INTRODUCTION

Springtime is a time of increasing sunshine, beautiful blossoms, new leaves on trees and flourishing of grass. However, in nature’s mood of abundance, spring time is also a time of flowering and pollination. For those with seasonal allergies, this can be a time of great frustration,  with annoying nasal symptoms really imposing on one’s quality of life in response to inhalation of pollens in the air. Seasonal allergies can manifest as predominantly nasal symptoms, known as allergic rhinitis,  or as chest symptoms like cough and wheeze in those with  asthma.

Allergic rhinitis is an allergic reaction of the nasal mucosa to environmental allergens which should be harmless. The reaction involves the immune system and leads to the release of chemical messengers inside the nose and surrounding tissue,  causing the 4 “typical” symptoms of:

• swelling
• itch
• sneezing
• rhinorrhoea (copious mucus).

Allergens can be present all year round (such as house dust mite, mould and animal dander- which tend to peak in autumn and winter when our household ventilation decreases because of colder weather) or seasonal (such as grass and tree pollens, which peak in spring and early summer).

In South Africa, tree pollen levels frequently peak over 2-3 months around August to October. Our grass pollen season is particularly long and relentless, spanning from September right through to March. Unfortunately, with climate change phenomena such as global warming, our pollen season will likely be even more intense and prolonged in future years.

DIAGNOSIS OF SEASONAL ALLERGIC RHINITIS

If someone suspects symptoms of allergic rhinitis, it is important to have it checked out by a doctor to rule out other conditions. Viral colds and allergic rhinitis can often mimic each other, although with colds a person may feel generally unwell. Equally important is having the correct testing for allergic rhinitis. Environmental allergies can be checked by a skin prick test or blood test. Skin prick tests are gentle pricks on the skin, usually on the forearm, which introduce a bit of allergen into the top layer of the skin. A weal and a flare will form at the site of the prick if the patient is allergic. Results are accurate and can be assessed within 15 minutes. Prior to undergoing skin prick testing, a person needs to be off antihistamine medications for at least 3 days before the test. Blood tests can check for a variety of environmental allergens and can be done even if someone is on antihistamines. Results take between one and a few days to come back.

MANAGEMENT OF SEASONAL ALLERGIC RHINITIS

Management of seasonal allergies includes avoidance of the allergen as far is possible. Avoiding being outside during “peak” pollen times, such as sunset, and being around freshly cut grass, is important. Usually avoidance alone is not sufficient to manage symptoms and medications are also needed. The medications given depend on the most dominant symptoms. Nasal corticosteroids sprays tend to be the best overall treatment. Nasal corticosteroids are safe with minimal absorption into the system in the spray form; making them far safer than steroid pills or injections. Nose bleeds are a potential side effect, especially if sprays are angled incorrectly towards the middle nasal septum, which is rich in blood vessels.

Antihistamines may be of use if itch and sneeze are predominant. Newer generation antihistamines are preferred with their cleaner side effect profile and minimal sedation.

A person should take their medications every day during the “season” of their allergies, consistent use leads to best results. If asthmatic, the controller asthma pump needs to be used daily.

If basic treatment is inadequate, then specialist referral to discuss further management options is advised. A more “curative” treatment is that of desensitisation, otherwise known as immunotherapy. In this treatment, tiny amounts of the allergen which the patient is allergic to are given to the patient on a regular basis for several years to try and “shift” the immune system into tolerating the allergen. The most commonly used form of immunotherapy for seasonal allergies is sublingual drops, given daily under the tongue, for a period of 3 or more years. Immunotherapy is generally safe and effective, but still expensive in South Africa as the therapy is imported.

CLOSING THOUGHTS

In summary, seasonal allergies can be accurately diagnosed and effectively managed.  Self-diagnosis is discouraged, as accurate diagnosis of the condition and the relevant allergens leads to optimal treatment planning. If seasonal allergies are poorly managed, headaches and concentration difficulties may arise, as well as complications such as asthma, ear infections and sinusitis.

Therefore , it is best to get the basics in place, including the right diagnosis and an effective management plan. Your family doctor can start the process, and specialist allergy centres are available to optimise diagnosis and treatment.

Allergic rhinitis is nothing to be sneezed at!