a&u Health Editor, Suzie Skipper chats to Dr Helen Brough, Consultant in Paediatric Allergy at The Portland Hospital and Head of Service for the Children’s Allergy Service at the Evelina London Children’s Hospital, St. Thomas’ Hospital about how to manage your child's hay fever allergy.
Poorly controlled hay fever can have a knock-on effect on asthma control (read Dr Brough's advice on asthma here). Untreated hay fever is also a trigger for children to touch their face more, due to itchy eyes and nose or sneezing, which could increase spread of the coronavirus. Hay fever can feel like early flu symptoms (headaches, nasal congestion, sneezing, fatigue).
Read Dr Helen Brough's top tips on dealing with your child's allergy during lockdown. You can also watch her youtube video too.
What is Hay fever?
It is essentially allergic inflammation of the eyes and nose due to pollen allergy. The majority of people get this because of grass pollen allergy, about 25% will get it because of tree pollen allergy and a fewer number get weed pollen allergy.
Hay fever is actually a misnomer! People used to think it was an allergy to hay but it is actually the pollen particles from tree or grass. You don't generally get a fever with hay fever. You can be allergic to house dust mite, moulds, dogs, cats and horses too.
Who gets Hay Fever?
Generally a combination of environmental and genetic factors determines whether your child will get hay fever or not. If someone in the family has it your child is more likely to get it too. It generally starts in childhood - 1 in 10 primary school aged children will have it and 1 in 7 secondary school aged children will get it and in adults about 1 out of 4 or 5. It is extremely common.
Itchy eyes, sneezing and a runny nose are typical symptoms. Children can also develop nasal congestion, cough and headache. If hay fever is untreated it can lead to sinusitis which can make children feel very unwell.
Some children can feel like they are getting a cold or flu during the early stages of hay fever and this is especially important in the current Covid-19 outbreak. Covid-19 classically causes fever and a persistent cough, whereas hay fever does not. Itchy eye, runny nose and sneezing are most likely to be caused by hay fever than Covid-19. There are other things that can seem like hay fever that aren't. For example in children a lot of infections can cause runny noses or red eyes like conjunctivitis.
When is the Hay fever season?
If your child has hay fever between March to May it is probably a tree pollen allergy. If they have it between May to August it's probably a grass pollen allergy. Certain types of allergy such as house dust mite and/or pet allergy are generally there all year round.
How can you test for Hay fever?
Skin prick testing - this is a pain free procedure which uses little drops of extract which has a standard amount of different allergens in them e.g. birch tree pollen. The consultant or allergy nurse will put a drop of the extract on your child's forearm and then scratch the surface skin gently with a tiny disposable lancet. You wait 15 mins to see if there is a reaction - usually a little bump and/or some redness around it. This helps identify what your child is allergic to.
Specific IgE testing - this is a blood test which looks for the allergic antibody in the blood whereas skin prick testing looks for the allergic antibody that is bound to the skin cells.
How can we treat it?
There are four ways of treating hay fever depending on how severe it is.
Allergen avoidance - there are lots of things you can do that can really reduce your child's hay fever symptoms without the need for any medication. Protect eyes by wearing wrap-around sunglasses and the nose with some vaseline around the nostril tips to prevent pollen from entering.
Shower before bed to reduce the amount of pollen on hair and skin. Dry clothes, especially bedlinen, inside. Do check the Met office for pollen counts so you will know whether it is low, medium or high count and remember pollen is highest at dusk.
What are the best treatments for Hay Fever?
1. Anti-histamines - are useful to treat mild hay fever. You can buy non-sedating anti-histamines over-the-counter. Dr Brough does not recommend sedating anti-histamines such as Piriton as they can make your child drowsy. These can be used as required if hay fever symptoms are intermittent or throughout the pollen season if symptoms are more persistent.
2. Nasal Sprays - you can use saline nasal sprays to clear out all of the allergens from the nose. Then use the steroid nasal sprays. Best to use after the saline spray as they are much more effective then. "It's really important to use the steroid spray in a certain way. It needs to be angled towards the side of the nose not straight up. You need to put your head forward and try not to sniff because otherwise you will just swallow the medication," advises Dr Brough.
3. Eye drops - can be really helpful as a lot of the discomfort for children who have bad hay fever is from eye symptoms.
- Antihistamines, nasal steroid sprays and eye drops do not increase the risk of Covid-19.
- Start the treatment a few weeks before the pollen season begins. For example if you allergic to tree pollens you should start at the beginning of February and if you are allergic grass pollens at the start of April. "This means that all the receptors on your cells that are trying to find the pollens will get internalised into the cells so that when the pollen arrives it can't actually bind to anything," explains Dr Brough.
4. Immunotherapy - The standard treatments for hay fever are good and they can really help with symptoms however when you stop taking them they stop working. Immunotherapy is the only disease modifying treatment available for hay fever. The way that it works is it that you use the allergen that the person is allergic to and you administer it either orally (under the tongue) or via an injection. This changes the way the immune system responds that allergen. It is usually a treatment course of 3 years so it is usually reserved for those who have more severe hay fever. Patients usually start feeling the benefits after approximately one year such as a 50% reduction in symptoms and reducing the amount of medication they need to use.
Some of the added benefits of immunotherapy are that after you stop the 3-year treatment you still can expect to have a reduction in symptoms for about 3-5 years after your child stops the treatment. There have also been studies that immunotherapy can prevent the development of new allergies and also of asthma.
Immunotherapy can be continued during the coronavirus pandemic and will not impact the body’s natural response to any viral infection.