Acupuncture, hay fever and allergic rhinitis

We feel a sense of excitement in early spring as blossom appears on the trees, then throughout the year plants spring forth into life and flowers open. Grass grows, lawns are mown. But this time for many also signals the start of seasonal hay fever.

Hay fever affects approximately 2 in 10 people in the UK and is caused by an allergy to pollen which is the fine powder that plants, grass, flowers and trees produce for fertilisation. Hay fever usually develops in childhood and gets milder or can disappear in some cases as we get older. It also tends to run in families and is more common if you have atopic conditions such as asthma and eczema.

Symptoms of hay fever vary from person to person and in severity. Commonly you may experience a runny, itchy or blocked nose, sneezing, watery itchy eyes, and itchy throat. These symptoms occur when your immune system reacts to the pollen and the cells in the lining of your eyes and nose produce histamine. This causes inflammation of the nose (rhinitis) or eyes (conjunctivitis) or sinuses (sinusitis). Some people also experience headaches, face pain, and loss of smell. People with asthma may find that pollen triggers their asthma symptoms e.g. coughing, wheezing, or shortness of breath, and require regular asthma medication during the hay fever seasons.

What can I do to avoid pollen?

As we go about our usual daily life it is hard to avoid pollen but some things that may help include:

• Check out the pollen count (number of pollen grains per cubic metre of air) by following the weather forecast on the TV, radio, or social media. The higher the pollen count the higher your exposure to pollen might be that day and you might plan outside activities on lower pollen count days if possible.
• Keep your house windows shut. Keep your car windows shut and look at pollen HEPA filters for your car’s air vents. Service your car’s air-conditioning.
• Stay indoors when the pollen count is high.
• Avoid cutting your lawn. Go lawn-free in your garden with gravel, paving, bark, ponds and vegetables.
• Wear wrap-around sunglasses.
• Drying closes inside rather than line-drying outside.
• Changing clothes regularly and shower to wash the pollen off after being outside.
• Pet hair can trap pollen. You may want to consider what pets you chose and where you keep them.
• Putting a thin layer of Vaseline inside the nostrils to trap the pollen may help.

Drug-free treatments

Acupuncture

Acupuncture dates back about 2000 years in China and has been used around the world for centuries. Contemporary practice in the UK varies but there are two main approaches; Western Medical Acupuncture and Traditional Chinese Acupuncture. Each practitioner can vary in their approach.   

Western Medical Acupuncture is where orthodox clinical diagnosis is carried before choosing acupuncture points based on neurophysiological principles. Needles are inserted in acupuncture points, tender points or trigger points. Segmental acupuncture, when needles are inserted along the spine where the nerves branch out to an affected area, can be used to enhance the effect or when you are unable to use local points e.g. scaring, mobility problems accessing areas, or for visceral conditions.

Many people find acupuncture reduces or relieves symptoms of hay fever including allergic rhinitis. They are often drawn to a drug-free approach or when conventional treatments have not been effective. However, both options can work well together. Acupuncture points commonly used include those on the face, forehead, head, and hands along with points on the arms and legs. Segmental acupuncture points along the spine may also be used.

Symptom response to acupuncture is variable between individuals. For those who find it effective, some notice an improvement with a few weeks and some benefit from a longer course. It may help to start the course of treatment before the hay fever season begins.

Diet

It may help to eat foods high in natural antihistamines and low in histamines. Try reducing or avoiding foods that derive from grass pollens such as wheat, grasses, milk, and also red meat, caffeine, alcohol, and fermented foods to see if hay fever symptoms improve. However, not all people react the same with certain foods. The Swiss Interest Group Histamine Intolerance SIGHI has developed a Food Compatibility List which grades foods from 0-3 with lactose, gluten and histamine and a Histamine Elimination Diet.

Drug treatments

• Antihistamines
  • First-generation/sedating antihistamines e.g. alimemazine, chlorphenamine, clemastine, cyproheptadine, hydroxyzine, ketotifen, and promethazine. These may cause drowsiness and affect driving but  may help if symptoms are disturbing your sleep.
  • Second-generation/non-sedating antihistamines e.g. acrivastine, cetirizine, desloratadine, fexofenadine, levocetirizine, loratadine, and mizolastine. These may still have some sedating effects.
• Antihistamine nasal sprays – These can work quickly to relieve symptoms but can also be used regularly to keep symptoms at bay e.g. beclomethasone, betamethasone, budesonide, fluticasone, mometasone, and triamcinolone. Sometimes sodium cromoglycate, ipratropium bromide, or decongestant nasal sprays are used.
• Eye drops
  • Antihistamine eyedrops e.g. antazoline, azelastine, and epinastine
  • Anti-inflammatory eyedrops e.g. diclofenac
  • Mast cell stabiliser eyedrops e.g. nedocromil, lodoxamine, and sodium cromoglycate.
• Nasal washouts – These are becoming increasingly popular to wash the pollen out or help with sinusitis. A squeezable bottle with a spout is filled with a saline/salt solution e.g. Neti-pot.
• Other treatments may include steroids or referral for immunotherapy.

Other resources

Allergy UK www.allergyuk.org

British Society for Allergy and Clinical Immunology www.bsaci.org

National Institute for Health and Care Excellence (NICE) 2015 www.cks.nice.org.uk/allergic-rhinitis

NHS www.nhs.uk/conditions/hay-fever/

Swiss Interest Group Histamine Intolerance (SIGHI) https://www.mastzellaktivierung.info/downloads/foodlist/21_FoodList_EN_alphabetic_withCateg.pdf https://www.histaminintoleranz.ch/downloads/SIGHI-Leaflet_HistamineEliminationDiet.pdf