HAY FEVER

MOST PEOPLE LOVE spring and summer - the sight of pink blossoms, the sound of birdsong, the scent of fresh-mown grass. But those who suffer from hay fever think of spring and summer as Big Sneeze Seasons - the sight of used tissues, the sound of sniffling and blowing, the distress of watery, itchy eyes. Such allergy symptoms plague some people year-round; doctors call this phenomenon perennial allergic rhinitis.
Hay fever has become more common worldwide than ever before, particularly among children and young adults. Among all ages, one in five people now gets hay fever.

DRUG TREATMENT

Traditional Antihistamines
Diphenhydramine, brompheniramine, clemastine, chlorpheniramine, others (many trade names). Function: block the action of histamine, a chemical released during allergic reactions, thereby relieving symptoms such as itching, sneezing and mucus production. Side effects: sedation, dizziness, dry mouth, nose and throat; less commonly agitation, irritability, nightmlares, weakness, fatigue; for antihistamines used as nasal sprays, bitter taste, nose irritation, increased secretions.

Non-Sedating Antihistamines
Acrivastine (Sensprex, Benadryl Allergy Relief), fexofenadine hydrochloride (Telfast), cetirizine (Zirtek), loratadine (Clarityn).
Function: block the action of histamine; these new drugs also fight inflammation. Side effects: dry mouth, nose and throat.

Oral Decongestants
Phenylpropanolamine (in combination remedies Contac, Day Nurse, many others), phenylephrine, pseudoephedrine (Sudafed, combination drugs). Function: relieve stuffiness (but no other allergy symptoms) by constricting the small blood vessels in the respiratory mucous membranes. Side effects: nervousness, irritability, insomnia, suppressed appetite, heart palpitations, rapid heart rate.

Nasal Decongestants
Phenylephrine (Fenox), oxymetazoline (Afrazine, Dristan, Sudafed,
Vicks Sinex), xylometazoline (Nazo-Mist, Otrivine). Function: relieve stuffiness (but no other allergy symptoms) by constricting the small blood vessels in the respiratory mucous membranes. Side effects: rebound congestion (the return of more stubborn congestion after use is discontinued); risk of dependency and abuse.

Intranasal Corticosteroids
Beclomethasone dipropionate (Beconase), budesonide (Rhinocort Aqua), fluticasone propionate (Flixonase), triamcinolone (Nasacort), mometasone furoate (Nasonex). Function: help control the allergic response to prevent symptoms. Side effects: burning or drying of the nose, sneezing; less commonly nosebleed, sore throat, ulcers in the nose.

Other Drugs
Sodium cromoglicate (Rynacrom). Function: blocks the release of inflammatory chemicals such as histamine when used preventively. Side effects: burning or stinging inside nose, increased sneezing.

Immunotherapy. Also called hyposensitisation, desensitisation injections or allergy shots; involves repeated injections of allergens into the skin. Usually reserved for people whose symptoms don't respond adequately to avoidance and drug therapy.

SALT FOR THE SNEEZES
Here's a simple home remedy for relieving hay fever: wash out your nose with salt water, with or without herbs. To make your own salt solution, add '/2 tea­spoon of salt or bicarbonate of soda to '/, litre of warm, clean water. You can also make a herbal tea and add the salt to that. Good candidates include herbs with astringent and anti-inflammatory action, such as eyebright, and those that act as mucous membrane tonics and antimicrobials, such as Oregon graperoot or goldenseal. Put your solution into one of the following containers: a creamer with a long spout, an eyedropper, or a neti pot (a smal I pot designed for this purpose, available at yoga equipment stores).
To use, turn your head to one side and lower it over the sink. Keeping your forehead slightly higher than your chin, gently pour the solution into your uppermost nostril. The solution will drain out of your other nostril. (Some of it may run down the back of your throat, so don't breathe while you're doing this.) This form of nasal irrigation helps flush out pollens, moulds and other allergens. It also helps thin mucus, making it easier to expel by gently blowing into a tissue.

HERBAL REMEDIES

Stinging Nettle (Urtica dioica)
One study found that nettle may offer some relief to people with hay fever. Of the 69 patients who completed the study, 58 per cent rated the freeze-dried preparation of nettle effective; 48 per cent said it worked as well or better than their conventional medications. Typical dosage: 300 milligrams of freeze-dried nettle in capsules two or three
times per day.

Ephedra (Ephedra sinica)
Also known as ma huang, this herb acts as a decongestant just like its chemically synthesised counterpart, pseudoephedrine. It's available dried in teas, capsules, tablets and liquid extracts. Dosage guidelines for ephedra vary, which is cause for some concern, because overdoses of this herb can cause serious side effects. Abuse of ephedra compounds in combination with caffeine has even caused deaths. Ephedra offers a good example of why herbal dosages are both tricky and controversial: an amount that has little effect on one person may be too much for another whose body size is smaller or whose metabolism is faster.
Typical dosage: 15 to 30 drops of tincture in water up to four times per day; or follow manufacturer's or practitioner's instructions. Caution: do not exceed the recommended dose. May cause high blood pressure, palpitations, nervousness, insomnia, nausea, flushing, appetite loss, headache. Not recommended for people with a history of anorexia, glaucoma, thyroid disease, heart disease, high blood pressure, difficulty urinating because of prostate enlargement or long-term insomnia. Do not use if you are pregnant or in combination with other central nervous system stimulants such as caffeine, theophylline, MAO-inhibiting drugs and amphetamines.

Peppermint (Mentha x piperita)
Inhaling peppermint's volatile oils makes you feel as if you can breathe easier, even when airflow is not actually increasing. One study found that both menthol oil extracted from peppermint and peppermint essential oil have anti­inflammatory effects. The researchers called for clinical trials to see if mint could help relieve such conditions as hay fever and asthma. Until the results are in, go ahead and drink mint tea (steep 1 teaspoon of dried herb in 1/4 litre of hot water for 15 minutes) as needed if it helps your hay fever. You can also use essential oil of peppermint in steam inhalation.

Simply boil a kettle of water, pour it carefully in a heat-resistant bowl, and add three to five drops of the essential oil. Cover your head with a towel. Holding your face at least 30 centimetres away from the steam, breathe deeply through your nose for several minutes. Caution: do not use peppermint internally if you have heartburn or oesophageal reflux.

Liquorice (Glycyrrhiza glabra)
Anti-inflammatory and anti-allergy, liquorice has actions that are similar to cortisone drugs. There are two kinds of liquorice. For hay fever, you want whole liquorice, not the DGL variety. Typical dosage: up to six 400- or 500-milligram capsules per day; or 20 to 30 drops of tincture up to 3 times per day. Caution: do not use liquorice for longer than six weeks. Do not use if you are pregnant or breastfeeding, or have high blood pressure, diabetes, thyroid, kidney, liver or heart disease. If you are already taking corticosteroid allergy medications, consult a doctor before adding liquorice to your treatment regimen.

Feverfew (Chrysanthemum parthenium)
Best known for preventing migraines, feverfew possesses anti­inflammatory properties that may relieve allergies. Although scientific studies have yet to confirm this, many herbalists view feverfew as an anti-allergy herb. You can nibble one to two fresh leaves a day or make them into a tea, but the bitter taste may drive you to using a liquid extract or capsule. Typical dosage: up to three 400-to 500-milligram capsules per day; or 15 to 30 drops of tincture per day. Caution: about 10 per cent of people report mouth ulcers, tongue inflammation or lip swelling. People allergic to other members of the daisy family may be allergic to feverfew. Do not use if you are pregnant.

Garlic (Allium sativum)
This pungent bulb contains the anti-inflammatory substance quercetin, which can help calm the allergic response during hay fever season. Garlic is a potent antibacterial and antiviral agent, too, so it could help ward off sinusitis and make your mucous membranes less of a target for opportunistic cold and flu viruses. Typical dosage: up to three 500- to 600-milligram capsules per day (look for products that deliver a daily dose of 4,000 to 5,000 micrograms of allicin); or just eat one or more fresh, raw garlic cloves per day. Caution: consult your doctor before taking garlic if you have stomach inflammation, take warfarin or other blood thinners, or expect to have surgery soon.

Reishi (Ganoderma lucidum)
This Chinese remedy boasts several healthful effects, including an ability to reduce allergies. Reishi inhibits some of the body chemicals that trigger inflammation, including histamine. In China it is used to treat asthma and other allergic disease. It's available in capsules, tablets, syrups and teas. Typical dosage: up to five 420-milligram capsules per day; or up to three 1,000-milligram tablets up to three times per day.

SUPPLEMENTS FOR PEOPLE WITH HAY FEVER
The following vitamins and other supplements may.help make allergy season a bit more manageable.

· Vitamin C and bioflavonoids. Although antihistamine drugs inhibit histamine after its release, these supplements prevent its formation. Foods rich in the bioflavonoid quercetin include onions, garlic and cayenne peppers. The recommended dose of vitamin C is 2,000 to 3,000 milligrams per day in divided doses; for quercetin, it's 500 milligrams two or three times per day.

· Omega-3 fatty acids. Abundant in flaxseed, flaxseed oil and cold-water fish (salmon, herring, mackerel and others), these acids can affect chemical pathways in the body in a way that eases allergy symptoms. Gamma­linoleic acid, an omega-6 fatty acid contained in evening primrose, borage and blackcurrant seed oils, has a similar effect. On the other hand, the saturated fats found in animal-derived foods tend to increase chemicals that promote inflammation. Some practitioners recommend a dose of up to 1 tablespoon of flaxseed oil per day to ensure adequate omega-3 intake.
But don't cook with flaxseed oil, as heat - even storage at room temperature - causes it to turn rancid.

THE MYTH OF THE STOIC SNEEZER
Hay fever isn't just an annoyance; doctors know that it increases your risk of other diseases. Lingering inflammation of the upper respiratory tract- one of hay fever's typical symptoms - can result in middle-ear infections, sinus infections, allergic conjunctivitis (pink-eye), long-term cough, recurrent nosebleeds and nasal polyps. One study even found a link in women between" year-round hay fever and recurrent vaginal yeast infections. And other allergic conditions, such as asthma and eczema, often go hand in hand with hay fever. So toughing out your hay fever symptoms may not be a good option for your general health.