Hay fever

Hay fever is an allergic reaction. Allergic Rhinitis, the medical term for hay fever means irritation of the nose. Hay fever usually starts during childhood or early adulthood and often diminishes slowly over decades. Hay fever is brought about by allergic reaction to outdoor or indoor contaminants, such as plant pollen, dust mites or chemicals. Anyone can develop hay fever especially those who are exposed to years of repeated inhalation of allergic substances. People who suffer from asthma and eczema are more prone to hay fever. It also tends to run in families. Passive smoking increases risk of developing hay fever.

Symptoms

Some people have symptoms all round the year. For others hay fever symptoms worsen at specific times of the year. Spring and fall are considered as main hay fever seasons. In severe cases nose bleeding may occur. Otherwise, the common symptoms of hay fever are:

• Repeated sneezing
  
• Runny or itchy nose
  
• Itchy or watery eyes
  
• Itchy, irritation in the throat, palate and ears
  
• Inability to concentrate
  
• Loss of sense of taste and smell
  
• General feeling of being unwell
  
• Feeling exhausted
  

Diagnosis

Skin prick test: After determining possible allergy-causing substances, a small amount of suspected allergy-causing substance is placed on the skin. Depending on patient's preference it could be on the forearm, upper arm or the back. The skin is pricked so the allergen goes under the skin's surface. The health care provider observes the skin for possible reactions like swelling, itchy feeling and redness of the skin. Reactions, if any can be noticed within 15-20 minutes which confirms hay fever. Skin prick test is not recommended for people with eczema or those taking certain medications like antihistamines as it will interfere in responding to allergic reaction. In such cases, blood test is done.

Blood test: Blood test is recommended when skin prick test cannot be done or if the results of skin prick test are not useful. A sample of blood will be taken from a vein in the arm and tested for the presence of the Immunoglobulin E (IgE) antibody. If the blood test is positive, it confirms the presence of hay fever.

Treating hay fever

The aim of treatment would be to stop exposing the body to allergic substances or preferably avoid it completely. There are a plethora of options to treat hay fever. The choice of treatment depends on the severity of hay fever and the symptoms. Age, occupation and life style is also given due consideration.

• Antihistamines medicines
  
• Antiallergic nasal sprays or eye drops
  
• Antihistamines sprays or drops for nose or eyes
  
• Steroid sprays or drops for the nose only
  
• Decongestant sprays
  
• Decongestant tablets
  
• Steroid tablets or injections
  
• Desensitizing injections
  

Some medications do not require prescription and are sold over-the-counter as non-prescription medications. It is best to seek health care provider's opinion taking into account the possible side effects.

• Know triggers and keep away from allergens
  
• keep environment clean
  
• Eat a healthy oil-free diet
  
• Include a lot of vitamin C
  
• Increase protein intake
  
• Drink boiled, filtered water
  
• Don't miss to drink herbal tea
  
• Avoid venturing out when pollen count is high
  
• Don't skip medications
  

Wheezing

Wheezing is a characteristic high pitched whistling sound made while breathing, a primary symptom of a chronic respiratory disease - Asthma. It is not uncommon in those with respiratory allergies, especially during the hay fever season. Sometimes, other respiratory infections could be accompanied by mild wheezing, especially when acute Bronchitis is experienced. It is also noticed in those with heart failure and Chronic Obstructive Pulmonary Disease COPD. While most commonly wheezing occurs during breathing out, it can sometimes also be related to breathing in.

Causes of Wheezing

Narrowing of airways results in breathing difficulty and wheezing. There could be several causes for narrowing of airways including inflammation from asthma, infection, allergic reaction or a physical obstruction such as tumor or foreign body inhalation. Among the possible causes of wheezing include allergies, insect bite or medication or pollen, pet dander, dust, foods, Bronchiolitis, bronchitis, childhood asthma, epiglottitis, GERD, heart failure, lung cancer, pneumonia, sleep apnea, smoking and vocal cord dysfunction.

Respiratory Syncytial Virus (RSV) Infection is also known as Bronchiolitis - inflammation of the bronchioles which in turn refer to the the narrow airways which branch from bronchi to the air sacs called as alveoli. This RSV infection largely affects infants and children.

To determine the cause of wheezing, your doctor will ask questions about any symptoms that triggers it. If you have no history of lung disease and develop wheezing after eating a certain food or in a certain season, respiratory allergy is suspected. The doctor checks the lungs with a stethoscope to find out where the wheezing is and how bad it is. During a first time evaluation, the doctor performs a spirometry - breathing test, and also a chest X ray.

Sometimes other blood tests and procedures become necessary depending upon the health condition. In case it is allergic wheezing, then a variety of tests to determine the allergies including dermatological examinations are done.

Wheezing problems

Wheezing is accompanied by difficult breathing, rapid breathing and briefly bluish skin color. Emergency care must be sought if wheezing begins suddenly after being stung by a bee, while taking medication, or eating an allergy-causing food or after choking on a small object or food.

Wheezing in infants

In case of a baby, wheezing could be due to cold or problematic asthma. But it is not always clear if the infant has asthma. It is essential to get a firm diagnosis and make sure that the child gets treated for any breathing problems. In some infants, Bronchiolitis could occur due to a viral infection. The airways swell making breathing difficult. As the airway of an infant is small, infants are easily affected. Wheezing could result due to Bronchiolitis, which may develop into asthma in later life. Otherwise a child could be born with a tendency to wheeze and therefore could be prone to bronchiolitis and asthma. Less common reasons for wheezing in infants include inhalation of a foreign object or piece of food into the lungs, premature birth, insufficiently developed airways and cystic fibrosis.

Treatment options

A variety of treatments are available to help alleviate wheezing. However, regular monitoring by a doctor is a must, especially if the patient has asthma, chronic allergies, severe bronchitis, emphysema or chronic obstructive pulmonary disease. In some, wheezing can be relieved by certain medications or by using an inhaler. Some might need insertion of a breathing tube into the throat. The doctor may recommend some or all of the following to reduce inflammation and open up the airways obstructing breathing to stop wheezing:

• A bronchodilator inhaler, which can act fast to dilate constricted airways.
  
• An inhaled Corticosteroid
  
• A long-acting bronchodilator and Corticosteroid combination
  
• A controller pill for asthma to reduce airway inflammation
  
• A non-sedating antihistamine pill or a prescription nasal spray for nasal allergies, which are available over the counter.

Self-care measures to ease wheezing

Moisturize the air by either using a humidifier or a steamy shower or just sit in the bathroom with the door closed while running a hot shower. This is simply because moist air can help relieve mild wheezing in some cases.

Drinking fluids can relax the airway and loosen up sticky mucus in the throat.

Active or passive smoking can worsen a cough and hence it is best to avoid tobacco.

Emergency

Normally, mild wheezing that accompanies bronchitis disappears when the infection subsides. But in case of breathing difficulty, she needs to rush to the doctor who can administer the following:

• A shot of epinephrine to open up the clogged respiratory passages.
  
• Oxygen
  
• Frequent nebulizer to ease breathing
  
• A mechanical ventilator to help you breathe

It is for the doctor to determine the cause of wheezing and then treat the patient for the specific cause.

Antihistamines

Allergies are one of the most common types of acquired health conditions as the causes include various factors. Most of these factors are related to the environment such as dust, pollen, virus and chemicals. Allergic reaction signifies the defense mechanism of the immune system to a foreign particle. Allergic reactions if untreated can lead to bigger complications such as bronchitis and sinusitis. Antihistamines were first synthesized by Daniel Bovet. They play a major role in controlling the release of histamines in the body which are produced as response to an allergen. Histamines are chemicals which are released from the mast cell damage. These chemicals initiate the process of allergic reaction in the blood and tissues which causes discomfort. Histamines have three types of receptors H1, H2 and H3 which are specific for different organ systems. The H1 receptor is associated with vasodilation and smooth muscle stimulation, H2 receptor is associated with the cardiac stimulation and H3 is associated with the feedback inhibition process regulated by the central nervous system.

Types of antihistamines

Antihistamines mainly act upon the receptors of the type of histamine released. Each antihistamine has a tendency to compete in binding to the receptors to inhibit the process of allergic stimulation caused in the organ system. There are two major classes of antihistamines. The first generation and the second generation are classified based on their sedative effect on the patient during the course of their action. The first generation of antihistamines are sedatives as they act upon the parasympathetic nervous system in preventing the release of acetylcholine. Their anticholinergic properties enable them to act fast in providing relief within a few minutes. People who experience motion sickness are often suggested to take antihistamines because it suppresses the ear balance discomfort.

The most common ingredients present in these medications are chlorpheneramine, doxylamine, brompheneramine and dimenhydrinate. Most of these first generation antihistamines are recommended in allergic reactions such as hay fever, viral infection, pollen and dander as they suppress the central nervous system. Patients experience drowsiness for a period of time during the first generation antihistamine treatment.

Second generation antihistamines are not sedative in nature and they have large molecular size and electrostatic nature which makes them noncompeting to cross the blood and brain barrier. The response pertaining to their action is comparatively slow as they do not act upon the central nervous system. Studies have shown the increased administration of non-sedative antihistamines in the recent times. Some of these second generation antihistamines have been banned from the market due to their adverse side effects such as arrhythmia. Most of these antihistamines are prescribed during seasonal allergies.

Side effects of antihistamines

The common side effect of most first generation antihistamines is drowsiness or dizziness. The other side effects include nausea, feeling of dryness in mouth and nostrils and sometimes blurred vision. These happen because of the inhibition of secretions from salivary, nasal and lachrymal glands during the onset of an allergic response. The suppression of central nervous system activity may initiate confusion, disorientation and sometimes hallucination in patients.

Rashes, chest congestion and difficulty in breathing have also been reported as adverse effects of antihistamine administration. In case of H2 receptor antihistamines, diarrhea is significant side effect along with headache. Most of the side effects caused by antihistamine intake subside within a few hours. However increased sensitivity to a certain type of antihistamine has to be immediately reported to the physician.