) are occasionally recommended if the allergen cannot be avoided and if symptoms are hard to control. Hyposensitization (or allergy desensitization) is a form of Immunotherapy in which the patient is Vaccinated with progressively larger doses of an Immunotherapy in medicine refers to an array of treatment strategies based upon the concept of modulating the Immune system to achieve a prophylactic and/or This includes regular injections of the allergen, given in increasing doses, which may help the body adjust to the antigen. These tend to be offered as a last resort as the therapy is more expensive at first, although patients may save money on medications and doctor visits in the long run. They may also increase the risk of triggering a secondary allergic reaction such as an asthma attack.

Allergy shot treatment is the closest thing to a ‘cure’ for allergic symptoms. This therapy requires a long-term commitment.

Herbal treatments

A large number of over-the-counter treatments are sold without FDA approval, including herbs like eyebright (Euphrasia officinalis), nettle (Urtica dioica), and bayberry (Myrica cerifera), which have not been shown to reduce the symptoms of nasal-pharynx congestion. A(n herb (ˈhɝb or /ˈɝb/ see pronunciation differences) is a plant that is valued for qualities such as medicinal properties flavor scent or the like For the Canadian Township, see Euphrasia Township Ontario. For the band see Euphrasia (band. Nettle is the common name for between 30-45 species of Flowering plants of the genus Urtica in the family Urticaceae, with a cosmopolitan though Myrica is a genus of about 35-50 species of small Trees and Shrubs in the family Myricaceae order Fagales In addition, feverfew (Tanacetum parthenium) and turmeric (Curcuma longa) has been shown to inhibit phospholipase A2, the enzyme which releases the inflammatory precursor arachidonic acid from the bi-layer membrane of mast cells (the main cells which respond to respiratory allergens and lead to inflammation) but this is only in test tubes and it is not established as anti-inflammatory in humans. Feverfew ( Tanacetum parthenium; syn Chrysanthemum parthenium ( L Turmeric ( Curcuma longa) is a Rhizomatous Herbaceous Perennial plant of the Ginger family Zingiberaceae Arachidonic acid (AA sometimes ARA is an Omega-6 fatty acid 204(ω-6 A mast cell (or mastocyte) is a resident cell of several types of tissues and contains many granules rich in Histamine and Heparin

Allergy immunotherapy

Allergy immunotherapy is commonly used in patients suffering from allergic rhinitis, allergic asthma, or life threatening stinging insect allergy. Hyposensitization (or allergy desensitization) is a form of Immunotherapy in which the patient is Vaccinated with progressively larger doses of an Rhinitis is the medical term describing irritation and inflammation of some internal areas of the Nose. Asthma is a chronic Condition involving the Respiratory system in which the airways occasionally constrict become inflamed, and are This type of therapy has been found to potentially alter the course of all three of the above disorders. Allergen immunotherapy provides long-term relief of the symptoms associated with rhinitis and asthma.

Homeopathy

It has been claimed that homeopathy provides relief free of side-effects. This article has been the subject of edit wars and has been placed on probation However, this is strongly disputed by the medical profession on the grounds that there is no valid evidence to support this claim. ^[8]

Acupuncture

Therapeutic efficacy of complementary-alternative treatments for rhinitis and asthma is not supported by currently available evidence. ^[9][10]

Nevertheless, there have been some attempts with controlled trials^[11] to show that acupuncture is more effective than antihistamine drugs in treatment of hay fever. History Antiquity In China, the practice of acupuncture can perhaps be traced as far back as Complementary-alternative medicines such as acupuncture are extensively offered in the treatment of allergic rhinitis by non-physicians but evidence-based recommendations are lacking. The methodology of clinical trials with complementary-alternative medicine is frequently inadequate. Meta-analyses provides no clear evidence for the efficacy of acupuncture in rhinitis (or asthma). It is not possible to provide evidence-based recommendations for acupuncture or homeopathy in the treatment of allergic rhinitis.

Honey

Eating locally produced unfiltered honey is believed by many to be a treatment for hayfever, supposedly by introducing manageable amounts of pollen to the body. Clinical studies have not provided any evidence for this belief. ^[12]

Expectations

Most symptoms of allergic rhinitis can be readily treated.

In some cases (particularly in children), people may outgrow an allergy as the immune system becomes less sensitive to the allergen. However, as a general rule, once a substance causes allergies for an individual, it can continue to affect the person over the long term.

More severe cases of allergic rhinitis require immunotherapy (allergy shots) or removal of tissue in the nose (e. g. , nasal polyps) or sinuses. Nasal polyps are polypoidal masses arising mainly from the Mucous membranes of the Nose and Paranasal sinuses They are overgrowths of the Paranasal sinuses are air-filled spaces communicating with the nasal cavity within the bones of the Skull and face

Complications

• drowsiness and other side effects of antihistamines
• side-effects of other medications (see the specific medication)
• asthma
• sinusitis
• nasal polyps
• disruption of lifestyle (can be extensive)

A case-control study found "symptomatic allergic rhinitis and rhinitis medication use are associated with a significantly increased risk of unexpectedly dropping a grade in summer examinations". Somnolence (or " drowsiness " is a state of near- Sleep, a strong desire for sleep or sleeping for unusually long periods (c A histamine antagonist is an agent which serves to inhibit the release or action of Histamine. In Medicine, an adverse effect is a harmful and undesired effect resulting from a medication or other intervention such as Chemotherapy or Surgery. Medication, also referred to as medicine, can be loosely defined as any substance intended for use in the diagnosis cure mitigation treatment or prevention of disease Asthma is a chronic Condition involving the Respiratory system in which the airways occasionally constrict become inflamed, and are Sinusitis is an Inflammation of the Paranasal sinuses which may or may not be as a result of infection from Bacterial fungal, viral Nasal polyps are polypoidal masses arising mainly from the Mucous membranes of the Nose and Paranasal sinuses They are overgrowths of the Case-control is a type of Epidemiological Study design. Case-control studies are used to identify factors that may contribute to a medical condition by comparing subjects ^[13]

References

External links

• American Academy of Otolaryngic Allergy
• American Academy of Allergy, Asthma & Immunology
• Ancient Herbal Remedy Beats Hayfever
• Asthma and Allergy Foundation of America – patient advocacy organization
• American Board of Allergy – ABAI establishes qualifications and examines physicians to become recognized specialists in allergy and immunology in the USA
• Daily Pollen Count in the USA
• Hay Fever information page. Asthma and Allergy Foundation of America
• Information on hay fever and children from Seattle Children's Hospital
• eMedicine Health
• Hayfever forum
• Hayfever and acupuncture
• Could you host a hookworm? Nottingham (UK) Hayfever Hookworm Trials
• David Beaulieu. The Asthma and Allergy Foundation of America (AAFA is a non-profit organization dedicated to finding a cure for and controlling Asthma, Food allergies, Nasal Giant Ragweed: Allergy Plants. About. com. Retrieved on 2006-09-19. Year 2006 ( MMVI) was a Common year starting on Sunday of the Gregorian calendar. Events 335 - Dalmatius is raised to the rank of Caesar by his uncle Constantine I. – Giant ragweed is a major source of fall allergies, site helps to identify the weed with included pictures.
• Clinical trial of a new nasal spray for the treatment of hayfever at the Woolcock Institute (Sydney, Au)
• Seasonal Allergic Rhinitis, Steven Jay WEISS MD.

© 2009 citizendia.org; parts available under the terms of GNU Free Documentation License, from http://en.wikipedia.org
Dapyx Software network: MP3 Explorer | Ebook Manager | Zenithic