Spot the difference: hay fever vs asthma

Dr Kishor Tewary explains the difference between hay fever and asthma and how to treat the two common problems.

How is hay fever different from asthma?

Both hay fever and asthma are on the spectrum of  atopic conditions, and are usually caused by the release of intrinsic enzymes/factors such as Histamine or Cytokines. Asthma symptoms occur due to the inflammation of upper airways causing a partial obstruction during exhalation, and presents with a typical musical sound called a 'wheeze' and/or difficulty breathing.

Hay fever symptoms occur due to inflammation of nasal mucosa and usually presents with nasal stuffiness, sneezing, runny nose and blocked nose. The eyes can also be affected causing itchiness with occasional redness, watery discharge and swelling around them.

Why do people suffer from hay fever?

Hay fever is usually caused by inflammation of nasal mucosa due to histamine release after being exposed to a trigger such as pollen.

If a child suffers from asthma are they also more likely to suffer from hay fever?

It is usually the other way round. Hay fever and asthma are both atopic conditions, and a person suffering with hay fever may have a predisposition to asthma. However, not everyone with hay fever suffers with Asthma symptoms.

How important is it that they continue their inhaler regime - is there any case for parents asking their GP to assess their inhaler dosage etc over the summer?

Once diagnosed with asthma, it is important to continue with inhalers as prescribed. There are usually 2 types of inhalers prescribed: blue and brown. Blue is a reliever and used 'as and when' a child feels wheezy or breathless.

The brown inhaler is a preventer, and once started should be continued every day as prescribed unless the doctor has reviewed the condition and decided to stop it.

It is quite common for people to experience a worsening of their asthma symptons due to seasonal triggers i.e. pollens, grass.

Once diagnosed doctors are supposed to provide an 'asthma treatment plan' to address these exacerbations and explain the ways to titrate the dose of inhalers. If provided with a treatment plan, people can titrate their inhalers themselves as per plan prescribed. However, if the symptoms are not settling, getting worse, or if the patient has not been provided with a treatment plan, they should seek an opinion from their doctor.  

Can hay fever go on to spark an asthma attack?

As both hay fever and asthma are on the spectrum of atopic conditions, a child suffering with hay fever may have a predisposition for asthma. However not every child with hay fever ends up having asthma symptoms..

What precautions can you take to protect your child from the effects of hay fever?

Avoidance of triggering factors such as exposure to grass and pollen can often help. However, it can be extremely difficult and damaging to a child's day to day life to implement this.

The general precautions recommended to alleviate symptoms are to avoid high pollen count areas/weather, to shake and wash clothes after coming inside from being outdoors, keeping windows closed, drying the clothes inside or in a dryer, and regular showering and cleaning hair and eyes on a daily basis. Often people advise to avoid histamine producing food such as smoked and cooked meat, fish, cheese and nuts and to eat more omega 3 fatty acids though green vegetables, carrots, beans, and fish oil. The evidence around this is variable.

Smoking also affects it adversely, and this should be noted by parents.

Once onset occurs, it is usually treated symptomatically. Many children respond to steroid nasal sprays which reduces inflammation within the nose or antihistamines.

There are also antihistamine nasal sprays available now, as well as non-medicated nasal sprays. Any medication should not be used without the advice from a pharmacist or a doctor.

We often think the problem is hay fever but are there other allergies you should be aware of

Hay fever typically presents with localised symptoms such as nasal congestion, stuffiness, eye irritation in combinations, and has a very seasonal occurrence at certain specific times of the year. Other localised conditions such as allergic conjunctivitis (eyes go red and sore, may have thin serous discharge), or perennial rhinitis (nasal symptoms all year round) can often be confused with hay fever. They are usually isolated and need some specific treatment. Children should be seen by a doctor if symptoms are not settling with normal day-to-day remedies, and/or going worse.

Are there any over-the-counter medicines that can offer good hay fever/allergy relief?

Antihistamine tablets and syrup are available over the counter, as well as non-medicated nasal sprays. However, you should not use these without discussing with the local pharmacist.

Are there any lifestyle changes such as diet or exercise that could ease the problem?

A good and active lifestyle often boosts immunity. Avoidance of histamine-releasing food and taking more carotine and omega 3 fatty acids have been shown to provide some relief, although the evidence is variable.

Are some parents actually missing the signs of asthma thinking there child is simply suffering from hay fever or an allergy?

Asthma often presents with a unique noise while breathing called a 'wheeze'. It is a musical sound often heard during exhalation. The child may have breathlessness in addition. Asthma should not be ruled out if parents think their child is wheezy or having any difficulty with breathing.

We don’t want to wrap our children in cotton wool but should asthmatic children avoid any particular environments during the summer?

Though asthma is most commonly precipitated by viral infections, a proportion of children may experience early onset with exposure to environmental factors such as pollen, grass, tree furs, animal furs etc. While avoidance of these factors often helps in alleviation of symptoms, it is not recommended to restrict a child from playing outside to the extent of affecting their development and socialization. A balance should be achieved by using the above precautions mentioned.

If your child has hay fever and you know they are not asthmatic is there any point taking them to their GP if you think symptoms are more severe than usual?

It is always advisable to see a doctor if symptoms are more severe than usual, or it can be discussed and assessed by a qualified pharmacist and take forward from there.

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