This is the time of year when hay fever causes misery. We all understand what the term hay fever means. Those summer symptoms of sneezing, nose blowing, itching of the nose, eyes and back of throat, the watery eyes and the difficulty breathing through the nose. However these symptoms have nothing to do with hay and are not associated with fever. Although "hay fever" is common now, with approximately 30% of school children being attacked, it was not always so and the term "hay fever" is a label from the past when doctors and scientists were trying to assign a cause for the development of these summer symptoms. We appreciate now that it is an allergy to the grass pollens, that is present in the air during the period of grass flowering, that is responsible for the development and timing of these symptoms
The common grasses within the UK, such as timothy grass, rye grass and cocksfoot generally flower from mid May until mid July. The onset of the flowering can be a little earlier or later depending upon warmth of the spring. The same symptoms arise with allergies to other pollens that may be ambient at different times of the year. Thus there are tree pollens, from early flowering trees such as hazels, present in the atmosphere from February onwards and there is a succession of different tree pollens through to the end of April/early May. Pollens from silver birch trees, which are well recognised to be associated with allergy, are most prevalent in March/April time. From July into August there are weed pollens, such as from plantain and nettle and also mould spores as we may experience "hay fever" from February through to August. They may then have symptoms for more than half of the year.
What many who do not suffer from "hay fever" do not appreciate is that this disease is more than inconvenient bouts of sneezing and nose blowing. Hay fever can make you feel "rotten". If the nose is blocked you don't sleep well at night, and tired during the day and can feel "grumpy". With deprived sleep individuals do not concentrate so well at work and school performance is impaired. Even without obviously disturbed sleep those with "hay fever" are not right in themselves and feel below par, as part of their illness. Some also experience asthma in association with the pollen exposure and headaches are common, due to the sinuses also being involved.
Treatment used appropriately can make a considerable difference to how people feel and not only reduce symptoms but also improve quality of life. In simple terms there are five main classes of conventional treatment available, of which two are most commonly recommended. These are antihistamines and intranasal steroids. The antihistamines are available both as tablets, which help both nose and eye symptoms as well as itching throat and, to an extent, asthma associated with hay fever, and as a nose spray or eye drops. The topical treatment administered to the nose or eye will only be effective at that site but if used solely for relief of intermittent symptoms will work quicker than a tablet. Non-sedating antihistamines such as Telfast, Zirtec, Clarityn, Xyzal or Neoclarityn, all of which can be taken just once a day are preferred over the sedating antihistamines. Antihistamines will help reduce itch, sneeze and runny nose but will have much less effect on nasal blockage/stiffness. They will not completely abolish symptoms. Intranasal steroids, so called as they are squirted directly into the nose and as such are effective at considerately lower doses than would be required if given as a tablet orally, are more effective than antihistamines in improving symptoms and importantly are effective at improving nasal obstructions/stiffness. For maximal effect, this type of intranasal therapy needs to be taken every day, as it is a preventer type of therapy rather than one that provides instant relief. For those who get hay fever each year we recommend starting this preventer therapy before symptoms usually start and continuing with it daily throughout the pollen season. In this way it may prevent the development of hay fever. this type of treatment will be directed at nasal symptoms and additional treatment may be required for eye symptoms. in this instance and of the other classes of treatment may be helpful - eye drops. These are available as either antihistamines eye drops, as mentioned, or as chromone eye drops such as Opticrom, or Rapitil. These eye drops help relieve itching, watering and the ache in the eye associated with hay fever. they can be used either regularly several times a day or intermittently as needed when symptoms dictate.
A fourth type of treatment is an intranasal decongestant spray. As the name suggests this type of treatment helps nasal blockage/stuffiness but has no effect on the nasal itch, sneeze or runny nose and has no effect on eye symptoms. While helpful relieving the obstructive symptoms in the nose this type of treatment should not be taken for more than 10 days at a time as if done can make the nasal symptoms worse rather than better. 
The final type of treatment, which has much more limited availability, is immunotherapy or desensitisation. This requires regular injections of pollen extract to downregulate the immune system and induce tolerance, so that symptoms do not arise in the summer. There are potential risks of inducing allergy reactions with this type of treatment and it needs to be given for at least three years to obtains the best results. As injections have to be given under supervision in a specialist centre and the injections start as weekly injections, this type of treatment is reserved for those who have tried all other treatments correctly, and have not found them adequate to control their symptoms. Research is ongoing to try and find ways of administering immunotherapy more safely and more easilly so that it could be more widely available.
The important messages to take home are that hay fever is not a trivial complaint but that if treated appropriately can be well controlled. 

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