Hay fever: What causes it, what are the symptoms and what are the treatment options?

"Any trivialization of the problem is out of the question in view of the documented situation," wrote the Robert Koch Institute back in 2016 on the subject of the "allergy problem in Germany". After all, allergies occur in one third of all Germans in the course of their lives. 15 percent receive the diagnosis of pollen allergy [1] . Experts assume that these figures will continue to rise significantly in the coming decades, particularly due to the effects of climate change [2] . Hay fever is a widespread disease that significantly reduces the quality of life of those affected. In addition, allergic asthma can develop in the long term without treatment of the allergy to Poland. This article answers the questions of what exactly hay fever is, how it can be treated and what sufferers can do themselves.

Table of Contents:

• Definition: what exactly is hay fever?
• Symptoms: How does a pollen allergy manifest itself?
• Course: What is the prognos e of pollen allergy?
• Causes: What causes hay fever?
• Diagnosis: How does the doctor determine whether a pollen allergy is present?
• Treatment: How can the symptoms of a pollen allergy be alleviated?
• Own measures: What can those affected do themselves?
• Pollen allergy in seniors: What is there to consider here?

Hay fever is called pollen allergy or seasonal allergic rhinitis by medical experts. Contrary to the name, pollen allergy is not an allergy to hay. Rather, pollen allergy is a hypersensitivity of the immune system to proteins of different plant pollens. However, other plant proteins related to those of pollen can also trigger the symptoms of a pollen allergy.

The term "seasonal" allergic rhinitis refers to the fact that plant pollen does not fly year-round: Each type of pollen has a specific window of time during the year when they travel. Some plants spread their pollen over only a few weeks, others over months. All in all, the period in which there is a pollen load in the air now extends to ten months a year due to climate change and the spread of foreign plants: only from mid-October to mid-December is pollen load from plants not an issue.

The following aspects should be considered:

• Pollen allergy sufferers are almost never allergic to all pollen that travels throughout the year. Therefore, it is unlikely that exposure to pollen will persist over the 10-month period.
• How long the respective pollen season is depends on regional differences as well as on the weather, i.e. temperatures, sunshine duration, rain etc.. Because these factors decide when a plant starts to grow and then also the corresponding pollen count begins.

Pollen allergy affects several organs of the body. Symptoms occur especially in the respiratory tract, the mucous membranes as well as the skin. However, the symptoms of pollen allergy are non-specific. Based on these symptoms alone, it is not possible to decide whether it is hay fever. This is because other allergens, such as dust mites, molds or animal dander, can also cause the same symptoms.

The leading symptoms of hay fever are:

• Sneezing attacks
• Runny nose but also stuffy nose
• Itchy, burning, reddened eyes

In addition, the following symptoms can occur as a result of these complaints:

• Unpleasant itching in the throat
• Burning in the throat
• Inflammations in the ear, nose and throat area, such as a sinusitis

In the course of the so-called floor change from the upper to the lower respiratory tract, further symptoms can occur:

• Cough
• attacks with shortness of breath
• Allergic asthma

Symptoms can also occur in the skin or existing symptoms can be aggravated by hay fever:

• Dry, itchy skin
• Aggravation of skin diseases, including in particular neurodermatitis or hives

A pollen allergy can basically occur in all phases of life. Pollen allergies often first appear in childhood and adolescence, but a pollen allergy can also begin in senior citizens. In principle, pollen allergies can also disappear again on their own. However, there is always the risk of the so-called floor change: This means that the pollen not only affects the upper respiratory tract, the eyes and the skin, but also the bronchial tubes. Asthma can then develop from this. Since asthmatic attacks can be acutely life-threatening, a pollen allergy should always be treated. A doctor must be contacted at the latest when warning symptoms occur, i.e. when coughing and shortness of breath are triggered by pollen.

Hay fever, like all allergies, is an overreaction of the immune system to usually harmless substances. The immune system recognizes the proteins of the pollen and mistakenly identifies them as pathogens. As a result, the so-called histamine is released, which causes the symptoms described above.

Why a person develops a pollen allergy depends on several factors:

• Genetic causes: In these cases, the tendency to develop allergies is inherited. The more members of a person's family (especially parents and siblings) suffer from allergies, the higher the risk that the child will also develop an allergy.
• Toxins such as nicotine and particulate matter from car exhaust, etc.: Children who grow up in cities and along large, busy roads or in households with smokers have an increased risk of allergies. Nicotine exposure in particular already affects the unborn child.
• Excessive hygiene [3] : This cause is not undisputed. However, there are researchers who believe that too much hygiene during childhood is detrimental to the development of the immune system. Since the immune system does not have to fight enough real pathogens, it looks for harmless substances to fight. Evidence shows that children who grow up on farms develop fewer allergies than children in the city.

If there is a suspicion of a pollen allergy, this should be clarified by a specialist. There are different specialties that can carry the additional title in the field of allergology:

• Family doctors and pediatricians
• Internists
• Ear, nose and throat specialists
• Pulmonary specialists

In the first step, the physician will take the so-called medical history. For this purpose, a detailed patient interview is conducted, during which the following questions are asked:

• What do the complaints look like specifically?
• In which situations do the complaints occur? Are they dependent on the seasons? If so, in which months do the complaints occur?
• Are the complaints equally strong outdoors and indoors? Are the complaints different in intensity during the day and at night?
• What is the residential environment (rural or urban) and the professional environment (outdoor or indoor activity)?
• Are there any allergies, neurodermatitis or asthma that have already been diagnosed?
• Are there any cases of allergies in the family? If yes: Who was/is affected?
• What medications are being taken?

On the basis of this questionnaire, it is usually already possible for specialists to make the diagnosis "pollen allergy". However, it is much more difficult to find out to which pollen an allergy actually exists. In order to find this out, several steps are taken:

• Pollen calendar: In this, the times are marked at which certain types of pollen usually fly. However, the period when pollen is specifically on the way varies from year to year, as rain and temperature have a major influence on the start of each pollen season.
• Examinations: A distinction is made between skin tests and provocation tests as well as blood tests. It is important that no medication is taken to suppress the allergic reaction before the tests are carried out. These include, for example, antihistamines and cortisone.

1. Prick test: Here, the skin is lightly anteritzed and a solution containing the respective pollen is dribbled on. If an allergy is present, a skin reaction can be read after a specified exposure time.
2. Provocation test: In this test procedure, the potential allergen is introduced into the nose. If an allergy is present, symptoms such as swelling mucous membranes or even anaphylactic shock occur. Therefore, the patient must remain in the practice for a sufficiently long time after this test.
3. Blood test: In this test procedure, a blood sample is examined for antibodies against specific pollen proteins. The higher the antibody concentration is, the more severe the allergy is.

Several different approaches are available for the treatment of allergy in terms of symptom relief [4] . The top priority in allergy treatment is avoidance of the allergens. For this purpose, a separate paragraph is provided below. Only if the avoidance of the allergens is not possible or not completely possible and the symptoms massively restrict the quality of life, a medicinal treatment should take place.

• Pollen allergy medications: These medications prevent the body's excessive defensive reaction to pollen. There are different groups of active ingredients. These differ in particular in the strength of their effect. The drugs in the cromone group of active ingredients have the weakest effect, the preparations in the antihistamine group of active ingredients are somewhat stronger, and the drugs in the glucocorticoid group of active ingredients are the strongest.
• Nasal sprays: Here, too, there are different active ingredients and combinations of active ingredients. On the one hand, cortisone nasal sprays are used. If these are not sufficient in their effect, fixed combination sprays can be used. These contain active ingredients that combine the properties of glucocorticoids and antihistamines. The so-called decongestant nasal sprays (active ingredient group alpha-sympathomimetics) also help. However, these may only be used for a short time.
• Specific immunotherapy: This therapy is a causal therapy. Patients are administered the allergen in very small doses before the start of the respective (specific) pollen season. In this way, the body becomes accustomed to the allergen, so to speak, and the overriding reaction does not occur when the pollen season begins.

Every person affected can do a few things themselves to keep the symptoms of pollen allergy as low as possible. In any case, these measures to avoid the allergen in question take precedence over any of the above-mentioned drug treatments.

• Pollen reduction at home: regular vacuuming and dusting removes a large part of the pollen. An FFP2 mask can be worn to minimize the impact of pollen when cleaning. Tapestries and decorative curtains should be avoided, as these are true pollen catchers.
• Pollen-free bedroom: To keep the bedroom as free of pollen as possible, sufferers should shower and wash their hair before going to bed. In addition, clothing worn outdoors should not be stored in the bedroom.
• Airing: In the city, the least pollen flies between 6:00 and 8:00 a.m., so that is when ventilation should be done. In the countryside, the best time to air is between 7 p.m. and midnight. Alternatively, a pollen screen in front of windows and balcony doors helps to keep pollen out of the house/apartment.
• Small helps for daytime: Washing your face regularly, will remove pollen that sticks to your skin.
• Nasal irrigation: rinsing with saline solution flushes pollen out of the nose, and rinsing may also have a therapeutic effect in some circumstances, according to a review of the study situation conducted by the Cochrane Society [5] .
• Vacation planning: Those who are free to plan their vacations should travel to places with low or no pollen levels during the period of heaviest pollen exposure.

Pollen allergies are also increasingly diagnosed in senior citizens in particular, as  a study by the Kaufmännische Krankenkasse [6] proves. According to this study, between 2008 and 2018, the number of pollen allergy sufferers in the 65 to 79 age group increased by 43 percent, and in the 80 plus age group, the number of pollen allergy sufferers doubled. Whether it is really such a sharp increase or whether at least to the tel the increase is due to the fact that allergies are now diagnosed more often, could not yet be clearly clarified.

 These points are particularly important for senior pollen allergy sufferers:

• Recurring flu-like symptoms can be signs of a pollen allergy. A clarification by the doctor provides information.
• If there is already a preload of the bronchial tubes, the risks of a pollen allergy are increased.
• Especially if medication must already be taken, self-medication with pollen allergy medication should be avoided. Interactions can lead to massive physical damage. The attending physician can select suitable active substances.