Grass pollen allergy

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A grass pollen allergy , also known as hay fever or allergic rhinitis , is an overreaction of the ( immune system ) to certain grasses. The five most overreacted grasses in Europe are

The grass pollen allergy usually leads to an allergic inflammation of the nasal mucous membrane ( rhinitis ). This is often accompanied by other diseases of the respiratory tract (comorbidity) such as inflammation of the paranasal sinuses ( sinusitis ) and ( asthma ).

The disease usually begins in early childhood and has impaired quality of life for decades. The health effects concern social life, school performance and work productivity. Depending on the source, the proportion of sick children and adolescents is put at 15 to over 30 percent. Cross allergies also play a major role in adulthood.

Pollen calendar

root cause

Hypersensitivity of the human body to certain substances is seen as the cause of the allergic reaction. Even if hereditary predisposition often plays a role, this does not mean that children of allergy sufferers also develop allergies. The modern living conditions of people are also discussed as triggers for allergies. The immune system of the affected person falsely reacts to the usually harmless pollen like a pathogen. In order to protect the body from this pathogen, it forms antibodies and sensitizes the body to grass pollen. Upon renewed contact, the person's immune system reacts immediately to the allergen and releases various messenger substances. One of the most important messenger substances is histamine. This reaction is also known colloquially as hay fever. In contrast to other allergic diseases of the respiratory tract, hay fever occurs only during the times when the offending pollen is flying.

Symptoms

A grass pollen allergy can manifest itself in different ways. Hay fever is often mistaken for a cold, as the signs are sometimes very similar. Typical symptoms that indicate a grass pollen allergy can be

In the area of ​​the eyes:

  • watery eyes
  • Burning eyes
  • itchy eyes up to conjunctivitis

In the area of ​​the nose:

  • irritated, itchy nose
  • pronounced fits of sneezing
  • runny, stuffy nose
  • parched nasal mucosa

In the throat / pharynx / lungs:

  • sore throat
  • Sore throat
  • Throat irritation
  • severe asthmatic attacks and / or shortness of breath.

These symptoms are very similar to those of a cold. In contrast to a cold, the symptoms of a grass pollen allergy appear much faster after contact with the respective allergen and only during the time that the causative allergen is in the air.

therapy

The treatment of allergic rhinitis has three main aspects: the waiting (avoidance of the allergen), pharmacotherapy (treatment of symptoms associated with acute effective drugs) and specific immunotherapy (long-term elimination of allergic reaction). It seems to be advantageous to intervene in the disease process as early as possible, because this avoids re-sensitization and prevents the development of asthma. Although allergic rhinitis is a chronic disease, its course can be stopped and often even cured with adequate (adapted) therapy. However, only a fraction of those affected are under medical treatment, and there is often an astonishing ignorance on the part of doctors about the meaning and treatment of allergic rhinitis.

Acupuncture also has a certain positive effect on allergic rhinitis - even if it is still unclear how positive the effect can really be classified. The symptoms and the need for medication have been significantly reduced by acupuncture, but the potency is classified as very low. The improvement in symptoms could also be due to a placebo effect.

Parental leave

Avoidance of allergens is the avoidance of allergy-causing substances. With some substances such as animal hair this is relatively easy, contact with cats or dogs can usually be avoided, but the situation is different with allergies to grass pollen. Since these can be carried through the air and thus inhaled almost all year round, it is hardly possible to avoid them. Contrary to previous beliefs that rain cleans the air, the concentration of allergenic particles in the air can even be greatly increased after a thunderstorm or rain shower. When it comes into contact with rainwater, the pollen releases countless starch and protein particles.

Pharmacotherapy

  • Cromones such as cromoglicic acid are available as locally (locally) effective therapeutic agents , but these are weaker than antihistamines and glucocorticoids ( cortisone ). These drugs stabilize the mast cells, but the onset of action is delayed, so that Cromone must be used a week before the first pollen flight in the event of a pollen allergy.
  • Antihistamines prevent the symptom-causing effects of histamine . They can be applied (introduced) locally as a nasal spray (such as levocabastine ) or systemically (for internal use) in tablet form such as levocetirizine , loratadine or fexofenadine . Modern antihistamines do not have a sedative (tiring) effect like antihistamines of the first generation, so that they are to be preferred to older substances, especially in children. The antihistamines block the peripheral histamine H 1 receptors ; thus they suppress the effects of histamine.
  • Topical glucocorticoids (cortisone) such as flunisolide , budesonide , mometasone and fluticasone are probably the most effective drugs for treating allergic rhinitis. They suppress all nasal symptoms, especially obstruction (constipation), which is hardly influenced by antihistamines. However, the conjunctivitis (inflammation of the conjunctiva of the eye) is not affected, which is why the simultaneous administration of a topical corticosteroid and an antihistamine can be useful. The topical (externally applied) glucocorticoids do not suppress the function of the adrenal cortex , so the side effects of (systemically acting) cortisone are not to be feared. Treatment can also be regular, with children receiving corticosteroids with low systemic bioavailability, such as fluticasone or mometasone. Systemic corticosteroids can be useful at the beginning of treatment, but should only be given for a limited time, as otherwise side effects such as diabetes mellitus can occur.
  • Nasal sympathomimetics (nasal spray / drops to decongest the nasal mucosa) remove the obstruction, but leave the other symptoms unaffected. However, they should only be used for a short period of time because they in turn can lead to rhinitis (inflammation of the nasal mucous membrane - rhinitis medicamentosa).
  • Some of medicinal plants derived products find application for the treatment of symptoms, both in herbal medicine and in homeopathy . However, the effectiveness of homeopathic preparations could not be proven . The following are used, for example:

Specific immunotherapy (SIT)

In the case of grass pollen allergy, only the specific immunotherapy, the so-called desensitization, has a permanent and causal effect. The body receives the allergen that causes the defense reaction in an increasing dose and can get used to it over time. Over time, the allergen is no longer classified as a danger to the human body.

There are different forms of therapy:

  • Subcutaneous immunotherapy (SCIT) - the allergens are injected subcutaneously under the skinby a specialist doctor ( allergist ) as thedose increases. The dose is increased at the beginning and the therapy is continued at regular intervals (4–6 weeks) after the maintenance dose has been reached, so that the immune system can get used to the allergen and the formation of antibodies can be regulated.
  • Sublingual immunotherapy (SLIT) - the allergens are administered via drops or orodispersible tablets that aredripped or placedunder the tongue ( sublingual ), from where they are absorbed through the oral mucosa. In contrast to SCIT, the allergens must be taken daily. The duration of treatment is similar to that of subcutaneous therapy, three years. Initially, the allergen dose is increased to the maintenance dose within a few days. After taking it for the first time under medical supervision, it can be carried out independently at home. Visits to the doctor are therefore required somewhat less often than with therapy with syringes. The advantage is that it is easy to take at home. The evidence on the clinical effectiveness of the tablets, which are currently only available for grass pollen allergy sufferers ( allergy immune tablets (AIT) , also known as "grass tablets" or "grass tablets") is clearly superior to that of the drops. Furthermore, tablets are explicitly approved for children from 5 years of age.

Sources and individual references

  1. ↑ Mikhail Sofiev, Karl-Christian Bergmann: Allergenic Pollen: A Review of the Production, Release, Distribution and Health Impacts . Springer Science & Business Media, September 23, 2012, ISBN 978-94-007-4880-4 , p. 193.

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