Edited extracts from the online forum held for one week (April 27-May 3) on www.talkallergy.com in partnership with AAA, NHS Choices and King’s College London Academy

7 year old seems to have hay fever
I suffer with hay fever and thought my daughter had escaped. However, she has various food allergies and seems to be showing the signs of what I think is hay fever. Are there any particular treatments you would recommend I could use for her as I’m keen to avoid dosing her up with all sorts of drowsy stuff? and only really familiar with my own treatments.

Dr Helen Brough advised:
Children with food allergy often develop allergies to inhalant allergens and may develop allergic rhinitis (hayfever) and asthma. This is called the Allergic March as in an atopic child eczema and food allergy may precede asthma/hay-fever.

I would recommend getting testing for inhalant allergens in your daughter and this could be done at your next food allergy appointment if she is already seen for these. However there are also clues in the history as to what she might be allergic to. Seasonal allergens like tree pollen (Feb/March – April/May) and grass pollen (April/May- July /Aug) usually declare themselves at these times of year. Allergens which are present all year round such as house dust mite and pet animals are more difficult to diagnose as there is often no clear seasonality (although house dust mite allergy can be worse in the winter). For pets often the child has symptoms (eyes itching, runny nose) when stroking or in close contact with the pet but this is not always the case.

With regards to treatment in children I would recommend a non-sedating antihistamine such as Cetirizine or Loratadine (both can be bought over the counter) and a steroid nasal spray which has minimal absorption of steroid into the body such as Avamys, Nasonex or Flixonase. Flixonase can be bought over the counter and is licensed from 4 years of age.

Nose runs all the time
I have asthma and I also think I have hay fever – but this has never been diagnosed, I tend to get problems with itchy eyes and throat around April/May time and this is helped by taking antihistamines. The problem I would really like a solution to is my constantly runny nose, I am sniffing all the time.  This does seem to get worse after eating but I have not found a solution.

Dr Joanna Lukawska advised:
Symptoms of runny nose, itchy eyes and throat make allergic cause very likely, April/May would suggest tree pollens.  You also describe runny nose throughout the year, which may or may not be related to common allergens, which persist in our environment regardless of the season such as house dust mite or pet dander. Your perennial symptoms appear slightly different to your seasonal hay fever and the only way to make an accurate diagnosis is to test you (skin prick or blood test). Does your runny nose improve when you take antihistamines? Have you tried topical steroid nasal sprays (you can get these over the counter)? Try using the above, topical steroid spray with or without a daily non drowsy type antihistamine and see if it helps. You could also try nasal douching (washing the nasal passages with saline solution, again several types available over the counter). In due course your family doctor may wish to make a referral to a specialist for testing and treatment if required.

Allergy but to what?
For some time now (a few years)I have had problems with my nose. I go through stages every day, usually morning but not always, where it runs constantly or is blocked in one nostril so I have trouble breathing through my nose and sneeze lots. To start with I thought it was hay fever but then it continued year round. Eventually I went to the doctor last year who said I had an allergy and my nose looked red, angry and inflamed inside. She prescribed me a Beconase nasal spray which helps but as soon as I stop using it all the symptoms come back and I have to start taking it again. I am currently taking it one spray in each nostril once a day. My GP said that because it’s a steroid I must ease myself off it soon but with no improvement unless I am taking it what should I do? I also can’t see what I am allergic to.  It can start in bed, in the car, at work or when I’m outside. I have changed my pillow and duvet to hypoallergenic which hasn’t made any difference.

Dr Joanna Lukawska advised:
The best way to move forward would be for your GP to make a referral to a specialist. I appreciate that depending where you live this may be difficult as there are very few allergy centres. The symptoms of runny, blocked nose and sneezing may well be related to house dust mite allergy. Do you get any eye symptoms associated with your nasal problems? Some people get isolated nasal symptoms, but a lot also get itchy, sore eyes. The diagnosis can be made by skin prick testing or a blood test (looking at specific antibodies in your blood to house dust mite). Hypoallergenic duvet and pillows might also help, but unfortunately our homes are perfect breeding environments for these creatures and they quickly colonise most surfaces such as carpets and curtains as well as beds. Don’t worry about using your steroid nasal spray, unless you get some unpleasant side effects, you can continue (the actual systemic distribution of steroid is very tiny, I presume you are an adult) You can add daily oral antihistamine (there are lots you can get over the counter: Cetirizine, Loratidine etc, better if it is non drowsy of course) Desensitisation oral or injection is also an option, but for this you will need your GP’s referral to Allergy/Immunology services.

Itchy chapped lips
Over the last few days my lips have become very chapped and itchy and a bit swollen. I suffer from hayfever and eczema and take antihistimines all year round. I remember this happening around the same time last year, is there something specific I may be allergic to?

Dr Adam Fox advised:
It’s most likely ‘lip licking’ eczema. Due to your pollen allergy (hayfever) your nose is blocked so you breathe through your mouth. The flow of air over your lips, dries them out and licking them makes it worse. If this makes sense, try to more actively treat the hayfever eg antihistamine or a nasal spray and this will help.

Inheriting environmental allergies
I know that asthma, hay fever, eczema etc are all related but I was just wondering what the chances are of passing on conditions and preventing them from being passed on. My mother has hay fever and allergies to many chemicals, she has very sensitive skin and psoriasis and gets nasty reactions if she uses anything that is harsh. Myself and my siblings have asthma, my brother is also allergic to horse hair and has quite severe hay fever as does my maternal aunt. There is also a history of mild eczema. My father’s side are all allergy free. Is it guaranteed that these will be passed on to future generations or can we do something to prevent it?

Dr Adam Fox replied:
You can pass on ‘atopy’ ie an allergic tendency rather than specific allergies. If both parents have allergies the chance of passing this on is greater. The only thing shown to help is aiming to exclusively breast feed for 4-6 months. What actually happens once you have allergic disease is very much dependent on environmental factors that we do not understand very well.

Chronic Rhinitis
In the past 10 years I’ve developed chronic rhinitis which appears to be gradually getting worse and worse. In the past year or so my symptoms have developed further and I’ve started to suffer from itchy ears, throat, eyes and tongue as well as the sneezing, watering eyes, headaches and a blocked or runny nose that I had initially. It affects me every day of the year. I take anthistamines daily, a nasal spray and vacuum regularly but my symptoms are getting more and more debilitating. What more can I do to relieve my symptoms?

Dr Helen Brough advised
Given the severity of your symptoms I would ask to be referred to an allergy specialist. It is obviously affecting your quality of life. It would be important to determine whether you are allergic to house dust mite. Allergens which are present all year round such as house dust mite are difficult to diagnose without testing as there is often no clear seasonality (although house dust mite allergy can be worse in the winter). House dust mite need high humidity and thus do not survive well at high altitude, thus often the rhinitis symptoms that you describe may resolve when on holiday in the mountains; this can be a good clue. If you were to find out you have house dust mite allergy then you could reduce exposure to house dust mite by buying special mattress, duvet and pillow covers. Also vacuuming with a HEPA filter vacuum and ventilating the room would be useful. However if you are not allergic to house dust mite then it will be quite a costly expense for little benefit. In addition if you were allergic to house dust mite you might be eligible for house dust mite desensitization. Another issue would be to determine whether you have sinusitis. This can manifest as persistent congestion and frontal headaches.

Disconnected symptoms?
This is about two separate problems, or at least I thought they were so, but with a common characteristic of an allergic reaction: one manifesting in the nose, and the other in the face/beard skin.: Is it possible that these two problems are related?

Nose: I have been having more and more often symptoms of what seems to be hayfever. It starts with an irritation in the nasal mucosa (like an itching between the back of the nostril and the palate) and after 1-2 days of irritation, cold symptoms start such as swelling of the throat and running nose, eventually becoming a cold. This has been happening quite frequently: at least once a month, but sometimes I am just recovered and then that initial irritation comes back again. This happened throughout the last year, and still happening, so I don’t think it has a seasonal cause. The increase may be associated with a change of residence, where I am now living in an appartment that is located in front to a field (lots of grass…). Yet, back in my childhood/teenage I used to live in a house surrounded by grass and never had this problem that time. Face/beard skin:It starts with the skin getting reddish, feeling a bit burning too, and in the next day the skin begins to flake and keeps like that for a few days, sometimes with the reddish getting back and restarting the cycle, some others it gets healed for a few days and it comes back again. This all happens mostly in the region surrounding my mouth and below my nostrils. Given that I have beard in these regions, I (and some dermatologists) first thought this is related to the shaving. This might be the case, but after some time with this (more than 3 years) I noticed that shaving or not is not actually what triggers the irritation, but just make it get worse if I shave when it is already irritated.

Dr Joanna Lukawska advised:
1. Facial symptoms (around the nose and mouth) difficult to answer without seeing you, but the most likely diagnosis is seborrhoeic dermatitis, which is a skin reaction to a very common fungus that tends to live on our skins, mainly in the relatively greasy areas. It can be treated with intermittent topical steroid creams such as hydrocortisone 1% twice a day for a week to get it under control and then antifungal cream (usually containing ketoconazole – Nizoral, but most other antifungal creams are equally good, the pharmacist will be able to advise you). You could also try a tea tree oil in the affected area as well as washing the area with a drying agent such as benzoyl skin wash (again ask your pharmacist).

2. Nasal symptoms (irritation, itching, turning into a cold) – it is possible that you are experiencing allergic reactions to a common aero allergen (house dust mite, pet dander, mold) it is also possible that these symptoms are related to viral infections (and are indeed just a cold). As you quite rightly identified they will not be related to grass pollen allergy as grasses pollinate only for a relatively short period of time in this country). You could try treating your nasal symptoms with oral antihistamines and nasal steroid spray +/- and see if it makes a difference (significant improvement would point towards an allergic cause). In due course you may be able to arrange for an allergy test if you still need it.

Fruit Allergy
I suffer mildly from a tree pollen allergy which I treat satisfactorily with antihistamine. Approximately seven years ago (I am 45 now) I started to have an allergic reaction to the skin on some fruits some of the time eg, apples, pears, nectarines, peaches, cherries, plums. I am not always allergic to the skins of these fruits but perhaps in 90% of cases. Again, I treat this with antihistamine after the event quite satisfactorily. When I suffer an allergic reaction, my lips and mouth feel swollen and I can feel a burning sensation down my throat. I know this is not caused by pesticides or detergent as it has happened with home grown fruit. Are you able to give me any explanation of this allergy and what causes the reaction, or whether it can develop into something more significant? I have never felt it significant enough to discuss with a GP.

Dr Adam Fox replied:
What you are describing is Oral Allergy Syndrome – it is pretty common and is the result of a crossreaction between the birch pollen you are allergic to and the protein found in the fruit you mention. In short, when you eat these fruit, your immune system thinks you have taken a mouthful of pollen and you react accordingly. The reactions are usually mild and if the fruit/vegetable is cooked or processed you will usually not react. For more info on this , check out the wikipedia article on it.

Increased symptoms of hay fever
This year my hay fever symptoms started early. My nose is running more and feels bloked most of the time. My eyes have been sore and runny. I am going to try using nasal sprays and eye drops to see if that will help. I take anti-histamine all year around to control allergies that I have. Normally my hay fever symptoms are not this bad until later into the hay fever season.

Dr Helen Brough advised:
It may be that you were previously only allergic to grass pollen (symptoms usually from May until July/August) and now you have become allergic to tree pollen (symptoms Feb/March to May). You must have other allergies to perennial allergens such as house dust mite or pets (that you own) if you are having symptoms all year round. I would certainly take a nasal steroid spray for your symptoms. Flixonase nasal spray can be bought over the counter. Other nasal sprays such as Nasonex and Avamys can be prescribed by your doctor. There are various eye drops that can be used. I would make sure you are taking a long-acting non-sedating antihistamine like Cetirizine (e.g. Zirtek/Piriteze) or Loratidine (e.g. Clarytin). These can be be bought in any pharmacy and most big supermarkets and can also be bought without brand names (usually cheaper this way too). Don’t take regular Piriton. In future it may be worthwhile starting the medication a few weeks before the season starts so as to be on top of things. This usually makes a big difference.

Hay fever & pine trees – are they connected?
About five years ago I had a terrible eye infection around March/April time after a holiday abroad. My doctor referred me to the eye hospital and I underwent a number of investigative visits. At first they thought it was allergic conjunctivitis – but eventually decided it was hay fever. As for the cause ….. I wasn’t given a clue. However, at the time we had pine trees in our garden and also where I went on holiday there were pine trees – coincidence? Not sure – we live nowhere near pine trees now and althougth I still get hay fever the symptoms are less severe. What I’m puzzled about is the pine trees – I didn’t think pine trees pollenated like other trees. Can the experts shed any light? Also, should I steer clear of pine trees or could I have become acclimatised now? What I want to do is to avoid any reoccurrence of the viscious attacks on my eyes that I experienced before … any help or guidance would really be appreciated. The only symptoms I get are runny and sometimes very pussey eyes.

Dr Helen Brough replied:
Allergic conjunctivitis can be part of the spectrum of hay-fever symptoms. Usually in allergic conjunctivis the eyes are runny, itchy and red. The eyes do not usually have pus except for a rare condition called veratokernal conjunctivitis which is usually because of tree pollen and classically causes a white stringy discharge from the eyes. It would be important to get a bacterial swab of your eyes the next time you have these symptoms as it may be infection that is causing this rather than allergy. That said pine tree pollen can cause hay-fever symptoms however it is a rare tree pollen allergen as pine tree pollen is quite heavy and thus does not remain aerosolised. Other tree pollens such as birch, alder, hazel which are not so visible remain aerosolised and thus cause the majority of spring-time hay fever in the UK. The best way to find out for sure is to get tested for tree pollen allergies by a specialist in allergies. Allergists can test for individual tree pollens using skin prick tests although pine tree pollen may be harder to get hold of for testing as it is such a rare allergy.

Eucalyptus for asthma
I have heard that eucalyptus can help relieve the symptoms of asthma. Is this true and if so how would this be done? I am assuming it would be like olbus oil and put a few drops on a tissue or in hot water and inhale the steam. I like the idea of natural remedies to help where possible.

Dr Joanna Lukawska advised:
Eucalyptus oil has antibacterial and antiviral qualities and a long history of use for symptoms of colds etc. In asthma there is some evidence that it might also help break down thick mucous. It is of course the main ingredient of Vicks VapoRub. Inhalation of vapour is safe;  however there isn’t enough scientific evidence, so far, to rate its effectiveness in asthma. There are several devices sold in pharmacies that allow you to inhale the vapour safely.  Eucalyptus oil should never be taken by mouth or applied to the skin full- strength; it ought to be diluted. You should not use it instead of your reliever or preventer inhalers, but try it as an additional (adjuvant) therapy, it may be particularly helpful when your asthma symptoms are made worse by chest infection. But again, do not rely on it entirely:  use your inhalers, seek medical help as you may need additional treatment such as antibiotics. I also like the idea of natural remedies (a lot of our present medications are based on natural products) and Eucalyptus smells so good.

Peak flow
Could you explain the peak flow values please? My peak flow at its very best is 420 which I appreciate is low but when first diagnosed with asthma it would average 180. Could it be that I have a small lung capacity? When my asthma is well controlled and I exercise I get out of breath quickly but also recover quickly.

Dr Joanna Lukawska explained:
Peak flow meter is used to estimate the degree of obstruction in the airways. It records how quickly you are able to blow out the air from your lungs (measured in litres per minute). Your peak flow readings will depend on your age, height and sex (higher expected values for adults, males and taller people) and hence it is very difficult to comment on individual readings. Your peak flow readings will be lower in your childhood and adolescence (180 compared to 420, also there has been a change in the type of devices we use over the last 15 years). Even in healthy people peak flow readings will vary and there is an art to taking a good peak flow reading. Generally, make sure you blow out as hard as you can, get a good seal around the mouth piece, and take the best reading out of 3, but having said all this a lot of patients find it a tricky exercise. Use your peak flow to monitor your asthma, but also rely on your own perception of symptom control (cough, exercise tolerance, night time symptoms). Quick post exercise recovery is a positive sign; however if you find that exercise makes you short of breath persistently, use your blue inhaler (couple of puffs) just before you go for a run etc. If this does not help speak to your GP as you may need an adjustment in your asthma medication.

Metal allergy
When I was younger I could wear all metals. When I was 14 I had my ears pierced for a second time as the holes had closed up. I had a terrible reaction with pain, pus and itching. We assumed it was the earrings even though they were nickel free. We changed the earrings but it still didn’t improve. I then noticed that when I used certain cutlery my mouth tingled and had a lasting metallic taste. I now react to all metals and have to coat any metal that is coming into contact with my skin in clear nail varnish. I get a rash that looks like small pus filled lumps (looks like tapioca), they itch terribly and can be painful.  I will start to react within about 20 minutes but the rash generally doesn’t appear until the next day. Why did it start when I used to be fine with metal? And should I have allergy testing?

Dr Adam Fox advised:
This sounds like a contact allergy/dermatitis. The most common cause is nickel which is often added to other metals (making them less pure and thus cheaper). If you can identify the exact cause you will probably be able to find some metals you are fine with. You should ask to see a dermatologist to get patch tested which will often reveal any other cause of contact allergy too. They can also advise on treatment to calm the rash down when it appears.

This article was first published in Allergy Newsletter No. 105. Summer 2012. Allergy Newsletter is the journal of Action Against Allergy