Hay fever: treatment, symptoms, causes, in children, adults. Hay fever: symptoms and treatment

Update: October 2018

A runny nose, watery eyes, and cough are not always signs of a cold. In the warm season, especially when repeated annually at approximately the same time, these symptoms indicate that a person has seasonal hay fever.

Hay fever (from the word “pollen” - “pollen”) is an allergic disease when, in response to the flowering of a particular plant, a person develops copious discharge from the nose, sneezing attacks, dry paroxysmal cough, in some cases - a feeling of lack of air or an itchy rash on the skin. Signs of this disease are found in people who have inherited defects in certain genes. The disease begins in childhood or adolescence; Women are more likely to get sick. Without treatment, hay fever can develop into such a serious chronic disease as bronchial asthma.

History of discovery

Although the ancient Greeks called ambrosia nectar “food of the gods,” the healers of that time, in particular Galen, already knew that it, as well as many other plants, could cause coughs and runny noses. They noticed that these symptoms disappeared with the onset of cold weather. There was no cure for this disease, and healers simply passed on information about it to their students.

It was not until 1819 that hay fever was officially described by John Bostock, who called it “hay fever.” He suggested that the reason lay in the smell of hay: a runny nose, watery eyes, cough and rash, often accompanied by chills, were observed mainly in residents of rural areas during the mowing period. The smell alone, he believed, was not enough: the disease occurs when a person inhales the juice of mown grass that has fallen on dust particles heated by the sun. And only in 1873, Dr. Blackley from Great Britain presented convincing evidence that hay, sunlight and dust are not the causes of hay fever - the disease occurs as a result of pollen from wind-pollinated plants entering the respiratory tract. This was proven by experiments on the doctor’s own body, suffering from allergies such as hay fever.

Why some people calmly work with plants and do not notice any manifestations of hay fever, while others, even living far from green spaces, begin to sneeze and cough with the onset of warm weather, became known relatively recently. Only at the end of the last century were genes identified whose presence in DNA determines allergies to certain pollens. It was also found that such genes are transmitted mainly from the mother, and to a lesser extent from the father. If both parents suffer from allergies, the risk of having a child susceptible to hay fever is extremely high. Whether he develops a disease or not will depend on the climate of his residence (whether the “necessary” plants grow there) and the nature of his diet (whether he receives from food those substances that he needs). chemical structure very similar to allergens).

Causes of hay fever

The disease occurs in a person who has special “defective” genes, when the plant (those plants) to which these genes dictate the occurrence of an allergy - an abnormal immune reaction - begins to bloom. These are representatives of the Earth's flora, pollinated by the wind: their pollen consists of tiny particles that can easily penetrate the respiratory tract (down to the smallest bronchi), settle on the mucous membrane of the lips, conjunctiva (this is a kind of mucous membrane of the eyes), and also the skin. Immune cells present in the skin and mucous membranes recognize the protein components of pollen and trigger the release of histidine, histamine. This causes the symptoms characteristic of hay fever.

“Defective” genes are passed on to the child with the following probability:

• 50% - if both parents are allergic;
• 25% - if “incorrect” immune reactions are observed in only one of the parents;
• 10% - in the family of parents who do not have allergies. This percentage tends to zero if the child grows up in an ecologically clean area, was born in winter or early spring (when there is no flowering), if he rarely suffers from viral infections.

The risk of developing the disease (when parents are non-allergic) or the chance that it will be severe (when one or both parents suffer from this pathology) increases if:

• the child was born from a mother who suffered an exacerbation of hay fever in the last 3 months of pregnancy;
• the child was born in the warm season;
• the city where the parents and the child live has an unfavorable environmental situation;
• in the first six months after birth, there was a release of toxic waste from factories into the air;
• complementary feeding was introduced to an infant under one year old early and not according to the rules;
• the child eats foods (especially during the hay fever season) that contain proteins similar to pollen allergens.

Hay fever is a seasonal disease, and it occurs in residents of different climatic zones in different period time: in the southern regions - earlier, in the northern - later. Hay fever also depends on the weather: when it rains, allergies do not torment people predisposed to it as much as in dry weather. This is due to the fact that dry wind carries pollen over much greater distances, while water, on the contrary, “nails” it to the ground. If the air temperature drops, it becomes easier for a person suffering from hay fever, since the pollen “walks” more at his feet, rather than rising closer to the eyes and respiratory tract. The highest concentration of allergen in the air occurs before a thunderstorm.

Spring hay fever develops mainly in April or early May. It is caused by pollen from trees such as:

• alder;
• hazel;
• poplar;
• birch;
• linden.

At this time, hay fever can be caused by pollen from coniferous plants: spruce, pine, cedar, fir. This allergy develops only in some people, which is due to the large size of pollen particles.

The next “wave” of the disease begins at the end of May and continues until the beginning of July. During this period, cereal plants bloom - both cultivated (wheat, barley, rye, oats) and weeds (wheatgrass, feather grass, hedgehog grass, bentgrass, ryegrass, foxtail, timothy). Allergies are especially severe in those who have increased sensitivity of the immune system to the listed cultural representatives of the flora and at the same time consume bread or porridge made from these grains. In this case, allergens enter not only with inhaled air, but also with food: heat treatment does not change the composition of molecules to which the immune system is “abnormally” sensitive.

The poplar fluff that flies at this time does not in itself cause allergies: it is not poplar pollen, and moreover, its size is too large to penetrate the respiratory tract. But this fluff perfectly carries the pollen of the plants listed above, and because of this, allergies arise.

Most people note the development of hay fever from the end of July to September (in the southern regions - until the beginning of October). During this period, weeds bloom: ragweed, nettle, wormwood, quinoa.

Symptoms of the disease

Signs of hay fever are observed every year, almost at the same time. The first symptoms are:

• itching in various areas: nose, throat, ears;
• bouts of sneezing;
• unpleasant sensations in the eyes: lacrimation, itching, sand; photophobia (this is the beginning of allergic conjunctivitis, which is also called “hay fever”);
• runny nose with a large amount of mucous discharge.

After about 8 hours, the disease is accompanied by one or more of the following symptoms:

• swelling of the eyelids and redness of the eyes;
• purulent discharge appears from the eyes;
• dry paroxysmal cough;
• difficulty breathing, more often in the form of attacks of suffocation;
• an increase in temperature to low numbers;
• increased fatigue and irritability;
• the appearance of urticaria or a rash on the skin as in atopic dermatitis;
• itching of the genitals;
• symptoms of cystitis: frequent urge to urinate, painful bowel movements bladder, the feeling that there is a lot of urine left in it after going to the toilet;
• when inhaling pollen from rye, oats or wheat, which is combined with the ingestion of products from these crops, not only signs of damage will be observed respiratory tract, but also symptoms indicating that inflammation and swelling of the gastrointestinal mucosa has occurred. These are abdominal pain, nausea, vomiting, and sometimes diarrhea.

Which people have hay fever more severely?

The likelihood that the disease will be severe, complicated by inflammation of the paranasal sinuses (sinusitis: sinusitis), and also subsequently develop into bronchial asthma, is higher in such people:

1. who has birth defects immune system. For example, when little secretory immunoglobulin A is produced - a substance that is secreted along with the secretion of the glands and is designed to protect the mucous membranes from microbes, preventing them from joining the cells;
2. with acquired immunodeficiencies. Basically, it is a suppression of the immune system during prolonged or chronic diseases, oncological diseases, treatment of cancer or autoimmune diseases with glucocorticoid hormones or cytostatic drugs;
3. who has had their tonsils removed;
4. who often suffers from bronchitis;
5. living in poor environmental conditions;
6. having other allergic diseases, especially bronchial asthma.

All these people, especially if they have 2 or more risk factors, should not leave hay fever without treatment: medications must be strictly prescribed by an allergist and taken according to the schedule prescribed by him.

Cross allergy

During the period of occurrence of these symptoms, cross-allergy easily develops - an increase in the symptoms of hay fever when antigens that have a similar structure to those that cause hypersensitivity enter the body. These molecules mainly enter the body as part of food. We will look at them in detail in the “Diet” section.

Hay fever in children

In a child genetically predisposed to hay fever, whose parents did not move to another climate before or immediately after his birth, it begins to manifest itself at 5-6 years of age. Its symptoms are no different from those described above.

The disease can appear earlier, up to 5-6 years, if parents bathe the baby in herbal decoctions (chamomile, oak bark), and he has an allergy to them “written in his genes.” In this case, the main symptoms will be skin symptoms (rash); signs of hay fever may not appear immediately.

Diagnostics

First, a person with the symptoms described above (cough, runny nose, lacrimation) should be examined by an ENT doctor. After examining the nasal cavity, throat and ears, he rules out ARVI and diagnoses “allergic rhinitis”. After this, you need to donate venous blood to check the level of immunoglobulin E (IgE) in it and contact an allergist who will tell you how to treat hay fever at this stage.

In the cold season, when the symptoms disappear, you should definitely visit the allergist again. During this period, the doctor will be able to conduct allergy tests (or prick tests) to help determine what specific substance a person is allergic to. Allergy tests consist of the following: small “notches” will be made on the forearms of the hands with a scarifier, into which allergens diluted many times over (diluted pollen of weeds, field grasses, etc.) will be dropped - one allergen for each scratch. The allergen that caused persistent redness is considered the cause of the disease. In case of hay fever, it is better to determine the “causal” allergen. Then it will be possible to take several courses very effective treatment with its help (this treatment of hay fever in adults is called allergen-specific immunotherapy).

Treatment

Therapy for this disease is initially carried out for a whole year in a row:

1. in warm weather, measures are taken to reduce the severity of the disease;
2. in cold weather, the “causal” allergen is identified and allergen- specific immunotherapy(ASIT).

Only with this approach can you significantly increase the chance of successfully keeping hay fever under control, and after 1-2 years of treatment, “go” to the minimum amount of medications taken with residual symptoms of the disease.

To reduce the symptoms of hay fever, treatment includes:

• lifestyle changes;
• diet;
• taking medications for hay fever.

Let's talk about each point in more detail.

Lifestyle change

During an exacerbation of hay fever, it is important that as little pollen as possible reaches the person. Of course, in the summer you can’t go outside wearing a respirator, but you need to remove pollen from open parts of the body, clothing, and surfaces of the room where the patient lives.

Therefore, in the warm season:

• rinsing the nose and mouth with 0.9% sodium chloride solution (saline sea ​​salt, drugs "Aqua-Maris", "Humer" and others) - after returning from the street;
• take a shower and wash your face every day, especially after returning from the street;
• wet cleaning every day is mandatory;
• ventilation of the room - at night and after rain;
• in the hot season, especially when there is a strong wind outside, do not go outside unless absolutely necessary;
• when plants are flowering, you shouldn’t go to places where there are a lot of them (for example, outside the city);
• summer holidays - in those regions where there are bodies of water and plants that cause allergies do not grow;
• the air in the room must be humidified. To do this, you can buy and use an air humidifier (or washer), you can hang gauze, folded in several layers, on window openings, and constantly moisten this gauze and wash it often. This way the humidity will be maintained, and the pollen will settle without getting into the room;
• all “dust collectors”: carpets, soft toys, feather pillows, duvets - must be removed from the room.

In the cold season, when you do not need to take pills for hay fever, strengthen your immune system, because it is its incorrect reaction that causes the symptoms of the disease. To do this:

• introduce hardening procedures into your daily routine;
• give up bad habits;
• find a suitable sport for yourself and practice it every day, at least in minimal quantities.

Diet

The essence of the diet for hay fever is to prevent the entry of additional allergens into the body, including potential ones. To do this, during the period of exacerbation, you will have to exclude all “allergenic” foods (honey, chocolate, citrus fruits, seafood, cow's milk), as well as those to which cross-allergy may occur:

Drug treatment

The main drugs for hay fever are those that will block the release of histamine from immune cells (antihistamines). During the period of acute allergies, first-generation drugs are prescribed, most of which cause drowsiness:

• "Diazolin";
• "Suprastin";
• "Tavegil"

in combination with third-generation drugs that do not cause drowsiness:

• “Cetirizine” from various companies and its analogues: “Zodak”, “Cetrin”, “L-cet”, “Zirtec”;
• "Fexofast" ("Allegra", "Fexadin");
• "Loratadine" ("Claritin");
• "Erius" ("Eden", "Dezal", "Lordestin", "Desloratadine-TEVA").

For hay fever antihistamines the first generation are mandatory, at least for a short course: they effectively eliminate the manifestations of the disease, allowing a person to breathe better. They are taken at night. Third generation drugs are taken in the morning, once a day; their effect lasts for a day.

In severe cases, instead of first-generation antihistamines in a short course, only under the “cover” of stomach protection with the drugs “Almagel” and “Omeprazole”, drugs for hay fever such as glucocorticoid hormones are prescribed: “Prednisolone”, “Metypred”.

If symptoms of hay fever are observed for a long time, after discontinuation of first-generation antihistamines, allergists prescribe a drug that blocks histamine receptors, which has a long-term effect. This is Ketotifen. Its effect begins only after 1-2 months from the start of use, but it well prevents the appearance of a dry cough and shortness of breath, as well as rashes, runny nose and watery eyes.

Drops for hay fever are also needed. These are locals antihistamines“Cromoglin” (“Cromogexal”, “Kromosol”), as well as Allergodil spray, which are instilled into the nose. If allergic rhinitis is complicated by the development of sinusitis, nasal sprays containing glucocorticoid hormones can be prescribed by a doctor: “Beconase” (“Nasobek”), “Avamys” (“Nazarel”) and others.

Symptomatic treatment

This is a therapy that is selected depending on the prevailing symptoms:

• in case of severe difficulty in nasal breathing, vasoconstrictor drugs are prescribed in the form of drops: “Lazolvan-rino”, “Nazol”, “NOK-spray” and others. They are used for no more than a week, when it is very difficult to breathe due to swelling, or when rhinitis is complicated by sinusitis;
• when symptoms of bronchial asthma appear: difficulty exhaling, attacks of suffocation, treatment is supplemented with leukotriene antagonists - the drugs “Akolat”, “Singulair”;
• for lacrimation are prescribed eye drops"Ketotifen" in combination with drugs that narrow the eye vessels ("Visin-allergies")

Homeopathic treatment

Treatment of hay fever with homeopathy is not approved by official medicine: it is quite dangerous to treat “like with like”, even at home - this can worsen your condition (up to anaphylactic shock). This is only possible with experienced, qualified homeopathic doctors who will actually select the right substances in the right dosages.

Another thing is to use separate homeopathic medicines to relieve a particular symptom. So, they really have a good effect:

• "Euphorbium-compositum" - to reduce the symptoms of a runny nose;
• “Cinnabsin” or “Sinupret” (preferably in drops) – to improve the condition of sinusitis;
• "Bronchalischeel" - to reduce the symptoms of allergic bronchitis;
• "Nux vomica" - for relief of runny nose and nasal congestion accompanied by headache.

Treatment during the interictal period

The main therapy used in the cold season is the already mentioned ASIT. In this case, a person undergoes allergy tests to identify one or more allergens. Next, these allergens are used to make a solution with their minimum concentration in it. The solution is first administered intradermally, in a minimal dosage, in the presence of a doctor (to ensure the absence of anaphylactic shock). Then every day, in ever increasing doses, the allergen is injected subcutaneously. By 14-21 days, a solution with a higher concentration of the allergen in it begins to be used, and after a while - with an even higher one. Thus, the body “accustoms” to this substance and during the flowering period it ceases to react to it in this way.

To treat hay fever, one course of ASIT is rarely enough. Often courses need to be conducted for several years in a row.

In addition to ASIT, other treatments are also carried out. Knowing the flowering time of allergy-causing plants, 2 months before this period they begin to take Ketotifen. Sometimes, at the very beginning of the flowering period, a single injection of the drug “Diprospan” is given.

What to do with severe hay fever

In severe cases, when hay fever is constantly complicated or sinusitis requiring surgical treatment, or attacks of suffocation, additional treatment methods are used:

• Plasmapheresis: taking a small volume of blood and then returning your own blood cells to the bloodstream. In this case, the blood plasma, in which all antibodies to the allergen, histamine and other substances are dissolved, is removed and replaced with saline and colloidal solutions. Thus, the concentration of substances that cause hay fever in the blood decreases.
• Operations. To reduce the manifestations of a runny nose, partial resection of the nasal turbinates is performed. This is done endoscopically, and a laser or exposure to liquid nitrogen is effectively used as a “cutting” tool.

If this treatment does not produce the desired effect, you need to change your region of residence.

Features of treatment for children

Treatment of hay fever in children is based on the same principles as in adults:

1. Walks and picnics - near bodies of water, preferably in an area where there is not an abundance of flowering herbs and trees. In summer you can go to the sea.
2. Wet cleaning, damp gauze on the window and night airing in the room are mandatory.
3. Important: swimming in the warm season - after visiting the street, BUT you cannot add herbal decoctions to the bath. There is also no need to use products containing herbs for skin and hair care.
4. The diet for a baby is based on the same principles: hyperallergenic foods and foods that can cause cross-allergy are excluded. Important: during the period of hay fever, you cannot introduce new foods (complementary foods). Even for children over 5 years old, do not give dishes with seafood, honey, nuts and chocolate at this time.
5. All drug treatment is agreed with the doctor, since not every drug can be used in childhood. But antihistamines (in syrups) and vasoconstrictor drops (in lower concentrations) are used in children, and in severe cases, drops based on glucocorticoid hormones and injections with hormones. If there is shortness of breath, wheezing, or an increase in the number of breaths per minute, hospitalization is indicated. “Hay fever of the eye,” that is, allergic conjunctivitis in children, is treated only by washing the eyes with saline or another saline solution or a drug recommended by a pediatric ophthalmologist.
6. After a walk, it is imperative to rinse (drip) your nose with saline solution.
7. Preparations made from herbs should not be used even during the interictal period. Especially if the child is still small and allergy tests have not been performed on him, that is, the source of the allergy is still unknown.
8. ASIT can be used in children from the age of 5 years.
9. Folk remedies and homeopathy are not used to treat hay fever in children.

Features of treatment during pregnancy

It is very difficult to treat hay fever during pregnancy: almost all drugs are prohibited for use during this period. In this case, an exacerbation of hay fever deprives the child of some oxygen, can be transmitted to him in the form of bronchial asthma, and also cause premature birth.

What to do? It is optimal to change your place of residence at least temporarily, if not for the entire period of bearing the baby, then at least from the 30th week and for the first few months after birth.

If this is not possible, the woman should start using medications in advance that will trap allergens and prevent them from entering the bloodstream from the nasal mucosa. These are Prevalin Allergy and Nazaval Plus. They are used before going outside. After going outside, you should definitely rinse your nose, not by swallowing the saline solution, but by actively blowing your nose. You can even purchase nasal rinsing systems like Dolphin or Aqua Maris to make this procedure easier.

During pregnancy, as an exception and only as prescribed by a doctor, only some antihistamines (Fexofast and analogues) and only certain vasoconstrictor drops (Lazolvan Rino, and only not earlier than the 2nd trimester) can be used. If hay fever occurs with complications, the pregnant woman will have to go to the hospital and undergo a course of treatment with glucocorticoid hormones and oxygen.

Prevention

Prevention of hay fever consists of the following measures:

• living in the city or at sea during the entire flowering period of plants;
• avoiding walking in dry, hot and windy weather;
• avoiding foods that may cause cross-allergy;
• humidification of indoor air;
• moistening mosquito nets or hanging gauze moistened with water on windows;
• wearing sunglasses;
• getting rid of bad habits;
• cleaning carpets and soft toys from the house;
• rinsing the nose with saline;
• hardening;
• refusal to dry things outside;
• avoiding contact with pets and their food.

An important measure specific prevention is to conduct the required number of ASIT courses. This is especially important for women who are planning a pregnancy. The last course of ASIT should end 1 year before trying to get pregnant.

Watery eyes, runny nose and cough are not always symptoms of a cold. In the warm season, these signs indicate the presence of hay fever. This allergic reaction organism for the flowering of any plant. Without treatment of this pathology, bronchial asthma develops. For this reason, many people want to know what the symptoms and treatment are for hay fever.

It is known that itching appears in the nasal passages, with hay fever, which is not infectious disease and it cannot be infected by airborne droplets. Hay fever is an allergic response of the human body to the influence of pollen from various plants. The reaction has a clearly recurring seasonality. Most often, the disease manifests itself as inflammation of the mucous membranes of the respiratory tract and eyes.
In addition, the disease is also commonly called:

• pollen bronchial asthma;
• pollen rhinopathy;
• hay fever;
• spring catarrh;
• allergic rhinoconjunctivitis.

The most correct term is hay fever.

Risk factors

The disease usually appears in the female half. Climatic, environmental and geographic factors influence infection rates. Rural residents often suffer from hay fever.

An important role is played by hereditary predisposition. If allergic diseases If two parents are endowed, then the risk of developing the disease in the baby will be 50%. If only one is sick, then the percentage drops to 25%. If both parents do not suffer from this pathology, then the risk of the disease is 10%.

The risk of illness increases significantly if a child from early childhood is constantly in an environment contaminated with allergens. Malnutrition and viral diseases also lead to the disease.

Causes of hay fever

The disease progresses when the body is overly sensitive to the action of a small stimulus. The irritant is pollen from wind-pollinated plants. To enter the human body, one inhalation or the deposition of small particles on the conjunctiva, nasal mucosa or oral cavity is enough.
The reason for the active action of pollen is permeability factors that facilitate the entry of microscopic elements into the epithelium.
After the onset of the local acute inflammatory process, soluble allergic particles are quickly absorbed into the blood and various parts of the body. They cling very strongly to cells and stimulate the release of histamine.
The result is a reaction in the form of spasms of smooth muscles, swelling of the mucous membrane, and difficulty breathing.
After contact with the irritant, literally 20 minutes pass, after which the allergic reaction begins to progress. In case of weakened immunity, allergies begin to appear in different parts of the body.
Plants to which pollen is most often allergic:

1. Trees at the time of flowering such as poplar, alder, willow, maple, birch.
2. Trees during leaf fall.
3. Meadow and cereal grasses.
4. Flowers such as buttercups, asters, lilies of the valley.
5. Weeds.

An allergic reaction may begin to occur when eating such plant products, which contain antigens with pollen. But Dr. Komarovsky believes that if the immune system is strong, then no allergies or hay fever will be scary.

Symptoms of hay fever

Signs of the disease appear at the same time every year. The main symptoms are:

• itching in the nose, ears and throat;
• the appearance of discomfort in the eyes such as itching, lacrimation, photophobia;
• itching in the genitals;
• rhinitis with discharge of a fair amount of mucus;
• increased fatigue.

Later, the following signs begin to appear:

• increased body temperature;
• difficulty breathing;
• the appearance of urticaria on the epidermis;
• symptoms of cystitis.

A dry paroxysmal cough appears. With hay fever, this phenomenon is associated with irritation of the respiratory tract.
When the first signs appear, you must urgently contact a specialist to avoid undesirable consequences.

Diagnosis of hay fever

A patient with these symptoms should be examined by a specialist. This is done by an otolaryngologist. When examining the nose, ear canals and oral cavity, the doctor must exclude ARVI. After this, a diagnosis of hay fever is made. Only after examination by an ENT specialist does the patient undergo testing venous blood on the level of immunoglobulin. Next, the patient goes directly to the allergist.


In the cold season, after the symptoms disappear, the doctor will be able to do allergy tests. Such tests will help determine which product a person is experiencing such a reaction to. Samples include:

• small notches are made on the forearms;
• diluted allergen is dripped onto each notch;
• an allergen that provokes bright and prolonged redness is the cause of the disease.

After identifying the allergen, the doctor prescribes an effective treatment for the disease.

Treatment of hay fever

At first treatment pathological condition takes place throughout the year:

• in warm weather, patients take measures to eliminate symptoms;
• during the cold period, the irritant is determined.

Only then is it possible to keep hay fever under control. After a couple of years, you can reach the minimum amount of funds used. To reduce symptoms you need to:

• change your lifestyle;
• stick to a diet;
• take medications against illness.

Lifestyle adjustments

At the time of exacerbation, the patient must be protected from pollen. During the warm season it is recommended:

• rinse your nose and oral cavity using sodium chloride solution;
• shower constantly;
• regularly perform wet cleaning;
• ventilate the room at night;
• do not leave the house during the hot period of the day;
• do not travel during flowering to places where there are many irritants;
• the air should always be slightly humid.

During the cold period, you do not need to take pills for hay fever. It is important to simply strengthen your immune system. To do this you need:

• give up bad habits;
• do hardening;
• exercise.

Diet

Diet for hay fever consists of eliminating foods containing allergens from the diet. At the time of exacerbation, it is necessary to exclude cow's milk, seafood, bee products, chocolate, and citrus fruits from the diet. It is also worth avoiding those foods that may cause cross-allergies. You should exclude beer, bananas, melon, potatoes, watermelon, margarine, apricots, red apples and much more.

Drug treatment

The main drugs in the treatment of the disease are those that block the release of histamine from immune cells. During the period of acute allergies, tablets are indicated:

• Tavegil;
• Suprastin;
• Diazolin.

Third generation medications may also be prescribed:

• Erius;
• Cetirizine;
• Loratadine.

Antihistamines for this pathology must be taken in a whole course. They provide excellent relief from symptoms.
During pregnancy, it is extremely difficult to treat this disease. All medications are contraindicated for use. It would be optimal for a pregnant woman to change her place of residence.

Symptomatic treatment

This is a therapy that is prescribed depending on the symptoms that appear:

1. For difficult nasal breathing, vasoconstricting medications are indicated: Nazol, NOC-Spray, Lazolvan-rino.
2. In case of symptoms of bronchial asthma, Singulair and Acolat are prescribed.
3. For watery eyes, Ketotifen eye drops are prescribed.

Homeopathic treatment

Official medicine does not approve of the treatment of this pathology using homeopathy. This is extremely dangerous and self-medication is not recommended. It is only possible to turn to experienced homeopaths.
You can use certain homeopathic medicines that can alleviate the patient's condition. A positive result is shown by:

• Cinnabsin;
• Sinupret;
• Nux vomica.

Treatment in children

If hay fever is diagnosed, treatment in children is carried out using the same methods as in adults:

1. Walks should be in places where there are not many flowering plants.
2. Do wet cleaning daily, hang moistened gauze on the window.
3. In spring, summer and autumn, take a bath after each walk, but do not use herbal decoctions.
4. Follow a strict diet, just like adults. If you are ill, you should not add new dishes to your diet.
5. At drug treatment listen to all doctor's recommendations. Not all drugs can be used for therapy in children.
6. After a walk, be sure to rinse your nose with saline solution.
7. Do not use homeopathic medicines.
8. ASIT can be used in children from 5 years of age.

Prevention of hay fever

Doctors offer several preventive measures that will help prevent the disease. Prevention methods are as follows:

1. Primary. Warn negative reactions and eliminate harmful factors. It is necessary to harden the body, eat right, and succumb to physical activity.
2. Secondary. It is important to reduce negative symptoms and prevent their manifestation. It is necessary to undergo a timely course of therapy.

The causes of hay fever, what it is, and the symptoms of the disease are known, so it is important to consult a doctor in a timely manner to get help. You should not resort to self-medication, as the consequences may be undesirable. Treat traditional methods is possible only after preliminary consultation with a specialist.

Published November 13, 2017Updated October 01, 2019

Definition of disease. Causes of the disease

Hay fever (hay fever) is a seasonal disease that is caused by increased sensitivity to pollen from various plants.

The main manifestations of hay fever are inflammation of the mucous membranes, mainly of the respiratory tract and eyes, associated with the flowering period of certain plants. Theoretically, an allergic reaction can exist to the pollen of any plant, but, as a rule, it is provoked by the pollen of wind-pollinated plants. There are several thousand common plant species on Earth, and only about 50 of them produce allergenic pollen. Plants with bright colors and a pleasant smell rarely cause allergies.

Today, the percentage of the world's population suffering from hay fever varies from 0.2% to 39%. The incidence of hay fever throughout the world doubles every 10 years; people aged 10 to 40 years are more often affected. Seasonal allergic rhinitis is very common in adolescence. According to international studies, it affects 40% of young people in the United States. As a rule, it begins at the age of 8-11 years. Boys get sick more often in childhood than girls, but by adulthood the incidence rates level out between the sexes.

The prevalence of hay fever is influenced by a number of factors:

• natural and climatic conditions (the prevalence of hay fever is much higher in the southern regions);
• the prevalence of certain plant species and the degree of their allergenic activity;
• environmental conditions (urban residents get sick 6 times more often).

Pollen is the male reproductive cells of plants, which are represented by many pollen grains, having features that can be distinguished by an experienced eye by examining the pollen under a microscope (various configurations, sizes, spines, ridges, ridges, pores), specific to specific plant species. The diameter of pollen grains of allergenic plants averages from 20 to 60 microns.

Taking into account the concentration of pollen in the air is called pollen monitoring; it is carried out in many large cities of Russia, and the data is posted on the website in the public domain.

Among the most common plants, birch pollen has the most pronounced allergenic activity. And it is not at all necessary to be in a forest or park for symptoms to occur. The fine pollen of this tree is scattered over tens of kilometers.

Pollen from allergenic representatives of cereal grasses has a diameter of 20-25 microns.

The most allergenic cereals in Russia:

• Timothy grass;
• cocksfoot;
• meadow fescue;
• meadow bluegrass (this inconspicuous grass with “spikelets” grows on almost any natural lawn).

Weeds are also wind-pollinated, and their pollen is carried over long distances. These include Asteraceae:

• ambrosia;
• chamomile (wormwood);
• goosefoot (white pigweed, tumbleweed);
• quinoa.

Pollen from wormwood and ragweed has the most pronounced allergenic activity.

The wormwood pollen allergen can cause cross-reactions (reactions to other allergens with a similar structure) with allergens of ragweed, sunflower, dandelion, coltsfoot, and birch pollen.

In central Russia, plant dusting occurs during three main periods:

A competent interview with an allergist-immunologist can significantly narrow the list of planned laboratory research. In European countries, diagnosis is somewhat more difficult, because dusting of different plants occurs almost simultaneously.

The common opinion of patients about the existence of an allergy to poplar fluff is not entirely correct, since the period of formation of this fluff coincides with the period of maximum concentrations of grass pollen, and the fluff is only a carrier of these pollen grains, as if wrapping them around itself, and transports them, being itself only a mechanical stimulus.

If you notice similar symptoms, consult your doctor. Do not self-medicate - it is dangerous for your health!

Symptoms of hay fever

Pollen allergy manifests itself with all signs of inflammation - redness, swelling, itching, copious mucous discharge, as well as:

• itching and redness of the eyes (conjunctiva and sclera);
• lacrimation (the discharge from the conjunctiva of the eyes is initially transparent, and then, due to infection, it can become purulent and thick);
• photophobia;
• a feeling of “sand” in the eyes (both eyes are more often affected, but to varying degrees);
• nasal congestion;
• severe itching in the nose and nasal throat;
• sneezing with the separation of liquid nasal secretions (up to painful attacks; sneezing attacks can alternate with attacks of almost complete nasal congestion; the intensity of rhinitis symptoms at night is usually greater than during the day);
• pain in the ears if the process involves auditory tubes;
• hoarse voice;
• increased sensitivity to irritants: cold, strong odors, road and house dust;
• cough;
• wheezing in chest;
• attacks of suffocation (one of the most severe manifestations of hay fever is bronchial asthma).

More rare symptoms of hay fever:

• skin rash, itching;
• sore throat;
• abdominal pain, heartburn;
• loose stools;
• pain in the heart.

All of the listed complaints, as a rule, are combined with complaints of a general nature (headache, weakness, fatigue, general malaise, dizziness, drowsiness, memory loss, fever, which in some cases is interpreted as manifestations of acute respiratory disease).

Hay fever is characterized by an improvement in the patient's condition on rainy, cloudy, windless days, which does not happen with acute respiratory viral infections and acute respiratory infections.

Pathogenesis of hay fever

The pathogenesis of hay fever is based on an immediate allergic reaction. After the allergen enters the mucous membrane of any organ (most of it settles on the nasal mucosa), antibodies (immunoglobulins E) are produced, which, combining with allergens (plant pollen) upon repeated contact, cause IgE-dependent activation of tissue basophils ( mast cells). As a result, a number of biologically active substances: histamine, leukotrienes, prostaglandins, bradykinins, platelet activating factor.

An allergic inflammatory reaction occurs: mucus production increases, the function of the ciliated epithelium of the respiratory tract decreases. Histamine expands blood vessels, as a result of which it decreases blood pressure. Due to the fact that the arterioles of the brain dilate, the pressure of the cerebrospinal fluid increases and a headache appears. When the concentration of histamine in the blood increases, a rash may appear on the skin, body temperature may rise, and breathing may be difficult due to swelling of the mucous membrane of the respiratory tract and spasm of smooth muscles. Noted rapid heartbeat(tachycardia), increased salivation, etc. This action of histamine explains a significant part of the general symptoms of hay fever.

Classification and stages of development of hay fever

There is no generally accepted classification of hay fever today. Based on the severity of symptoms and their impact on the quality of life of patients, there are 3 types of hay fever:

Complications of hay fever

Untimely diagnosis and treatment of the rhinoconjunctival form of hay fever (when only the structures of the nose and eyes are involved) can lead to or worsen the course of an existing one. Complications include hearing impairment, proliferation of the nasal mucosa (formation of polyps), which may subsequently require surgical intervention.

Long-lasting swelling of the mucous membrane of the nasal passages and constant breathing through the mouth in a small child can lead to a characteristic facial expression with a raised expression. upper lip and the formation of malocclusion in the future. Impaired nasal breathing significantly reduces the attention of children and can lead to a decrease in school performance.

Diagnosis of hay fever

Today, many research methods are known for diagnosing hay fever. They are all complementary; it is difficult to focus on one parameter or one deviation from the norm during examination.

The most basic and most important is history taking: detailed questioning of the patient about the symptoms, their severity, duration, previously taken medications for this issue and assessment of their effectiveness, in the patient’s opinion. Frequency of complaints, difference in well-being when changing place of stay, region (for example, a sharp improvement in well-being on a business trip, on vacation). It is clarified whether there are any blood relatives with allergic diseases - this increases the risk of such diseases. Competent questioning allows you to further minimize the financial costs of searching for the causative allergen and do without intermediate tests.

During an external examination, the so-called “classic” symptoms attract attention - “allergic fireworks”, “allergic glasses”, swelling under the eyes, a constantly slightly open mouth, “sniffing” of the nose, redness around the wings of the nose.

Basic laboratory parameters include general analysis blood, where an indirect sign of allergic changes in the human body will be an increase in the level of eosinophils, total immunoglobulin E (igE), or a more modern indicator - eosinophil cationic protein.

Great assistants to the allergist-immunologist are otorhinolaryngologists (ENT doctors) which, upon examination, can clearly describe the amount, nature of nasal secretion, and color of the mucous membrane. The presence of a deviated nasal septum may explain why one half of the patient’s nose breathes worse; nasal polyps are seen by an ENT specialist in most cases without special equipment. The middle ear may show fluid or other signs of Eustachian tube dysfunction. At the discretion of the ENT specialist, an endoscopic examination of the ENT organs (examination using a flexible endoscope) or computed tomography of the paranasal sinuses (a very informative X-ray examination, where the structures of the nose can be viewed “layer by layer”, in sections) is performed.

If there is an eye clinic, a consultation may be required ophthalmologist.

Study of smears and swabs from the nasal cavity allows you to distinguish between allergic and infectious rhinitis. In case of allergy, eosinophilic infiltration is characteristic, while in case of bacterial infection neutrophils are detected. The most informative are smears taken under the control of an endoscope, and not taken “blindly” from the nostril.

For precise definition active allergen is carried out skin testing with a set of pollen allergens, common in the patient’s area of ​​residence. Allergic skin tests performed during a period when contact with pollen is completely absent. It's simple and quick test, but it has limitations and contraindications:

• period of exacerbation of the underlying disease;
• hives or asthma attacks;
• taking antihistamines;
• use of systemic hormones in the treatment (for example, Prednisolone);
• ARVI, influenza, severe diseases of the cardiovascular system, liver, kidneys and other organs;
• pregnancy;
• tuberculosis process at any stage.

A water-salt extract of allergens is applied to the injured skin of the forearm in a certain way (for example, with a scarifier), and after 20 minutes the skin’s reaction to this “provocation” is assessed and conclusions are drawn. Temporary exposure of the allergen to the skin “requires” immobility from the patient (you need to sit quietly), which limits this diagnosis in young children.

Determination of specific immunoglobulins E (igE)

You can diagnose without damaging the skin using a blood test. To do this, the patient only needs to donate blood from a vein. Next, an analysis is carried out in the laboratory (radioisotope, chemiluminescent or enzyme immunoassay)

Molecular allergology -uh that's the one modern method diagnostics of allergic diseases, allows to increase the accuracy of diagnosis and prognosis for allergies and plays an important role in 3 key points:

1. differentiation of true sensitization and cross-reactivity in polysensitized patients (if allergic manifestations are present to several allergens at once);
2. assessing the risk of developing acute systemic reactions instead of weak and local ones food allergies, which reduces the patient’s unreasonable anxiety;
3. identification of causative allergens for allergen-specific immunotherapy (ASIT).

The most common chip technology is the Immuna Solid phase Allergen Chip (ISAC). This is the most comprehensive platform that includes more than 100 allergenic molecules in a single study.

The results of all these tests (skin and laboratory) must be compared with the clinical picture of the disease, since the presence of sensitization to allergens is not necessarily accompanied by clinical manifestations.

Treatment of hay fever

Hay fever is treated in an outpatient setting.

The main types of therapy for hay fever:

1. prevention of contact with an allergen;
2. pharmacotherapy;
3. allergen-specific immunotherapy;
4. patient education.

Preventing contact with allergens

Elimination of allergens reduces the severity of hay fever and the need for drug treatment. Well-known events are:

• moving to another climatic zone during the flowering period of causally significant plants;
• exclusion of cross-reacting foods from the diet;
• carrying out daily wet cleaning;
• the use of special filters, for example, HEPA fine air purification, which retain up to 99.97% of all particles measuring 0.3 microns or more;
• For patients with allergic conjunctivitis, it is not unreasonable to recommend wearing sunglasses for the purpose of mechanical protection as an obstacle when pollen gets on the conjunctiva. In addition, you should stop wearing contact lenses during the flowering period of the “culprit” plant;
• local application of saline solutions to the nasal mucosa leads to dilution and removal of the allergen;
• the use of tear substitutes (drugs such as “artificial tears”) helps moisturize the surface of the eyes and wash out the allergen.

Pharmacotherapy

Volume drug therapy and choice medicines depends on the severity of clinical manifestations and is determined only by a doctor.

The list of drugs for this disease includes:

• Aantihistamines (H1-blockers prevent the release of new portions of histamine and are most effective in preventing immediate allergic reactions). There are I and II generations of these drugs. Injection solutions are available only in the first generation, while in the second generation they are tablets. There are also local drops for the nose and eyes;
• Decongestants (more common name vasoconstrictors ). Provide short-term vasoconstriction and, accordingly, reduce swelling of the mucous membrane. This category of drugs can be used very short-term due to the existing “withdrawal phenomenon” - inflammation and dryness after cessation of therapy. They are ineffective for severe allergic diseases;
• Cromony for the treatment of allergic rhinitis and conjunctivitis. Used topically. Today they are mainly used in pediatrics;
• Topical glucorticosteroids (GKS) can be applied to the nose, eyes and bronchi (in the form of dosed inhalations of aerosol or powder);
• Leukotriene receptor antagonists - a relatively new class of funds. Reduce the severity of allergic inflammation;
• Barrier method used to prevent the “sticking” of allergens to the nasal mucosa;
• Inhalation therapy n It is used in case of involvement of the bronchi in an allergic reaction, with obstruction of the bronchi. Bronchodilators (beta2-agonists) and corticosteroids are used.

Specific immunotherapy (ASIT, SLIT) aims to reduce the specific sensitivity of a particular patient to a specific causative allergen. This is achieved by introducing the allergen, starting with small doses, with a gradual increase. This therapy can be carried out with water-salt allergens, adjuvant allergen vaccines (subcutaneous injections). There are also preparations for sublingual (sublingual) use: drops or tablets that contain a certain dose of the allergen. ASIT of the future is cutaneous methods, moreover, with several allergens at once, but for now both doctors and patients can only dream about this.

Forecast. Prevention

The clinic of allergic conditions should not be underestimated, since over time the symptoms may worsen, and the amount of required drug therapy may increase significantly. It is advisable to prevent the progression of the disease, for example, to prevent the formation of bronchial asthma.

For the purpose of prevention, a number of measures can be recommended for people with hay fever:

• Avoid walking in parks and forests during the flowering period of the “culprit” plant. Upon returning from the street, if possible, take a shower or wash, washing off allergens from your skin and hair. Wear sunglasses to protect your eyes;
• follow an allergenic diet with the exclusion of food products that have a similar allergenic structure to the causative plant (cross-allergy). Definitely give up honey;
• when ventilating the room, you can place a damp cloth (gauze) on the window opening, which will collect pollen grains, but it will need to be rinsed periodically;
• refuse to ventilate on hot days, or do it at night between 3-5 am, when the concentration of pollen in the air is significantly lower;
• install supply ventilation with HEPA filters;
• use air purifiers (available in hardware stores);
• carry out wet cleaning of the living space, minimize “soft” surfaces in the house or apartment (carpets, upholstered furniture, curtains retain allergens, including pollen);
• don't plan surgical interventions or visiting the dentist during the period of active plant dusting;
• refuse treatment with herbal medicines (which contain herbs).

There is the concept of “pre-season prevention”, when the doctor prescribes a number of medications in advance that reduce the severity of clinical manifestations during the flowering period of the allergen plant. In any case, to select a list of required activities, the volume drug therapy and management tactics for each individual patient, it is necessary to seek advice from an allergist-immunologist.

is a complex of seasonal allergic reactions to plant pollen. The disease manifests itself as rhinitis, dermatitis, conjunctivitis, and allergic asthmatic bronchitis. It is characterized by swelling of the mucous membranes of the nose and eyes, nasal congestion, runny nose, sneezing, coughing, suffocation, impaired sense of smell, itching and skin rashes. Without appropriate treatment, it will have a progressive course and may develop into bronchial asthma. Diagnosed using rhinoscopy, allergy tests, and rhinocytogram examination. Treatment - antihistamines, topical corticosteroids, ASIT.

General information

Hay fever (“hay fever”) comes from the Latin word “pollen” – pollen. As a rule, the disease develops in childhood or young adulthood. The disease occurs cyclically, worsens when the allergen appears and goes into remission when it disappears. According to scientists, 10-15% of the world's population suffers from pollen allergies. Most often, hay fever occurs in dry and warm climates, in regions where many species of pollinated plants grow. Most of the patients are young people 10-30 years old living in big cities. Hay fever is observed less frequently in rural residents. Hay fever develops more often in women (in some regions of Russia, every third woman is affected). The incidence rate is influenced by environmental, climatic and geographical factors.

Causes of hay fever

Allergic diseases develop with sensitization (increased sensitivity) to the effects of a certain environmental factor. In case of hay fever, pollen from grasses and trees plays the role of such a factor. Small pollen measuring only 10-50 microns settles on the skin and mucous membranes of the patient, causing a specific reaction in the body.

The period of exacerbation of hay fever coincides with the flowering period of certain trees and grasses. Patients with allergies to hazel, oak, alder and birch pollen experience an exacerbation of hay fever in April and May. In June and July, patients who have developed an allergy to grass pollen (timothy, foxtail, fescue, wheatgrass and bluegrass) suffer. In August and September, symptoms of the disease appear in people with allergies to ragweed, quinoa and wormwood pollen.

The severity of clinical manifestations depends on the weather. In windy, dry weather, the concentration of pollen in the air increases, and the symptoms of hay fever intensify. In rainy, damp weather there is a small amount of pollen in the air, and the manifestations of the disease become less pronounced.

The decisive role in the occurrence of hay fever belongs to hereditary predisposition. If both parents suffer from allergic diseases, the probability of developing allergies in the child is 50%, if one - 25%, if the parents do not have allergic diseases - about 10%. The risk of hay fever increases if a child at an early age is constantly in an environment contaminated with allergens, eats poorly or is often sick viral diseases.

Symptoms of hay fever

Typically, hay fever develops in two stages. At the first stage, transient clinical manifestations of the disease occur. Patients complain of itching in the nose, throat, ears and tracheal area. The patient's eyelids become swollen and hyperemic. Characterized by prolonged bouts of continuous sneezing. Mucous discharge appears from the nose. Allergic conjunctivitis develops, accompanied by photophobia, lacrimation and a feeling of sand in the eyes.

After 6-8 hours from the moment of exposure to the allergen, the next phase of hay fever begins. The inflammatory reaction intensifies. The discharge from the eyes becomes purulent. Hyperthermia is possible. Some patients develop hives or difficulty breathing due to bronchial asthma. In some cases, angioedema, contact or atopic dermatitis, cystitis or inflammation of the external genitalia may develop.

Hay fever can be accompanied by the phenomena of so-called “pollen intoxication” - fatigue, increased irritability, decreased appetite, depression and migraine attacks. If the patient for some reason ingests pollen (for example, with honey), nausea and vomiting may occur, which are accompanied sharp pain in the stomach.

Diagnostics

The diagnosis of hay fever is made on the basis of a characteristic history (seasonality of exacerbations, hereditary predisposition), data from an objective examination by an otolaryngologist and additional studies.

During examination of the nasal cavity (rhinoscopy), swelling of the mucous membrane and narrowing of the nasal passages are revealed. When vasoconstrictors are instilled into the nose, swelling of the mucous membrane persists. The detection of eosinophils when examining prints of the mucous membrane of the eyes and nose confirms the allergic nature of the disease. To identify the specific allergen that caused the development of hay fever, a series of provocative tests and skin allergy tests are performed.

Treatment of hay fever

It is necessary to minimize contact with the allergen. A patient with hay fever is advised to reduce the time spent outside, especially in dry and windy weather. It is not recommended to open windows. You should use special air purifiers designed to capture plant pollen, and exclude certain foods from your diet that can cause cross-allergies. In case of mild hay fever, the patient is prescribed antihistamines (for oral administration - astemizole, fexofenadine, loratadine, locally - levocabastine and azelastine sprays).

A patient suffering from moderate hay fever is recommended to use topical glucocorticosteroids (nasal sprays triamcinolone, fluticasone, mometasone, beclomethasone, etc.). For bronchial asthma, inhaled glucocorticosteroid drugs are used. With concomitant severe viral, bacterial, fungal infections and immune disorders glucocorticosteroids should be used with caution.

In severe hay fever, local glucocorticosteroids are combined with antihistamines general action. If the patient is concerned about severe nasal congestion, it is possible to prescribe vasoconstrictors (naphazoline, xylometazoline, oxymetazoline) for no more than a week. It should be remembered that long-term use of such drugs can lead to the development of drug-induced rhinitis. Severe hay fever combined with narrowing of the nasal passages is an indication for surgical treatment. The operation consists of partial removal of the turbinates and can be performed in various ways, including using a laser and cryodestruction.

The most effective means in the fight against hay fever is allergen-specific immunotherapy. The treatment regimen involves introducing increasing doses of the allergen into the patient's body. As a result of treatment, the patient's body's sensitivity to the allergen decreases. Specific immunotherapy can be carried out simultaneously with taking medications.

Prevention

• If possible, it is worth going to another climate zone during the flowering period.
• Patients are strictly not recommended to travel outside the city during the flowering period.
• It is better to ventilate the room in damp, windless weather. In order to prevent the allergen from entering the apartment, you can hang a dampened thick cloth on the window.
• Patients with hay fever should take a shower after coming in from outside.
• During an exacerbation, it is recommended to wash your eyes and gargle several times a day to remove the allergen.
• After washing, clothes should not be dried outside to avoid pollen settling.

For quotation: Osipova G.L. Hay fever is an allergic seasonal disease // Breast cancer. 2000. No. 3. P. 151

Research Institute of Pulmonology, Ministry of Health of the Russian Federation

Hay fever (from lat. pollen- pollen) is a common allergic disease: the number of patients with hay fever in different countries ranges from 1.6 to 24%, and the incidence of hay fever is growing from year to year. Thus, according to Swiss scientists, the prevalence of hay fever in Switzerland in 1926 was only 1%, in 1958 - 4.4%, in 1985 - 9.6%, in 1993 - 13.5%. The incidence of hay fever is influenced by climatic-geographical, environmental, ethnographic, and diagnostic factors.

Hay fever - seasonal allergic inflammatory disease, caused by plant pollen, manifesting clinically in the form of allergic rhinitis and conjunctivitis and sometimes accompanied by the development of bronchial asthma and other symptoms.

Hay fever is a disease with a genetic predisposition. It is known that allergies develop in 50% of cases if both parents have allergic diseases, in 25% if one of the parents is allergic, and in 12.5% ​​if the parents do not have allergies. In addition to genetic factors, the development of hay fever is also influenced by environmental factors (the presence of high concentrations of allergens in the air at birth and in the first months of life, environmental pollution with pollutants, viral infections etc.) .

In 1819, Bostock first officially reported a case of periodic lesions of the eyes and chest and identified this disease as hay fever, since he considered hay to be the cause of its occurrence. In 1873, Blackley and Wiman first proved that pollen was the cause of the disease. In Russia, the first report of hay fever was made by L. Silich in 1889.

Of the several thousand plant species distributed around the globe, only about 50 produce pollen, which is an allergenic pollen. These are wind-pollinated plants, widespread in this geographical area, the pollen of which is very light and has a round shape with a diameter of 20 to 35 microns. Plants that are brightly colored and have a pleasant smell, and are pollinated by insects, rarely cause allergies. The central zone of the European part of Russia is characterized by 3 seasonal periods of plant flowering(Table 1).

Spring period is the period of dusting of wind-pollinated trees (April - end of May).

Summer period is the period of dusting of cereal grasses (June - end of July).

The summer-autumn period is the period of dusting of weeds (end of July - October).

It should be taken into account that, depending on meteorological conditions, the flowering time of plants may deviate from the calendar by 7-14 days.

Each climatic and geographical zone is characterized by its own pollen allergens and symptoms of pollen allergy usually occur when there are about 50 pollen granules per 1m3 in the air. The concentration of pollen in the air is determined through continuous monitoring.

In the Rostov region, the leading role in the development of hay fever is played by pollen allergens from quinoa, wormwood, sunflower and ryegrass. In the regions of the North Caucasus and Stavropol Territory, the development of the disease is caused by ragweed pollen. IN Saratov region The cause of hay fever is often pollen from goosefoot, hemp, and cyclochena. In Kuzbass, the causes of hay fever are birch, wormwood, and cereals.

Most often, the first symptoms of hay fever appear at a young age (from 8 to 20 years), but the disease can also occur in children early age, and in people of older age groups. The onset of the disease coincides with the flowering period of plants to the pollen of which the patient is allergic; the symptoms of the disease recur annually at the same time.

Exacerbations of hay fever are more often observed in dry, windy weather - during periods of maximum pollen concentration in the air and, conversely, relief of hay fever symptoms is observed in damp, rainy weather, when there is a decrease in the concentration of pollen allergens in the air.

Thus, knowing the flowering calendar individual species plants characteristic of each climatic-geographical zone, it is possible, by comparing the beginning of flowering of certain plants with the onset of the disease, to establish a group of putative pollen allergens to which the patient reacts.

The mechanism of an allergic reaction in hay fever

Hay fever refers to allergic diseases, the basis of the pathogenesis of which is immediate allergic reaction . The plant pollen to which the patient reacts is an allergen for him. Allergens (antigens) that enter the mucosa are “processed” by both Langerhans cells and other antigen-presenting cells and “presented” immunocompetent cells mucous membrane (in case of allergies, these are Th 2 lymphocytes that secrete biologically active regulatory proteins: interleukins 3, 4, 5, 13), resulting in the production of IgE antibodies. IgE antibodies are fixed on high-affinity receptors of mast cells, basophils of the mucous membrane and low-affinity receptors of other cells, such as monocytes, eosinophils, B cells. When the allergen repeatedly enters the mucous membrane, IgE-dependent activation of mast cells in the nasal mucosa occurs, which causes the release of inflammatory mediators: histamine, bradykinin, tryptase, leukotrienes, prostaglandins, etc. The released mediators cause all the symptoms of an allergic disease in a patient suffering from allergies .

Almost all patients experience biphasic allergic reaction, consisting of an immediate type reaction, which begins immediately and as a result of which quickly passing symptoms occur: itching of the nose, itching of the eyelids, sneezing, rhinorrhea, lacrimation, mild congestion of the nasal passages, and a late phase of allergic inflammation, usually occurring after 6-8 hours , in which all the symptoms of hay fever become more severe. The presence of pollen antigens in the air contributes to the continuation of the inflammatory reaction.

As a result of allergic inflammation during hay fever, mucus secretion increases and the function of the ciliated epithelium of the respiratory tract is inhibited. When histamine acts on blood vessels, they expand, leading not only to swelling of the mucous membrane, but also to headaches. When the concentration of histamine in the blood increases, urticaria may appear on the skin, and body temperature may increase; as a result of swelling of the mucous membrane of the respiratory tract, spasm of smooth muscles, difficulty breathing appears. Tachycardia, increased salivation, etc. may also be observed. This nonspecific action of histamine explains a significant part of the general symptoms of hay fever.

Clinical picture

The most common clinical manifestations of hay fever are allergic rhinitis, allergic conjunctivitis and bronchial asthma.

Damage to the nasal mucosa without involvement of the paranasal sinuses is very rare. The patient is bothered by a feeling of itching in the nose, a burning sensation, tickling, repeated paroxysmal sneezing appears, accompanied by copious mucous discharge from the nose and difficulty in nasal breathing, hyperemia and maceration of the skin of the vestibule of the nose. Typically, allergic inflammation spreads to the paranasal sinuses, nasopharynx, auditory tubes, and larynx. Itching appears in the ear canals, pharynx, and trachea.

Eye lesions include itching and irritation of the mucous membranes, itching and redness of the eyelids, swelling, lacrimation, a feeling of pain, photophobia, a feeling of “sand” in the eyes. Bacterial inflammation often occurs and purulent discharge appears.

One of the most severe clinical manifestations of hay fever is bronchial asthma, manifested by coughing, wheezing, heaviness in the chest and difficulty breathing, which are usually reversible.

More rare symptoms of hay fever include urticaria, Quincke's edema, atopic and contact dermatitis etc.

With hay fever, the patient usually develops weakness, fatigue, reduced ability to work and concentration, and increased irritability. Patients complain about headache, sleep disturbance.

Diagnostics

The diagnosis of hay fever is based on a carefully collected medical history, which is characterized by the annual seasonality of the disease and the presence in most cases of a family allergic history.

The examination includes skin and provocative pollen allergen tests which are carried out by an allergist during the period of remission. If necessary, measure content of total immunoglobulin E in blood serum(IgE), the level of which is usually elevated in hay fever.

Conduct rhinoscopy: the patient is determined to have swelling of the nasal mucosa, especially the lower and middle turbinates, narrowing of the nasal passages, which are filled with transparent mucous secretions, their color usually varies from pale pink to bluish. Swelling of the mucous membrane persists even when vasoconstrictor drugs are instilled. However, when an infection occurs, nasal discharge becomes viscous, mucopurulent.

Rhinomanometry allows us to obtain objective evidence of obstruction of the nasal passages when exposed to pollen allergens in patients with hay fever and to monitor the therapy.

During ophthalmological examination bright hyperemia of the conjunctiva is revealed. The discharge from the palpebral fissure is scanty, often colorless, transparent, in the form of lumps or long threads. A cytological examination of prints from the mucous membrane of the nose and conjunctiva of the eyes is carried out, in which in most cases it is found high content eosinophils. A blood test in almost all patients shows an increase in the absolute number of eosinophils.

During X-ray examination Changes in the mucous membranes of the paranasal sinuses are observed in the form of concentric parietal darkening, and in some patients polyps are detected. With a long-term exacerbation of hay fever in a patient, a symmetrical homogeneous darkening of the maxillary sinuses, and less often of the ethmoidal labyrinth and main sinuses, is determined on the radiograph.

Elimination of allergens

To the patient it is necessary to reduce the total antigenic load of pollen allergens : limit your time outdoors in dry, hot weather and in the morning, since the concentration of pollen allergens is highest at this time; use air purifiers that capture pollen indoors; at work and at home, if possible, do not open windows, especially in the early hours and preferably until the early evening; avoid trips to nature, where there is currently a high concentration of pollen allergens; recommend travel to other climatic zones during the flowering period of plants; when planning your next vacation, you need to find out the flowering dates of plants in the area of ​​the resort chosen by the patient; Avoid contact with related plant allergens, food products and herbal medicines (Table 2), since consuming them orally or topically can lead to an exacerbation of hay fever.

Pharmacotherapy

Used in the treatment of hay fever stepwise approach based on the severity of symptoms of the disease .

1st stage - for mild cases of the disease, use only antihistamines (systemic and local), cromoglycate and sodium nedocromil (topically).

2nd stage - for moderate severity, topical glucocorticosteroids are used.

3rd stage - in severe cases, topical glucocorticosteroids and systemic antihistamines are used.

Antihistamines used both locally and systemically. Their mechanism of action is based on preventing the pathological effects of histamine, which is released from mast cells and from basophils during allergic reactions. When patients take antihistamines, symptoms of allergic rhinitis such as itching in the nose, sneezing, rhinorrhea, and nasal congestion are significantly reduced. The drugs are effective for allergic conjunctivitis, urticaria, Quincke's edema and other symptoms of hay fever.

Currently, all antihistamines are usually divided into 2 groups. First generation antihistamines (chloropyramine, clemastine etc.) have a fairly pronounced sedative effect, a short-term therapeutic effect; with long-term use, addiction to the drug is possible. Antihistamines II generation drugs (loratadine, fexofenadine etc.) are characterized by a significantly smaller sedative effect or its absence, the duration of the therapeutic effect is about 24 hours, and the absence of addiction with prolonged use.

The sedative effect characteristic of early antihistamines limits their use, especially in patients whose professional activities require concentration, increased attention, and quick decision-making. In addition, these antihistamines increase the effects of alcohol on the body. Most of them have an antimuscarinic effect, which is clinically manifested by dry mucous membranes and other symptoms. First generation antihistamines are prescribed with caution to patients suffering from epilepsy, prostate hypertrophy, glaucoma, and severe liver damage. Most first generation antihistamines are contraindicated in patients with porphyria.

TO 1st generation antihistamines The following well-known drugs include: chloropyramine, clemastine, diphenhydramine, quinuclidil, ketotifen and others.

Second generation antihistamines have significant advantages over first generation antihistamines. The low ability to penetrate the blood-brain barrier significantly reduces the severity of the sedative effect of new antihistamines, so they can be recommended for vehicle drivers and people working with precision machinery. II generation drugs include: loratadine, fexofenadine, terfenadine, astemizole and others. The drugs differ in the severity of the sedative effect and pharmacokinetics, which determines the specific purpose of each of them.

IN recent years developed for the treatment of allergic rhinitis and allergic conjunctivitis topical antihistamines in the form of nasal and eye sprays, such as acelastine and levocabastine . Local drugs do not have the side effects characteristic of some systemic antihistamines.

With severe nasal congestion, it is sometimes necessary to prescribe vasoconstrictor drugs- a-adrenergic receptor stimulants. However, these drugs are not curative; they only temporarily relieve the symptoms of rhinitis. Duration of treatment vasoconstrictor drops, as a rule, should not exceed 5-7 days due to the risk of developing rhinitis medicamentosa. The most commonly prescribed vasoconstrictor drugs are imidazoline derivatives, such as oxymetazoline, xylometazoline, naphazoline .

Sodium cromoglycate preparations used topically in the form of nasal sprays and drops, eye drops, inhalations. The mechanism of action is the binding of sodium cromoglycate to a special membrane protein, which leads to inhibition of IgE-dependent degranulation of mast cells. Drugs in this group, as a rule, do not cause serious side effects, but in terms of effectiveness they are significantly inferior to topical glucocorticosteroids. Sodium cromoglycate preparations are prescribed several days before the start of pollination of plants, since the maximum effect occurs after a few days (on average 7-12 days).

Glucocorticosteroid drugs

Glucocorticosteroids (GCS) have high anti-inflammatory activity. Depending on the clinical manifestations of hay fever and the severity of symptoms, GCS is prescribed locally in the form of eye drops, sprays, inhalations, as well as orally and parenterally. Topical (local) corticosteroids are most often used.

Topical forms of glucocorticosteroids highly effective and have minimal unwanted effects. They should be prescribed with caution to patients with immunosuppression, severe bacterial, fungal and viral (herpetic) infections.

Topical corticosteroids, when prescribed to patients with allergic rhinitis, have a pronounced therapeutic effect, reducing both nasal congestion and itching, sneezing, and rhinorrhea. Currently, six groups of steroid drugs have been developed for the treatment allergic rhinitis: beclomethasone, budesonide, flunisolide, fluticasone, triamcinolone, mometasone furoate .

Dexamethasone eye drops are usually prescribed for fairly severe allergic conjunctivitis, 1-2 drops every 4-6 hours. long-term use possible increase in intraocular pressure. When purulent discharge appears in patients with seasonal allergic conjunctivitis, it is advisable to prescribe a combination drug garazon . Garazon (betamethasone + gentamicin) - sterile eye and ear drops in a dropper bottle. Prescribe 1-2 drops 2-4 times a day. Long-term use is not recommended to avoid complications (external uveitis and lens perforation). Contraindications: allergy to gentamicin.

Specific immunotherapy

A special place in the treatment of patients with hay fever is occupied by specific immunotherapy (SIT), which, unlike pharmacotherapy, causes changes in the immune system, since its use causes a phenotypic correction of the immune response to a specific allergen. For many years, allergists in different countries of the world have successfully treated allergies with the allergens themselves. This treatment method was first used in 1911 by Noon and Freeman for patients suffering from allergies. They showed that if a patient with a pollen allergy is injected with a grass pollen extract before the flowering season of plants, then such a patient practically does not experience allergy symptoms during the flowering period of the plants to which he reacts.

Currently, many researchers confirm the reliability of these first experiments. This decrease in the body's sensitivity to an allergen is called hyposensitization. When hyposensitization is carried out with allergens that cause allergies in the patient, the immune system begins to produce blocking antibodies (IgG). T lymphocytes program the immune system to stop producing IgE, i.e. the immune system “switches” from one program to another and an allergic reaction does not occur.

SIT with allergens can be performed in different ways: allergens can be administered to the patient subcutaneously (the classic route of allergen administration), under the tongue, or into the nasal passages. There are other ways of introducing the allergen into the patient’s body. The method of introducing the allergen is chosen in each specific case by an allergist. Specific vaccination with allergens is carried out only in allergological offices and allergological departments of a hospital under the supervision of an allergist.

Treatment is usually carried out over 3-5 years. With successful treatment, allergy symptoms practically do not bother the patient for many years. It should be noted that during treatment with allergens, sometimes the patient may experience local and general reactions. The most common local reaction is redness, swelling, itching at the site of allergen injection; sometimes there is a reaction in the form of skin itching, sneezing, nasal discharge, and in some cases, a patient with atopic asthma may experience difficulty breathing. The causes of such complications are an accelerated course of immunotherapy, unstable asthma (therefore, control of asthma symptoms with medications before immunotherapy is necessary); increased sensitivity patient to injected allergens, use of b-blockers in patients.

Immunotherapy and pharmacotherapy can be used in combination.

Patient education

For successful treatment of hay fever, it is necessary to inform the patient about the nature of this disease. Education strategies include understanding the symptoms of hay fever; symptom monitoring; an action plan developed in advance by an allergist; written instructions.

Loratadine -
Clarotadine (trade name)
(AKRIKHIN)