Sunday 22 September 2019

Achoo! How to survive hay fever season - What to eat (and what to avoid)

With antihistamines coming under new scrutiny, sufferers are looking for safer and even drug-free ways to tackle allergies, writes Victoria Lambert

The widespread consumption of hay fever pills could be contributing to the increase of antibiotic resistance. Stock Image
The widespread consumption of hay fever pills could be contributing to the increase of antibiotic resistance. Stock Image

Victoria Lambert

For anyone celebrating the arrival of summer by stockpiling over-the-counter hay fever treatments, news of a new vaccine may come as blessed relief.

The treatment, developed in Vienna, involves synthetic grass pollen being injected into the sufferer's system, reducing the classic wheezing and sneezing symptoms by 25pc. It is also said that three injections a year could leave sufferers symptom-free.

That's the good news. But those for whom summer is synonymous with red eyes and handkerchiefs - an estimated one in five of the population - there's bad news, too. Though the vaccine, known as BM32, passed its latest trials in March, it has another round before it can be approved - and won't be available until 2021 at the earliest.

While the latest research, published in the Journal of Allergy and Clinical Immunology, is certainly encouraging, that's three more summers to sneeze our way through. So how best to tackle the condition now?

There's no time to waver. Hay fever kicks off for many of us at the end of March, when tree pollen gets airborne. As that wanes in mid-May, grass pollen becomes a trigger for three months, with weed pollen becoming an issue from the end of June into September.

"Hay fever - or allergic rhinitis - is an allergic reaction to pollen," explains Professor Helen Stokes-Lampard, chair of the Royal College of GPs in London. She says: "It's something that many people suffer from, particularly in the spring and summer months, when it's often warm, humid and windy."

She adds: "In most circumstances, symptoms can be helped with over-the counter antihistamine medication, and by taking simple steps to reduce a person's exposure to pollen.

"Measures can include making sure windows and doors are shut, having a shower after being outside, applying Vaseline to nostrils to help trap pollen particles, and buying pollen filters for indoor air vents. It's also advised that patients avoid keeping fresh flowers indoors, stay away from smoke and, where possible, keep pets outside."

Interestingly, antihistamines are coming under new scrutiny. Recent research from the Institute of Biology and Experimental Medicine in Argentina said that hay fever tablets can affect the production of male sexual hormones in the testicles, which can lead to lower quality sperm, as well as a reduced sperm count.

Moreover, the widespread consumption of hay fever pills could be contributing to the increase of antibiotic resistance by changing the growth of bacteria in the human gut. Researchers from the European Molecular Biology Laboratory (EMBL) looked at the impact of 1,000 common drugs on 40 strains of gut bacteria and found that loratadine, a common hay fever medication, was one of those having a negative impact as it may be encouraging so-called "unhelpful bacteria" to develop new resistant strains in the same way as antibiotics do.

Anand Kasbekar, a consultant ENT surgeon and honorary assistant professor at Nottingham University Hospitals and The Spire Nottingham Hospital, recommends that anyone presenting with hay fever is also asked a few key questions to pick up possible undiagnosed asthma.

"A lot of patients with asthma also have allergic rhinitis, and effective treatment of the nose improves the chest and asthma symptoms. Similarly, effective treatment of the asthma improves the nasal symptoms."

If you do get referred, options include steroids, which may be delivered as tablets or in a nasal spray. But steroids bring significant side effects which must be weighed up.

Prolonged use of most nasal steroid sprays is safe although can lead to thrush infections in the throat, as well as hoarseness. Stronger doses taken by mouth, or Kenalog injections of triamcinolone acetonide (usually into the buttock, and before the hay fever season starts), can cause nausea, bloating, stomach pain, osteoporosis, high blood pressure and insomnia.

Most of us will make do with an over-the-counter treatment, but are you getting the full benefit? "For some people, [to get the most of a nasal spray] surgery is needed," says Kasbekar, "as medication may not be able to get into the nose if the nasal cartilage is really bent. A septoplasty, where we straighten the nasal septum, allows the medicine to get into the nose and can really help with effective symptom control."

In certain circumstances, if the treatment doesn't work, a patient might be sent for immunotherapy working with a specialist allergy team. This means being exposed to increasing doses of an allergen, such as grass pollen, under medical supervision.

Currently, that might mean an injection four times a year or a few months' worth of daily tablets taken for three years. A study published in the journal JAMA last February, by Imperial College London, found that immunotherapy treatments were highly effective as long as they were pursued for three years.

These results - at about 60pc to 70pc reduction of symptoms - are better than those offered by the new Austrian immunotherapy vaccine still in trials, says Professor S Hasan Arshad, chair in Allergy and Clinical Immunology at the University of Southampton.

Prof Arshad says: "Traditional immunotherapy desensitises the patient by exposing them to the whole protein which is causing the allergy. Now scientists are isolating the part of the protein, the peptide which engages with the immune system.

"If we inject that, patients won't get a reaction but will still build up tolerance. It's safer and effective and we can use a high dose immediately and reduce the number of injections so everyone is happy."

He adds: "I think the Austrian vaccine looks promising, but will need to show better efficacy before it will become available." By comparison, traditional antihistamine tablets have been shown to cut hayfever symptoms by up to 20pc, and nasal sprays by up to 30pc.

And what about a drug-free approach? Dee Atkinson, a medical herbalist, says the sufferers should be proactive - and be starting their regime now. "My top tip is to start treatment a good three weeks before your hay fever usually begins."

She recommends "a multi-faceted approach - some dietary advice, often to cut out dairy products, combined with a focused herbal remedy".

"My 'go-to' herbs include Luffa operculata (sponge cucumber), to relieve typical hay fever symptoms such as sneezing, a tickly nose or throat and blocked nose, and I often recommend Euphrasia (eyebright) eye drops and a Luffa nasal spray to be used at the same time," she says.

Like Prof Stokes-Lampard, Kasbekar says the most important measure we can take is to avoid allergens in the first place. "Keep the window shut at night when pollen levels are high. Keep your house clean to avoid dust mites. These are simple things you can do before you think about medication."

What to eat (and what to avoid) to prevent hay fever

LOW-HISTAMINE foods to help reduce hay fever symptoms

• Fresh fish

• Fresh chicken

• Eggs

• Fresh fruits (except strawberries)

• Fresh vegetables

• Oils

• Green leafy herbs

• Herbal teas

HIGH-HISTAMINE foods that may increase symptoms

• Alcohol

• Smoked meat (ham, salami etc)

• Walnuts and cashew nuts

• Salty foods

• Mature cheese

• Chocolate

• Sugary foods

• Foods with artificial colourings

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