The three types of hay fever in Britain – and how to manage the one you’ve got
You might still be wearing your winter coat but, like millions, suffering from hay fever – the unpleasant reminder that it is in fact spring.
Symptoms – which are most commonly sneezing, nose congestion and irritated eyes – are an allergic reaction to tree, grass or weed pollen in the air. When your immune system comes into contact with the harmless powder, it releases histamines and other chemicals, leading to symptoms that range from being mild but irritating to severe.
They tend to be at their worst between late March and September – especially when the weather is warm, humid and windy, as this causes a high pollen count.
England and Wales are expected to log medium pollen counts over the weekend, while levels will remain low in Scotland and Northern Ireland. However, it will rise to high in the south and east of the country early next week.
The types – tree, grass and weed
Around one in five people in the UK are allergic to tree, grass or weed pollen. “I would say 60 per cent have a grass pollen allergy, 30 per cent have tree pollen and about 5 to 10 per cent have weed pollen,” says Dr Adrian Morris, an allergy consultant at the Surrey Allergy Clinic.
Each pollen variety has a season, starting and ending around the same time each year. However, these can vary based on temperature, rainfall, wind and sunlight, notes Yolanda Clewlow, the Met Office’s UK pollen forecast manager.
Typically, trees release pollen grains during spring, usually from late March until mid-May, with one in four people feeling the effects.
“Its season is very early – it may not seem like hay fever. People may confuse it with a cold when they’ve actually got a tree pollen allergy,” says Morris.
Those battling sniffles, watery eyes and a cough right now could be allergic to tree pollen, or the culprit could be grass pollen, which usually runs from May to July.
“We’re starting to see a mishmash of tree and grass pollen,” Morris says. “Grass pollen is usually next month to August but because the weather has been relatively warm and there’s been quite a lot of rain, that makes the grass pollinate earlier – so I think we’re going to have a bumper grass pollen season this year.”
Weeds emit pollen from June to September. It is the least common cause of hay fever in the UK, though it’s on the rise as one variety called ragweed is taking off rapidly, Morris says.
However, pollen counts vary day to day and location. “It depends on the horticultural make-up of a particular area,” says Amena Warner, head of clinical services for Allergy UK.
“Somewhere with a dense population of trees is likely to have a higher pollen count than somewhere with fewer trees and green areas. Equally, coastal locations will probably have a lower pollen count because the proximity to the sea creates an atmosphere which disperses pollen more readily than one which is more inland.”
As each pollen allergy causes the same symptoms, it can be hard to tell which is the culprit. Other than monitoring the time of year symptoms kick in, a blood or skin prick test is the only other way to detect a pollen allergy.
Blood tests measure antibodies in the bloodstream, which can reveal the allergen causing hay fever symptoms, while a skin prick test involves putting a small amount of different allergens onto the skin to check for a reaction.
“It’s helpful for people with symptoms to do a test because they know what season to be wary of, how allergic they are and know what’s the most effective treatment,” Morris says.
Some unlucky sufferers are allergic to more than one type of pollen. They tend to suffer worse symptoms – struggling to breathe properly and suffering from blurry vision, he adds.
The treatments
While it may be viewed as trivial, hay fever can interfere with sleep and concentration and trigger frequent headaches, sore throats and sinus infections.
Trying to avoid pollen is the most obvious, though tricky, approach. Morris recommends staying inside at peak times – typically mid-morning when pollen is first shed and early evening when the grains drop down to nose level.
Other ways to minimise exposure include wearing sunglasses to prevent pollen getting in the eyes and putting Vaseline around the nose to trap the grains before they can be inhaled, as well as showering and washing clothes after spending time outdoors, he notes.
Some sufferers take to cutting down trees in their garden or putting down astroturf. “There’s honestly no point because the neighbour’s grass or tree pollen will blow over the wall and you’re not really going to protect yourself much more,” Morris says.
Medicines, such as antihistamines, decongestants and eye drops, can relieve symptoms and most can be bought over the counter in pharmacies and supermarkets.
“We recommend starting reasonably early – as soon as the pollen count starts to creep up, take antihistamines,” says Morris. “If that’s not controlling things, migrate onto the nasal spray and eye drops.”
GPs can also prescribe steroid treatments when these options don’t work.
People who are still debilitated by their hay fever symptoms after trying these methods may be offered immunotherapy, which involves being given tiny amounts of pollen in the form of a tablet or a wafer that is placed under the tongue. It may also be offered as an injection but this is becoming less common as the oral options are more convenient for patients.
In theory, this method of controlled exposure to pollen teaches the immune system to tolerate it rather than try to fight it off – effectively reversing the allergy.
“It really does transform people’s quality of life, particularly those with a grass pollen allergy because it’s a long season – they can be really incapacitated for four months of the year,” Morris says. Around 70 per cent of immunotherapy patients have “fantastic” results, 20 per cent have modest results and 10 per cent find that it does not ease their symptoms, he says.
The tablets or wafers are taken daily from two months before the pollen season begins. “If you do it for three consecutive years, you get a long-term cure of the hay fever to that pollen,” he explains.
“That cure lasts for about 10 years, and then it sort of fizzles out, so you might do it when you’re 30 and you have a wonderful time but you’re 40 and then suddenly discover the hay fever starts to come back again and repeat the treatment.”
However, it is not risk-free. In rare cases, immunotherapy can trigger severe allergic reactions, though this is more common when it is offered as an injection, Morris says. Meanwhile, the tablets and wafers can cause severe itching under the tongue, which causes some patients to stop taking it.
Additionally, it is not widely available. Just 1,000 NHS allergy patients per year are estimated to be offered immunotherapy, in part due to its high price of around £100 per month, meaning that a three-year course would cost £3,600.
“A lot of the private medical insurance won’t actually pay for it and the NHS will only give it if it’s absolutely essential – they would rather recommend antihistamines,” Morris says.
Immunotherapy should be offered more widely but there is a lack of specialists to deliver the treatment, with just one allergist for every 500,000 people with an allergy, according to Warner.
Some patients have sought out another supposed hay fever treatment in the form of a jab called Kenalog, which is the brand name for the prescription-only steroid injection triamcinolone acetonide. However, it is not licensed for treating hay fever and can be risky, as it works by temporarily suppressing the immune system.
“It can last anything from a week to a month and give you benefits for that period of time,” says Morris. “But because it’s quite a high dose of steroid, it has downsides and can cause things like osteoporosis, cataracts and diabetes, so we frown upon it now. It’s not offered in mainstream allergy clinics any longer.”
A safer option would be to go to the GP for oral steroids to temporarily nip hay fever symptoms in the bud. “For an emergency, you can take a small amount of oral steroid just for a day or two to get through something that’s important, such as a wedding or exam, in the middle of grass pollen season,” he says.
The jury is still out on whether home remedies can ease hay fever, with a teaspoon of honey a day often suggested. “The theory behind that is there’s going to be a little bit of pollen in the honey and you may effectively desensitise yourself a bit,” Morris explains. “I don’t know if it works or not. I’ve never seen any evidence but it’s a nice idea.”
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