Summer 2014 has been hailed as one of the worst summers on record for those who have pollen allergies. Here, we ask Consultant Paediatric Allergist, Dr Adam Fox, how to best manage the symptoms of paediatric hay fever.
What is hay fever?
Hay fever is caused by an allergy to pollen – most commonly grass or tree pollen. Tree pollen causes symptoms in February to April and grass pollen typically causes symptoms from April to July. It is the most common allergic problem and tends to develop in atopic people – those who have inherited an allergic tendency from their parents. Hay fever usually develops over the course of childhood or early adulthood but occasionally it can be a problem in toddlers or may even develop much later in life. Symptoms of hay fever can include itchy eyes, a running nose and frequently sneezing.
How should paediatric hay fever be managed?
The best way to help any allergy is to avoid the allergen, but this can be difficult with pollen. There are some things you can do to help keep the pollen at bay and this includes using pollen filters in cars, wearing wraparound sunglasses and washing your child’s hair at night (to remove the pollen that then gets onto their pillow). In terms of medication, age appropriate antihistamines can help to ease symptoms especially long acting, non-sedating varieties such as cetirizine or loratidine. If your child’s hay fever symptoms persist despite the use of antihistamines, then prescription nasal sprays might be a suitable treatment to consider.
How will I know if my child’s hay fever is severe?
If your child’s hay fever is interfering with their day-to-day activities or sleep then it needs to be addressed as this can have a real impact upon their development. The effect on sleep means that a child’s ability to concentrate and learn is impaired which can affect their school performance. This is particularly important for older children as studies have shown that students with hay fever are also more likely to drop exam grades in the summer.
How is severe hay fever treated at The Portland Hospital?
If you suspect your child has severe hay fever they will be carefully assessed by a paediatric allergist to pinpoint the exact cause and severity of their symptoms. As hay fever can be linked to an increased risk of asthma, a lung function test may also be performed. If necessary your consultant may recommend a trial of optimal medication and desensitisation (also known as immunotherapy).
What is immunotherapy and how can it be used to treat severe hay fever?
Immunotherapy works on the principle that the immune system can be distracted from reacting to an allergen if slowly increasing doses of that same allergen are given either under the tongue or by injection. Eventually, when high doses of the allergen are given, the symptoms can significantly improve. This is a well proven and very safe treatment for pollens as well as dust mite, cat, dog and horse allergies. Results can be dramatic for children with severe hay fever and the therapy can be used in children with well controlled asthma or multiple allergies. Some patients who can control their hay fever with medication may also wish to consider immunotherapy as a way to reduce their reliance on antihistamines or steroid treatments. However, for most patients, immunotherapy is used when they have persistent troublesome symptoms despite regular antihistamines and nasal sprays.
Is immunotherapy a cure for severe hay fever?
In theory immunotherapy is a cure for severe hay fever; however, in reality treatment will likely improve severe hay fever symptoms significantly but not completely eliminate them. The good news is that for patients with severe hay fever successful treatment with immunotherapy could be the difference between being dependent on steroid medication and having hay fever that does not interfere with their day-to-day life.
How frequently do immunotherapy doses need to be administered for this therapy to be effective against severe hay fever?
Sublingual immunotherapy (where the allergen is given under the tongue) requires a daily dose at home. For pollens, this is taken for 6 months of the year whilst for year round allergies (e.g. dust mite, pets) it is given all year round. Treatment courses last 3 years in order to get a long term effect that continues for years beyond the treatment course. The injections are used much less commonly in young children and can cause severe reactions. For this reason they must only be given in a highly specialised environment equipped to deal with such reactions such as The Portland Hospital which also offers a offers a comprehensive Allergy Challenge Testing Service within its dedicated Paediatric Day Case Unit.
How safe is immunotherapy as a severe hay fever treatment?
Over a billion doses of sublingual immunotherapy have been given worldwide so we know it is a very safe treatment. Reactions to the sublingual immunotherapy are common but are very mild and can include itchiness for a few minutes after the dose is administered. Very few children drop out of treatment due to side effects.
Are there any other allergies that immunotherapy can treat?
Immunotherapy is most commonly used for the treatment of grass and tree pollen allergies but is a very versatile treatment and has been shown to reduce the risk of asthma developing in children from 50% to 25%. Dust mite and pet allergies (e.g. cat, dog, horses) can also be treated with immunotherapy and researchers are currently looking at the potential of immunotherapy as a treatment for the management of common food allergies such as milk and egg.
For more information on the treatment options for paediatric allergies at The Portland Hospitalor to book an appointment with Dr Fox please telephone 0203 758 9160 or email firstname.lastname@example.org