A LOT OF PLEASANT IS RELATED TO THE COMING OF SPRING: IT IS finally getting warm and the greenery is BREAKING through. But for many of us, the flowering season is hardly a reason for joy – those who are allergic to pollen, or hay fever, await the first flowers with horror. Together with the allergist-immunologist of the Institute of Immunology of the FMBA, Evgenia Nazarova, we figure out what allergens are, how hay fever manifests itself and what can be done to make life easier for yourself in this difficult period.

Why do flowers make
us suffer?

When it becomes impossible to breathe due to the awakening nature, it seems that life is unfairly punishing us. In fact, this is how the defense mechanisms of the immune system work: the body perceives certain substances – allergens – as a potential threat and produces antibodies (also called immunoglobulins E) that try to destroy this allergen. At the same time, the concentration of histamine rises in the blood, due to which swelling and general malaise occurs.

Immune responses to stimuli, or triggers, can occur throughout the year – for example, through contact with house dust or animal hair, or during a certain season when pollen is released. Pollinosis is one of the most common diseases in the world. According to the WHO, almost every third person on the planet encounters it. In Europe, pollen sensitivity is observed in 44% of people, in the United States it is 43%, and in New Zealand – 46%. In 2014, in the UK alone, according to statistics from the charity organization AllergyUK, 18 million people consulted a doctor with symptoms of hay fever.

Researchers suggest that allergies have become so widespread not only because of modern food and unfavorable ecology, but also because of too zealous hygiene. Perhaps genetic predisposition also plays a role: according to some data, the probability that children inherit the hypersensitivity of one of the parents is 30-60%, and if both parents are allergic, then 50-70%. Although it cannot yet be said with certainty that genes are to blame for everything, in recent years, many scientific experiments have been carried out that confirm the hypothesis of kinship continuity. If the allergy did not appear in childhood, it is too early to rejoice: there are no guarantees that it will not manifest itself at all. Today it has become finally clear that the disease can occur for the first time at any age, even in the elderly.

Maybe it’s still a cold?

Symptoms of hay fever are reminiscent of a common cold: the nose hurts, itches, becomes stuffy, eyes watery, itchy throat and, of course, all the time you want to sneeze. You can try to distinguish hay fever from a cold if you pay attention to when all this happens. Colds are more typical for the autumn-winter period and usually go away in about a week, but allergies can be much more stubborn and appear during the flowering of different plants. In spring, pollen from trees (birch, alder, hazel) spreads, in June-July – cereals (timothy, fescue, hedgehogs), and from July to September – weeds (quinoa, wormwood, ragweed).

Many allergy sufferers are convinced that they react to poplar fluff, but this statement is more fiction than truth. The fluff flakes are too large to get on the mucous membranes, and it itself is not an allergen: itching or sneezing can occur if the fluff literally tickled your nose. On the other hand, allergy sufferers should be afraid of poplar fluff: like a sponge, it collects pollen from other plants and carries it around. In the spring and autumn, spores of certain fungi – Alternaria, Cladosporium, Aspergillus – can also cause allergies. There are cases of sensitivity to two or more allergens, and only a special examination can give exact information about which trigger worked .

The examination can include the so-called skin tests, when allergens are applied to the skin or injected, and then the reaction is monitored after twenty minutes, five to six hours and a couple of days. This is a proven and reliable diagnostic method, to which, however, there are a number of contraindications. There is also a blood test for specific antibodies to individual allergens, including medicinal, household and construction allergens.

What to do?

If the season has already begun and the allergy has manifested itself, you can use antihistamine tablets, nasal sprays, eye drops; These remedies are sold without a prescription, but it is best to consult a doctor who will recommend therapy depending on the specific symptoms. True, this treatment option does not give a long-term effect: it allows you to reduce the manifestations of the disease, but does not completely eliminate it.

The drugs available today are effective and safe: unlike the antihistamines of previous generations, they do not cause drowsiness and practically do not affect daily life. Such drugs suppress the amount of histamine in the blood, reducing the intensity of the allergic reaction – so, swelling, itching and congestion disappear. But even they are not ideal: once you stop taking it, the histamine level is restored, and the allergic reaction not only recurs, but can also become stronger. In addition, if the drug was effective this season, it is not a fact that it will help next time. Every year the allergy progresses and the intensity of the immune response grows – the effectiveness of antihistamines, respectively, decreases.

If possible, it is best to literally avoid hay fever – to leave for another climatic zone for the period of plant dusting. For those who are forced to be in an allergic environment, there are also protective equipment: anti-allergenic masks and filters. Some studies have found filters to be even more effective in reducing hay fever symptoms than antihistamines. More than half of the participants in the experiments would like to continue using filters in their daily lives. Nevertheless, scientists are not yet ready to confidently say that nasal filters really protect against pollinosis better, and some users note that it is difficult to breathe with them. In any case, if the allergic reaction has already begun, such a remedy is unlikely to help. With nasal congestion, any mechanical obstruction will only make breathing more difficult and worsen your well-being.

Can allergies be cured once and for all?

The most effective method is allergen-specific immunotherapy, which affects the very cause of the disease and reduces sensitivity to triggers. It is carried out before the beginning of the allergic season: the doctor identifies the main allergen in order to then introduce it in small doses and observe the reaction. Such treatment is similar to vaccinations: usually it is subcutaneous injections or the intake of an allergen in a sublingual form (in tablets or drops). The latter is much more convenient and better suited, for example, to children, but some allergens are available only for injection, and then there is no need to choose.

In Russia, allergy immunotherapy is carried out for adults of any age and for children from the age of five. Of course, before starting treatment, the doctor will conduct a general examination and take anamnesis – it may be contraindicated in people with certain diseases of the cardiovascular system or the digestive tract. During pregnancy and breastfeeding, no immunotherapy is given at all. By itself, the allergen will not harm either the mother or the child, but a reaction to it can cause a number of symptoms that cannot be removed with medicines allowed during pregnancy. It’s easier to postpone and make an appointment with an allergist after breastfeeding is complete.

Allergen-specific immunotherapy is carried out in courses for several years. A series of procedures begins before the beginning of the dusting season, and when it ends, they are repeated. As a rule, treatment with an allergen is carried out for three years in a row, and on the fourth, remission occurs – that is, the sensitivity to stimuli decreases. This means that during the allergic season, a person can safely be outdoors without experiencing any discomfort. Sometimes three years of treatment is not enough, and then the course of therapy is carried out additionally for the fourth or even fifth year. Improvement usually occurs after the first course of therapy, but the maximum effect, including in terms of resistance, is achieved after a few years. This allows the patient to enjoy an allergy-free life for three to five years, and then the treatment is repeated. Sometimes remission lasts even ten years, but each case is different, and it is impossible to predict how long the effect will last.

And if you do not treat?

Despite the inconvenient and costly need to resume courses of allergen-specific immunotherapy, this method has a significant advantage: it does not allow the disease to progress to more severe and life-threatening forms. The problem with allergies, whether seasonal or persistent, is that we rarely perceive it as a disease and therefore sometimes take it lightly. Even if the symptoms of hay fever are not too disturbing – a slight nasal congestion, itchy eyes – there is a risk that they will worsen over time.

Allergies, if left unchecked, can get worse; when examining up to 50% of people with allergic rhinitis, doctors diagnose bronchial asthma, for the treatment of which serious interventions are needed: special inhalers and intravenous drugs. The question of how justified is the treatment of hay fever and which way of dealing with it is better remains open. In any case, if you know about your allergies and notice a worsening of symptoms, a routine checkup with a specialist and timely therapy will protect you from more dangerous chronic ailments.