Summer exams are well underway, but hay fever could be having a greater impact on students' results than many of them - and their parents and teachers - think. As the sun hits Greater Manchester, thousands are struggling with pollen allergies, and one leading Manchester allergist has explained just how detrimental it can be on young people.
The Manchester Evening News spoke to Dr Susana Marinho, a Consultant Allergist and Clinical Lead of the Allergy Service at Wythenshawe Hospital. Exactly why people begin to suffer hay fever - is ‘the million dollar question’, she says.
The effect it can have is visible, according to studies on the subject, as not only did students suffer the impact of their symptoms but treatments, rather than helping, can actually adding to the problem. However, there are a few pointers to ways that allergy sufferers can get relief that affect their cognitive performance less.
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Allergies of any kind can show up regardless of age and could happen at any point of exposure to the allergen, says Dr Marinho. Babies, for example, will not develop allergies to pollen until they have been exposed to enough of it.
But we now live in an age of an 'allergy epidemic', according to the consultant. Increased cleanliness and use of antibiotics appear to contribute to the immune system's development of allergies, compared to people who are exposed to infections more frequently.
Another big factor contributing to a pollen allergy is genetics, as people with relatives who have hay fever are more predisposed to suffering with it themselves. "What we do know is that there isn't a single one size fits all kind of explanation," says Dr Marinho.
Hay fever can have huge impacts on people's general health and wellbeing, warns Dr Marinho, meaning it's important to get the right treatment through the difficult summer months. "It affects your cognitive performance," she says.
"It affects your ability to work or learn in school. It affects your ability to sleep. So sometimes you do have days off work as a result of this and some patients have told me 'it's only hay fever, I shouldn't be off work', and maybe employers and colleagues may scrunch their noses and think 'what's that about?', but actually it can be that bad."
And for students sitting their summer exams, be it GCSEs, A-Levels or university tests, the cognitive changes can be severe. "One study done by Samantha Walker in 2007 looked at kids that were sitting that GCSE exams.
"They sit them in the summer, which is exactly the peak of the grass pollen season. But they take their mock exams in the winter. Normally when you sit your mock exam, you're expected in your actual exam to have the same grade or a grade above.
"What the study found, after looking at almost 2,000 students sitting these exams here in the UK, was that they were 40 per cent more likely to drop a grade between their mark in their actual exam if they had hay fever. 70 per cent more likely if they were taking a sedating antihistamine
"That shows you the impact and potential consequences for their future life. Not only did they have the impact due to their symptoms, but then the treatment, rather than helping, is actually adding to that and quite significantly. So you can see how bad this can be."
Lifestyle changes
Dr Marinho is reminding people that there are basic lifestyle changes hay fever sufferers may not have considered which could make a big difference when it comes to their symptoms.
"One treatment is avoiding the allergens, but that's not the most practical thing. Then we have use of medications, and if that isn't enough, we can actually desensitise to the allergens and to the pollen - but that is the last step if the other measures aren't enough. And most patients will not need that.
“There are a number of things you can try - having your windows closed during peak season. When you get home, strip and have a shower so if you're carrying any pollen, you can at least clear that up. Another important one is drying clothes outside - maybe don't do that during the pollen season because they'll be covered in pollen, particularly your bedsheets which you'll then be sleeping on."
There are over-the-counter and prescribed medications, nasal sprays, rinses and hospital treatments, depending on how severe the effects of the allergies are. It's not one single solution that will help, it's a combination of different measures that will do the trick, she says.
"There's nasal filters and some barrier methods," Dr Marinho adds. "I think they can be cosmetically acceptable, and they are a barrier that will stop the pollen from going into your nose.
"This doesn't really help with the eyes if you also have ocular symptoms, the pollen will still get your eyes, but at least it reduces exposure a little bit."
Medications
For medication, antihistamines are the obvious option, but 'absolutely not drowsy ones'. "Some of these are only available on prescription but cetirizine (Piriteze), Benadryl and loratadine (Clarityn) are available over-the-counter," says the consultant.
"For many patients, this isn't enough and that's when you to add a nasal spray and rinsing. Nasal steroids are a key treatment. They also help with ocular symptoms because nose and eyes are connected.
"Lots of patients will think steroids are a problem and they'll have lots of side effects. That's not true. Nasal steroids act on the nose. This is why we want a nasal spray rather than telling patients to take tablets, so that we just use the drug that goes in the organ that we need to treat. It doesn't go anywhere else.
“Pirinase is available over the counter, and there are other options that can be prescribed by GPs."
Nasal sprays can provide relief - and there are some myths about the steroids that need debunking, according to Dr Marinho. "Rinsing with saline is another key treatment and and one that many patients think is not a treatment, why would I bother.
"No one likes putting things up their noses, but it makes a very significant difference and there's very good evidence that if you rinse and clear nose before you use the nasal spray, you get much better results.
"Another thing to highlight about the nasal spray is that, unlike antihistamines, they don't work right away. There's lots of patients who are told to take them and then give up because they don't see any benefits immediately, whereas when you take an antihistamine you tend to see, within minutes, your symptoms improving.
“It’s an anti-inflammatory treatment, you need to give it a week or two before you see symptoms improving. Look down, try and point the nozzle away so it doesn't go to the middle of the nose. Don't sniff hard because sniffing hard just gets it into your throat. Just have a gentle breathe."
Hospital treatment
“If none of this works, it's still not the end of the road. We can desensitise and we can actually give what we call immunotherapy," adds Dr Marinho.
"We'll actually give patients something that they're allergic to, but in a controlled, It has been demonstrated that actually induces tolerance, so that when they're exposed to pollen, or dust mites or animals, they don't react as dramatically.
"None of these treatments, I have to say leads to a complete cure of symptoms. We don't really have that as of yet. But it will help quite significant reducing symptoms - sometimes up to 75 per cent reduction in symptoms and medication needs, to the point that patients will just need the odd antihistamine here and there. But they'll spend our springs and summers much better than they previously have."
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