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Hay Fever
A recent study from Japan has highlighted the
importance of starting preventative treatment for
seasonal allergic rhinitis (hay fever) and allergic
conjunctivitis well before the pollen season starts.
The elegant study evaluated the effectiveness off
pre-seasonal topical olopatadine (anti-histamine eye
drops) in reducing the clinical features of seasonal
allergic conjunctivitis (SAC).
Adult patients with previously diagnosed SAC
received pre-seasonal treatment in one eye only for
at least two months before the onset of their
symptoms, at which point they used the treatment in
both eyes. Symptoms in the eyes that received
pre-seasonal treatment were much less than in the
eyes not so treated, and this discrepancy continued
for four weeks after both eyes were treated. The
implication is therefore to start hay fever and SAC
therapy well in advance of symptoms, and I would
suggest starting whatever therapies worked in
previous years for your hay fever or SAC at least
two months before the time your symptoms usually
begin, and continuing your treatments every day
until 2-4 weeks after your symptoms usually get
better at the end of the season.
An editorial in a prestigious American journal
agrees after an expert panel reviewed all the
evidence and current guidelines. If you suffer from
hay fever with or without allergic conjunctivitis
(itchy sore eyes), use regular daily antihistamine
tablets (the non-sedating ones) or regular nasal
steroid sprays; if control is poor, use both. Start
before “your” season and continue 2-4 weeks after it
usually finishes. If control is still poor, talk to
your doctor about additional therapies and advice
which may include allergy testing.
- Pre-seasonal Treatment with Topical
Olopatidine Suppresses the Clinical Symptoms of
Seasonal Allergic Conjunctivitis. Am J Ophth
January 2011
- Suggested updated approaches to patient
management. Ann All Asthma Immunol 2011
Food Allergy in Children
There has been a huge increase in the occurrence of
food allergy in children in the UK over the last 20
years and about 1 in 20 children are now affected.
The NHS has published new NICE guidelines on the
diagnosis and assessment of food allergies in
children. The evidence-based guidelines are
concerned with children who present with severe or
recurrent asthma, eczema, anaphylaxis, urticaria
(hives), rhinitis, gastro-intestinal symptoms and
oral allergy syndrome (tingling and swelling of the
mouth and face after eating certain foods).
Food allergy should be considered if a child has
multiple symptoms affecting more than just the lungs
or just the skin. The guidelines acknowledge that
allergy services are few and far between, but
recommend referral to a GP with special interest, or
a specialist clinic for a full assessment and
possible skin prick or blood tests.
Some types of allergy do not have specific or
reliable tests, and excluding certain foods may be
needed – but this should not be considered unless on
the advice of experienced doctors and usually
specialist dietician advice is needed as well.
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