What happens when you encounter pollen?
Pollen grains settle on the mucous membranes of the nose, eyes and respiratory tract and dissolve in the mucus, releasing proteins. In a person without allergies, the immune system does not react to them. With hay fever, the body has previously developed special antibodies of the IgE class against these proteins, and they sit on the surface of the mast cells of the mucosa, like cocked springs. Contact with pollen triggers the release of histamine and other substances: blood vessels dilate, the mucous membrane swells, glands begin to secrete fluid, and nerve endings become irritated. Outwardly, it looks like a sneezing attack and a watery runny nose, but in essence the body is trying to wash away and sneeze out what it considers dangerous.
- Paroxysmal sneezing - in series several times in a row, often in the morning
- Copious, clear, watery nasal discharge, not thick or green
- Nasal congestion that worsens at night and when lying down
- Itching in the nose, palate, throat and ears is the most characteristic symptom, which almost never occurs with a cold.
- Red, itchy, watery eyes, gritty feeling, eyelid swelling in the morning
- Dry cough, usually at night, sore throat from mucus running down the back wall
- Fatigue, headache, decreased concentration are a consequence of constant congestion and poor sleep
Separately, it is worth mentioning the general condition. Patients with hay fever often describe the season as a “month in the fog”: a stuffy nose forces them to breathe through their mouths, sleep becomes shallow, drowsiness sets in during the day, performance decreases, and schoolchildren’s performance sagging. This is not an exaggeration or suspiciousness, but a natural consequence of chronic inflammation of the mucous membrane and lack of sleep. That is why the phrase “be patient, it’s just an allergy” is inappropriate: the season lasts not two days, but weeks, and the quality of life during this time decreases noticeably.
Dust calendar: three waves of one season
Hay fever almost never lasts the entire warm period in a row. The season breaks up into waves, and based on the time of exacerbation, one can with a high probability guess the culprit even before testing. In the conditions of Uzbekistan, with an early warm spring and a long dry autumn, there are usually three waves, and the boundaries between them are blurred - in some years they overlap.
- Весенняя волна, ориентировочно с конца февраля до мая: пыльца деревьев — чинара, тополь, ясень, вяз, клён, шелковица, орех, а также цветущие сады. Начинается раньше, чем большинство людей ожидает: первые жалобы нередко появляются, когда на улице ещё прохладно.
- Летняя волна, примерно с мая по июль: пыльца злаковых трав — пырей, райграс, мятлик, тимофеевка, а также цветение пшеницы и кукурузы. Это самая тяжёлая волна для многих пациентов, потому что злаки растут буквально везде, включая городские газоны и обочины.
- Осенняя волна, с июля по сентябрь и до первых холодов: сорные травы — полынь, лебеда, амброзия, конопля. Для Ташкента и области полынь имеет особое значение, а её пыльца отличается ещё и широкой перекрёстной реактивностью с пищевыми продуктами.
The practical meaning of the calendar is simple: it turns treatment from a reaction to symptoms into a plan. If a person knows that his wave begins in mid-April, basic therapy begins not when the nose is already running, but one or two weeks before the expected start. Treatment initiated prophylactically works noticeably better than the same medicine prescribed at the peak of inflammation - it is easier to keep the mucous membrane in a calm state than to soothe an already inflamed one. It is worth keeping a short diary: the start and end dates of complaints over two or three years give a more accurate picture than any general tables.
Cross allergy: why does melon make your mouth itch in summer?
Many patients with hay fever notice a strange thing: from a raw apple, cherry or slice of melon, the palate begins to itch, the lips become slightly swollen, and a tingling sensation appears in the mouth. After a few minutes everything goes away on its own. This is oral allergy syndrome - a consequence of the fact that the proteins in pollen and the proteins in some fruits and vegetables are similar in structure, and the immune system confuses them. The reaction is usually limited to the mouth and throat because these proteins are destroyed in the stomach and by heat.
- Tree pollen: apple, pear, cherry, peach, apricot, plum, carrot, celery, nuts, kiwi
- Pollen of cereal grasses: melon, watermelon, tomato, potato, wheat flour, peanuts
- Wormwood pollen: melon, watermelon, celery, carrots, spices, seeds and sunflower oil, citrus fruits, chamomile and other herbal preparations
- Quinoa and ragweed pollen: melon, watermelon, banana, squash, cucumber
An important rule follows from this list: a person with an allergy to wormwood should not be treated with decoctions of chamomile, calendula, coltsfoot, yarrow - they all belong to the same family of Compositae, and instead of relief, you can get an aggravation. The same applies to herbal remedies for coughs and cosmetics with herbal extracts. At the same time, it is usually not necessary to completely exclude fruits and melons: most people tolerate a heat-treated product normally - baked apples, jam, compote do not cause problems, because unstable proteins are destroyed when heated.
How to make a diagnosis
The diagnosis begins not with tests, but with questioning: in which weeks complaints appear, where exactly - in the city, outside the city, indoors or outdoors, what changes after rain, whether there is a reaction to food. A good history narrows down the suspects better than any broad panel. Then they confirm the assumption objectively.
- Кожные пробы прик-тестом: каплю раствора аллергена наносят на кожу предплечья и делают микроукол. Результат виден через 15–20 минут. Метод точный и недорогой, но требует отмены антигистаминных препаратов за несколько дней и не проводится в разгар обострения и при выраженной экземе.
- Анализ крови на специфические IgE к отдельным аллергенам. Подходит, когда кожные пробы невозможны: при обострении, при приёме препаратов, при распространённом поражении кожи, у маленьких детей.
- Молекулярная диагностика по отдельным белкам аллергена. Она помогает понять, к чему именно чувствителен организм — к главному белку растения или к его перекрёстному компоненту, и от этого зависит, будет ли эффективна иммунотерапия.
- Осмотр ЛОР-врача с риноскопией: оценивают состояние слизистой, исключают полипы и искривление перегородки, которые могут быть main причиной заложенности.
- При кашле, ночных пробуждениях и одышке — спирометрия для исключения бронхиальной астмы, даже если приступов удушья не было.
It is useful to understand the difference between sensitization and disease. A positive test only means that the body has antibodies to this allergen. The diagnosis is made when the result coincides with the real clinical picture - that is, the person really feels unwell during the dusting season of this plant. If the test is positive and there are no complaints in the corresponding weeks, there is nothing to treat and nothing needs to be ruled out.
Treatment: relieve symptoms and influence the cause
Therapy for hay fever is developed in stages, depending on the volume of symptoms. The point is for a person to live the season normally: sleep, work, and not give up on the street. For mild cases, one drug is enough; for moderate and severe cases, several are combined, and at the same time they solve the strategic task of reducing sensitivity to the allergen for the future.
- Second-generation antihistamines in tablets are a basic remedy: they relieve sneezing, itching, watery discharge, and have little effect on congestion. Modern ones almost do not cause drowsiness, unlike old ones
- Intranasal glucocorticosteroids are the most effective group for severe congestion and the most effective remedy for moderate rhinitis in general. Requires regular use
- Eye drops with antihistamine or cromone action - for severe conjunctivitis
- Rinsing the nose with saline is a simple and underappreciated measure that mechanically removes settled pollen and reduces the need for medication. Especially useful in the evening, after returning from the street
- Antileukotriene drugs - as prescribed by a doctor, more often when rhinitis is combined with asthma
- Vasoconstrictor drops - only in a short course for a few days, no longer: they do not treat allergies and with prolonged use cause drug dependence of the mucous membrane
A separate and main line is allergen-specific immunotherapy, ASIT. This is the only method that does not act on the symptoms, but on the mechanism of the disease itself: the body is injected with gradually increasing doses of the same allergen over a long period of time, and the immune response to it is rebuilt. The course lasts more than one season, but usually three to five years, the drug is administered sublingually or subcutaneously, and begins outside the dusting season. The effect develops gradually and persists for years after completion of the course. It is equally important that ASIT reduces the likelihood of two things: the addition of bronchial asthma and the expansion of the spectrum of allergies to new plants. That is why it should be discussed not when it is “totally unbearable,” but at an early stage, while sensitivity is limited to one or two allergens.
Life in the season and myths on which time is wasted
It is impossible to completely avoid pollen - it is not a cat that you can not have. But it is quite possible to reduce the dose, and the dose directly affects the severity of symptoms and the amount of medication needed.
- Ventilate in the evening and at night or after rain, rather than in the early morning when pollen concentrations are highest.
- On the window - a damp mesh or gauze, which is regularly moistened; In the car, keep the windows closed and turn on the air recirculation
- Returning from the street, rinse your nose with saline solution, wash, gargle, change clothes; It is better to wash your hair in the evening so as not to sleep with pollen settled on your hair
- Do not dry clothes outside during high season - they act as pollen traps
- Sunglasses significantly reduce eye symptoms; during difficult weeks it is better to replace contact lenses with glasses
- Plan trips out of town and gardening for days after rain, rather than during dry, windy weather.
- Do not smoke indoors or be in smoky places: tobacco smoke increases inflammation of the mucous membranes and makes the course more severe.
Now about what doesn't work. The advice to treat allergies with honey is based on a misunderstanding. The pollen that causes hay fever comes from wind-pollinated plants: it is light, dry, and flies through the air for kilometers. Bees collect pollen from completely different, insect-pollinated plants - heavy and sticky, which does not spread through the air and does not get into the nose. Therefore, honey cannot “accustom” the body to the allergen that causes symptoms. But honey itself is a complex product with an admixture of pollen and proteins, and in people with allergies, especially to wormwood and other Asteraceae, it sometimes causes its own reaction, even severe. Herbal remedies and “cleanses” are also pointless and risky: with pollen allergies, herbs are exactly the same class of allergens, only taken orally.