Allergic Rhinitis and Hayfever

by Alex C Pitt

Hayfever

Hayfever or seasonal allergic rhinitis most commonly effects boys aged 5 to 10 and girls aged 15 to 20 but some younger children can be effected too. Your child has hayfever if they have cold like symptoms in the spring and summer months which are made worse when they go outside. It’s mainly a reaction to grass and pollen. Like a blocked, itchy or runny nose, explosive sneezing and itchy eyes. Their ears and palate can also itch and their eyes and their eyelids may appear puffy and swollen.

Allergic Rhinitis

If they have these symptoms at other times of the year they are probably allergic to something else – like house-dust mites, cat or dog dander (shed skin or fur), or perhaps hamster or rabbit- and have perennial allergic rhinitis. Occasionally foods such as milk, egg, wheat and soya cause sensitisation. Children are sensitised in early life but may only develop symptoms later. It usually occurs before the age of 10. Children are often misdiagnosed as having a permanent cold and receive inappropriate treatment with antibiotics.
Some children’s symptoms are very subtle and include a constant blocked nose, snoring, a watery runny nose, loss of taste and smell and sneezing on waking in the morning. It’s important that it’s diagnosed because they might go on to develop other problems such as glue ear which can effect hearing, chronic sinusitis or other breathing difficulties such as asthma. Although allergic rhinitis isn’t life threatening children may feel tired, irritable, moody and have problems concentrating, learning and sleeping.

What is an allergic reaction?

An allergic reaction occurs when pollen is breathed in and sticks on the inside of the nose. This reaction causes the release of chemicals including leukotrines, prostaglandins and histamines which cause inflammation and irritation. That’s why the child starts sneezing as the body tries to blow out the allergen that’s irritating it.

As the nose starts to swell it produces a watery liquid to wash out the irritation which turns to thick mucus and the nose gets blocked. Sometimes the eyes get red and itchy, starting to water and the roof of the mouth and ears also become itchy and the child can start coughing. About half of patients with allergic rhinitis suffer from recurrencing symptoms some hours later, without any new allergen being present.

Avoid the allergens

Which pollens are worse

Tree and grass pollens and some fungi trigger hayfever during springtime and early summer. The pollens most likely to cause early spring problems are those from trees such as the Silver Birch, Ash, Oak and London Plane. Grasses pollinate during mid-summer from May to August. The most profusely pollinating grasses are Timothy, Rye, Cocksfoot, Meadow and Fescue. Occasionally in late summer and autumn Weeds such as Nettles and Dock as well as Mugwort and Plantain can trigger hayfever.

Pollen Counts

Pollen counts are higher when the weather is warmer and are higher early in the morning or late evening. You can get a pollen count for the day from newspapers or telextext or on the internet. Click here (www.bbc.co.uk/weather/features/pollen.shtml)or here(http://www.pollenforecast.org/) for the current pollen count.

Stop the pollen getting in

Give your child sunglasses to wear which will reduce pollen getting in their eyes. Saline douches or a little Vaseline applied inside the nose will reduce their symptoms. You can avoid areas like parks or fields, particularly in the early evening when there is a lot of pollen at ground level. Advise them not to go near or lie on freshly cut grass. While driving keep the windows closed and make sure a pollen filter is fitted to the vent.

In the house

If your child has been outside change their clothes and give them a warm bath at night. You’ll stop them bringing pollen in with them and relax them too. Make sure all bed linen is cleaned regularly, buy non allergic bedding and you can get rid of dust mites. But don’t line dry washing outside as it could pick up pollen and bring it inside.

Sleep with the bedroom window shut to stop pollen getting in. If it’s too hot you can get a fan. Or put a net curtain over the windows. Also avoid smoking in the house; you shouldn’t smoke near children anyway, as it only worsens allergies. And don’t bring fresh flowers into the house.

Animals

If your child reacts to animal fur or dander like dogs or cats it might be better not to let them live in the house. Or you can wash the pet once a week to lower the amount of allergen they release into the home and ban them from the bedroom and vacuum regularly. Cats though are a particular problem as the allergen is in their saliva which goes on their fur when they wash themselves so perhaps you shouldn’t have cats if your child has allergies.

Air purifiers and ionisers

You can use air purifiers and ionisers to reduce pollen levels in the home. Air purifiers use filters to deep clean the air and remove both large and small airborne particles. They have washable filters which claim to remove 99% of airborne pollutants found in the home.
Some air purifiers have an inbuilt ioniser which emits streams of negative ions into the surrounding air. They negatively charge the air which makes dust particles cling together becoming heavy and falling to the ground leaving the air clean.

Going on holiday

If you’re going on holiday or on a day trip this summer go somewhere near the sea as the wind coming off the sea virtually eliminates pollen.

Teach children how to blow their noses

Rubbing and scratching their noses makes them red raw and uncomfortable. A continuous runny nose irritates the upper lip. So teach your child to carry tissues and put soft ones in their pockets. Teach them to blow each nostril one at a time closing the other nostril, dab don’t rub the nose. Also if they can stay clean and wash their hands frequently they’ll avoid spreading infection.

Food Allergies and Diet

Sometimes a child can have hayfever symptoms because their body is fighting some food that it is allergic to. So check with a nutritionist or have an allergy test. It could be an allergy to wheat, dairy of nuts that’s causing the problem. Testing is usually done by means of a pin prick, blood or patch test.

Pollen Food Allergy Syndrome Some children develop hayfever in early spring and then notice that they begin to develop itching and swelling of their mouth and throat on eating fresh fruit and vegetables.

• Silver Birch pollen allergy sufferers develop oral allergies to Apples, Peaches, Cherries, Carrots, Celery, Hazelnuts, Peanuts and Walnuts.
• Grass Pollen allergy sufferers develop oral allergies to Tomato, Melon and Watermelon.
• Mugwort pollen allergy cross-reacts with Apple, Celery and Carrot.
• Ragweed Pollen allergy cross-reacts with Bananas, Melon and Honey.

There’s no reaction to cooked or canned foods and the reaction is usually remains just in the mouth and throat.

Dairy Products

You may find there is an intolerance to dairy products during hayfever season and you can substitute with soya, sheep’s milk, almond or rice milk. It controls mucus and makes life more comfortable but replace the lost calcium with a daily supplement including vitamin D and don’t cut out milk for a child without seeking professional advice.

Fats

Saturated fats found in dairy products and red meat are not good for anyone especially hayfever sufferers so if possible cut down on red meat and dairy products at least during hayfever season. Essential fats found in fish nuts, oils, mega 3 fish oils and flaxseed oil increase anti-inflammatory prostaglandins as does extra virgin olive oil, safflower oil and avocados.

Other good foods

Bromelain boosts beneficial prostaglandins which aid in sinus congestion and its found in pineapples or as a supplement. As long as your child doesn’t react to them give them plenty of fresh fruit and vegetables. Add garlic, leeks, onions and spring onions to food as they have anti-mucus and anti-bacterial properties.
Give your child freshly squeezed lemon juice and water during a hay fever attack to soothe symptoms. Locally produced honey can be good for its homeopathic pollen protection, but some children can react to it.

Look after your liver

Different types of therapy see a link between the problems associated with hay fever and the liver as well as the lungs. In springtime the body naturally cleanses itself of all the toxins, fats and gallstones that have built up in our bodies over the winter time due to overeating and staying indoors. In hayfever the liver is trying to purge the body, and the lung system is a handy route for expelling toxins and phlegm. Conventional treatments that try to push these toxins back into the body could lead to illnesses elsewhere in the body.

There are detoxification programmes using for example rice protein powder, fasting or food cures which only allow eating certain fruits, vegetables, rice, water and tea, until the liver is detoxified. These must only be carried out with the approval of a doctor. There is also acupuncture treatment which concentrates on a single point associated with the liver, which as been studied and found to be effective, but again only consider acupuncture for children under medical supervision.

Conventional treatments for hayfever

There is a huge range of hayfever treatments available in chemists and on prescription from your doctor. We list a few of them and some possible side effects.

Anti-histamines

Anti-histamines are the most common treatments for hayfever. Available without prescription in tablet or liquid form which is easier to administer to smaller children. Some anti-histamines such as Piriton and Actifed are very effective but they cause drowsiness which may be a problem although it’s helpful if symptoms are particularly troublesome at night. They can cause other reactions such as stomach upset, headaches, dry mouth, or dizzyness.
Newer anti-histamines ones such as Clarityn and Zirtek claim not to cause drowsiness but they’re not all suitable for young children They can also cause reactions or side effects like headaches, upset stomach, agitation, a dry mouth, dizziness or severe drowsiness. If any of these side effects occur the child should stop taking the tablets.

Nasal sprays and eye drops

There are nasal sprays containing anti-histamines and anti-inflammatory nasal sprays such as Rhinolast, but the advice is against using it for longer than 4 weeks. These reduce inflammation in the delicate lining of the nose. There are also eye drops like Opticrom containing sodium cromoglycate. These act on the linings of the nose and eyes to stop the allergen triggering a reaction. Note that these sorts of sprays and eydrops usually contain a preservative benzalkanium chloride to which your child can be allergic as well. Do not use Beconase Allergy for children. It’s too strong a drug and contains a corticosteroid called beclomethasone dipropionate.

Decongestants

Decongestants like Otrivine may be used topically and relieve nasal congestion very rapidly but over-use of Ephedrine can cause rebound nasal congestion and so-called “rhinitis medicamentosa” so continuous use should be restricted to 7 – 10 days at a time.
Oral decongestants such as Sudafed also combat nasal blockage but they constrict blood vessels in the nose and throughout the body to some degree so may exacerbate hypertension, dry mucus membranes, cause bladder neck obstruction and glaucoma as well as insomnia, restlessness, headache and palpitations.

Oral corticosteroids

These are not justified for routine use in hay fever, though a short high dose course of prednisolone for short periods may be used for the initial control of severe or disabling symptoms as they have significant side effects.

Immunotherapy

In some countries such as America and Europe desensitisation immunotherapy is popular and is recommended for those who are severely allergic to grass pollen and Birch or house dust-mite and for whom medication isn’t working. It’s a course of injections which start before the tree or grass pollen season and usually take 3 years to complete. Minute amounts of pollen are injected to induce immune tolerance and cure the allergy.
Immunotherapy is no longer used widely in the UK due to a report in 1986 in the British Medical Journal which cautioned against its use in general practice and cited 26 anaphylactic deaths over 30 years mainly linked to inappropriate use in treating asthma sufferers. Research is continuing though to find better ways to standardise the vaccine and make the procedure safer.

Complimentary therapies

There are many complimentary therapies that can offer improvements in your child’s hayfever or allergic rhinitis. Most have been used for centuries in different countries. Some have been subjected to medical trials more recently against conventional Western medicines and placebos. Generally they are shown to be effective, but the results may not be immediate as they are not strong fast acting drugs and most aim to correct the underlying cause of the problem rather than merely suppress the symptoms.

Many remedies such as homeopathic and herbal medicines are available in pharmacies or health food shops. We describe some remedies here but there are plenty of books and websites that you can search out for more information. Alternatively you might want to seek the advice of a registered therapist and there are links at the end of the document for how to find one. If your child has severe symptoms its advisable to consult your doctor before administering complimentary therapies.

Homeopathy

What is homeopathy?

Antihistamines relieve symptoms but don’t address the underlying causes and may have toxic side effects. But homeopathic treatment can calm the allergic reaction. Remedies made from plant, mineral or animal substances are prepared in minute amounts and prescribed according to scientific principles. They are safe to give to infants and children.

Patients are given a tiny dose of a substance that would cause the symptoms of their illness in a healthy person. In small does the substance can stimulate the body’s own healing process, help build up tolerances, greater immunity and fewer allergies.

A holistic approach to healing

The homoeopath will assess the patients needs and study material medicas which document the action of over 2000 homeopathic remedies. A good hoemopath will look not just at the symptoms but at the psychological, metabolic and physiological profile of the child. Because of this holistic approach, often homeopathic treatments can improve general health and well-being and lessen the likelihood of developing other diseases.

Single or combination medicines

Usually a patient is given a single remedy. But there are combination remedies in which several homeopathic substances are mixed together. Generally though homeopaths find that single homeopathic medicines have the potential to truly cure a person’s disease, while combination medicines at best provide safe but temporary relief of symptoms.

Homeopathic immunotherapy

One type of homoeopathic medicine includes a very small amount of the agent which the patient is allergic to (e.g. pollen or house dust mite). This can help if the allergic trigger can be identified, but most people have more than one trigger.

Does it work

Because some view homeopathic remedies sceptically there have been several studies made where the patients do not know whether they have been given a remedy or placebo. For example in one study a 30c potency of a combination remedy using 12 common pollens was tested against a placebo. Those taking the remedy had six times fewer symptoms than those given the placebo. Patients were allowed to use an antihistamine if their remedy didn’t work adequately. Those taking the homeopathic remedy needed the anti-histamine half as often as those given the placebo.

A German study in 1999 compared a homoeopathic nasal spray for hay fever with conventional cromolyn sodium spray. 146 patients with hayfever symptoms participated in the trial for 42 days. The homoeopathic remedy of 0.14 ml per application, 4 times per day contained Luffa operculata, galphimia glauca, histamine and sulphur. It showed quick and lasting effects which produced an almost complete remission of hay fever symptoms. There were no major adverse side effects, with minor adverse effects in 3 patients.

Availability of treatment

Remedies are readily available in pharmacies and health food shops and are relatively inexpensive. You can use them safely alongside conventional drugs and sometimes they can alleviate the side effects of such drugs. Homeopaths are listed in Yellow Pages and two good links to homeopathic websites can be found here(www.lyghtforce.com/HomeopathyOnline) and here(homeopathy-uk.com).

Recommended remedies

It is best to see a homeopath who will recommend the best homeopathic treatments to suit your child’s ailments and moods. But here are a few frequently recommended single treatments for hayfever:

• Alium cepa — or red onion. Its for burning smarting eyes, a streaming and stuffy nose, tickling in the back of the throat, a cough and nasal discharge that irritates the upper lip and eyes sensitive to light. Sufferer feels worse indoors in a warm room and better in open air.
• Arsenicum album – a poisonous mineral transformed into a healing homeopathic medicine. For burning eyelids and bloodshot eyes that are gritty and sensitive to light, watery and burning nasal discharge, burning throat, wheezing. Sufferer feels restless, worried and is often very tired. Often with asthmatic tendencies, especially at night.
• Gelsemium from the poisonous plant, yellow jasmine. For heavy swollen eyes, flushed and heavy feeling face, sneezing and streaming nose, sore throat. Sufferer feels apathetic, listless, giddy and trembling.
• Nat mur, from salt or sodium chloride. It’s for smarting, light sensitive eyes that feel bruised, violent sneezing, cough which makes the eyes water more. Sufferer feels depressed and touchy.
• Euphrasia from the plant eyebright. It’s for swollen, burning eyes, with thick tears or pus. The nose also runs but with a blander discharge and symptoms are worse in the daytime, when warm and indoors and the eyes may hurt from too much light. Sufferer can have a cough in the daytime which improves at night.

There are also combination treatments available over the counter such as New Era Combination H, a homeopathically prepared biochemic remedy which contains mag phos, nat mur and silica. It’s only side effect would be in children who are intolerant of lactose which it also contains. They are tablets to be taken whenever you experience hayfever symptoms.

Vitamins and supplements

Vitamin C

Certain vitamins are now believed to reduce histamine production like vitamin C. It’s naturally found in kiwi fruit, cherries, berries and sweet potatoes. Or you can get formulas suitable for children which are chewable, and gentle on the stomach. Low allergy formulas are enhanced with natural sources of vitamin C like Acerola (malpighia punicifolia) and Rosehip (rosa canina), also contain Bioflavonoids, which increase absorption of vitamin C. Avoid too much though or it can cause flatulence and diarrhoea and don’t give vitamin C supplements to children under two.

Quercitin

Bioflavanoids such as Quercitin reduce the sensitivity of histamine producing white blood cells. Quercitin is found in blue green algae, spiruline, kelp and luckily also in red onions if you can’t find seaweed. You can get it as a supplement too.

Panthothenic acid

Panthothenic acid or Vitamin B5 reduces allergic reactions and nasal congestion. You can buy it as tablets or it’s found naturally in almost all foods, particularly whole wheat, beans, freshwater fish, meats, and fresh vegetables. It’s a water-soluble vitamin and as such is often lost in cooking and processing. B-vitamins are commonly added back to enrich processed grains like breads and breakfast cereals.

Herbs

Herbs that heal

Herbal remedies have been traditionally used because certain herbs have natural antibiotic effects. They can assist in the relief of symptoms of upper respiratory infections and relieve the symptoms of allergy and hayfever and help with the elimination of excess mucus. But choose your herbs carefully as some can be dangerous for children or if used in large quantities.

Supplements

There are supplements you can buy which use a mixture of herbs, but it’s best to check with a doctor or herbalist before giving these to children and never give them to children under two. Herbs commonly found in these are echinacea, garlic, golden seal, elderflower extract. Or there are immune balance formulas typically made up of tinctures of astragalus, marshmallow root, raspberry and St John’s wort. You can get these as teas as well.

Herbs from pollen

Some herbs whose pollen can cause symptoms of hay fever have been used as a way to reduce symptoms of hay fever such as goldenrod and ragweed (ambrosia ambrosioides), and elder. However some people can be allergic to these plants so avoid them unless under the care of a doctor of natural medicine. None of these herbs has been scientifically evaluated for effects in treating people with hay fever.

Plantain

Plantain is also an anti-mucous herb that aids in alleviating allergic conditions such as sinusitis, hayfever and excema and you can make it into tea. It eases irritation and it’s a blood-purifier in many conditions with blood toxicity and/or an allergic component.

Herbs that you find at home

The following are all supposed to be good for hayfever: thyme, rosemary, cinnamon, cloves, horseradish and chili for antiseptic and expectorant effect. Ginger can also be beneficial and you can buy ginger as a herbal tea perhaps mixed with apple or you can add it to vegetables.

Redbush tea

Rooibos or redbush tea is made from a herb that’s indigenous to South Africa, it’s now readily available over here and it relieves a number of symptoms including allergies, asthma and hayfever. It contains vitamin C as well as various minerals. Its perfectly safe to give even to babies, it has a mild flavour that children like and you make it with milk and honey.

Ephedra

Ephedra sinica (Ma huang) is a standard remedy for hay fever in Chinese medicine. Synthetic ephedrine and pseudoephedrine are popular over-the-counter drugs used for hay fever based on this tradition. Ephedra can dramatically reduce symptoms of watery, itchy eyes, runny nose and sneezing. However it also has dangerous side effects and over-use can increase blood pressure and heart rate, resulting in insomnia and anxiety. Safe dosages are critical, say experts.

Nettle Leaf

Sometimes nettle leaf can be recommended but only one study has investigated this. For centuries, cultures around the world have used this herb to treat nasal and respiratory troubles, including coughs, runny nose and chest congestion. But it is a powerful plant and toxic effects such as gastric irritation, burning skin sensation, edema and urine suppression from drinking nettle tea have been recorded so approach this herb with caution.

Hydrotherapy

What is hydrotherapy

Hydrotherapy is the use of water in the treatment of disease. The healing power of was harnessed by ancient Greeks, Romans and Chinese. Hydrotherapy and hydrothermal therapy can be used to tone up the body, to stimulate digestion, the circulation, and the immune system, and to bring relief from pain. It calms the lungs, heart, stomach, and endocrine system by stimulating nerve reflexes on the spinal cord.

Some things you can do at home

• Splash the face and immerse the nostrils in cold water as this helps to flush away pollen and dust particles. To ease congestion give a steam inhalation over a bowl of very hot water with a towel over the head.
• For relieving swollen itchy eyes, try a cooling eye mask made by wrapping crushed ice in a flannel. You can also bathe the eyes with tepid salty water or an infusion with the herb eyebright – both recommended as homeopathic remedies too.
• Sniff cold water up the nose and spit it out through the mouth to wash all the pollen grains out of the nasal passages.
• Keep a bottle of distilled water in the fridge and use it in an eyebath to irrigate the eyes, using clean water for each eye.
• Make sure your child drinks plenty of water, especially in the summer and when they exercise. Mineral waters are good but check the salt content for small children. If you use tap water filter it first to remove traces of pesticides, nitrates and other impurities and boil it to evaporate off the chlorine, and then cool it. To aid digestion drink water at room temperature, as the cold halts digestion temporarily.
• Alternating hot and cold compresses can be used 2-4 times a day (or more) to relieve inflammation or congestion of the sinuses. Soak one cloth in tolerably hot water then ring out and apply to the forehead, eyes and upper cheek for about 3 minutes. Replace with a second cloth that’s been soaked in ice cold water and keep in place for about 30 seconds. Repeat the alternating hot and cold compresses 3 times.

Aromatherapy

What is it?

Aromatherapy comes from a Greek word meaning spice or fragrance, and therapy meaning treatment. The scents of plants (petals, leaves, berries, roots, fruit, buds, grasses, resin or seeds) are used to prevent or cure illnesses of the body and mind. The scents or essential oils (or plant essences) are concentrated perfumes that evaporate readily into the surrounding atmosphere and are said to have therapeutic properties.

Some oils

Some oils that are good for hayfever are chamomile, peppermint, lavender and lemon but not if your child has asthma as well. Essential oils can be beneficial when inhaled with just a couple of drops in a bowl of hot water or you can add a few drops to a vaporiser in the child’s bedroom or use it in the bath, or put some in an oil burner.
Be really careful with these around small children and do not allow them to ingest oils or put them neat on the skin. Do a patch test first to check for sensitivity and do not use the same oils for more than a month at a time. It might be best to discuss the use of aromatherapy for hayfever treatment with an aromatherapist first.

Links

www.mypharmacy.co.uk online pharmacy which lists descriptions of over the counter drugs
www.surgerydoor.co.uk
www.familymedicine.co.uk
www.allergy-clinic.co.uk/hayfever.htm
search.bbc.co.uk/health/allergy/
www.blueair.co.uk/ sells air purifiers
www.mothernature.com

Pollen Count

A regional pollen count index for the UK can be found at www.bbc.co.uk/weather/features/pollen.shtml.

Homeopathy

www.lyghtforce.com/HomeopathyOnline
homeopathy-uk.com