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Dr Duncan

Hay fever or a cold? Treatment options.

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But the warmer weather and some decent winter rains have been great for the weeds in our garden which are thriving: and all around wild flowers, crops and grasses are flourishing. In other words there’s lots of pollen entering our “airspace” and that means that the hay fever season is almost upon us too.

So how do we tell the difference between a hay fever runny nose, and the common cold? And when should we start to think about needing antibiotics for these Upper Respiratory Tract Infections or URTIs?

Our noses are extremely sensitive organs, and part of their job description is to recognise and respond to anything noxious that might enter our bodies that way. If something were to enter via the nose, then it has a sort of “rapid response” system whereby the lining of the nose swells in order to reduce air flow through the nose, and it also releases a watery mucous to help wash out any substances that may have stuck to the lining of the nose.

The challenge is that viruses, chemicals, pollens, house dust mites and a whole plethora of things can trigger this response, leaving you sneezing with a stuffed up, yet runny nose.

The big help in diagnosing whether it’s a virus or hay fever, is that viral infections also trigger the body’s  “thermo-regulatory” system that automatically raises the body temperature in an attempt to “cook and kill” the viruses! So with virus infections, the patient usually has a raised temperature. Viruses also trigger the body’s immune system which releases specialised white cells to fight the invading forces, and in the ensuing carnage yellow crystals will appear in these white cells as they ingest the viral particles, which give a yellow tinge to the mucous they inhabit. And with evaporation this can progress to the more lurid green discharge often seen streaming from little children’s nostrils!  Hence with colds you get a blocked runny nose plus a raised temperature and a yellowy/green mucous discharge from the nose as well.

With hay fever, the pollen in the air is the male gamete of the plant that produced it, and this male gamete is, in some ways, trying to do its job by “mating” with the surface it lands on – in this case, the lining of your nose!!  Naturally, the nose is having none of that and reacts to the foreign protein, causing the lining of the nose to swell and to produce copious amounts of watery mucous. But it’s not just the lining of the nose that the pollen irritates: the eyes are affected too, leading to redness, tearing and an itchy sensation. So hay fever produces not only sneezing and blocked noses, but also itchy, watery eyes as well. However, as it’s not an infection, there is no raised temperature.

Viral infections are spread via droplets and hand to face contact – someone sneezes into their hand and then opens a door; you’re the next one to push through the door with your hand and then five minutes later you scratch your nose, and, hey presto, the link is made and you introduce the virus particles to the surface of your nose! The incubation period is about 3 to five days before the classic nasal congestion, sneezing and runny nose appear – plus the mild fever.

When it comes to treating both conditions, the aim is to try and reduce the impact of the symptoms until we either withdraw from the allergen – the pollen, house dust mite or chemical: or our body’s immune system cleans up the virus. In the first instance, it might be impossible to fully escape your environment by moving to a different location, and so treatment may need to be ongoing. In the case of infection, the body’s immune system will usually destroy the common cold virus in 5 to 7 days.

The aim of both treatment options is to decongest the nose: but the methods of achieving this goal differs in the two conditions.

Treating the symptoms of viral nasal congestion:

Simple nasal decongestant sprays for up to 3 days will provide relief: do not use them for any longer as that may lead to damage to the lining of the nose. Oral decongestants are effective, but as they go through your mouth, enter your stomach and then through the blood stream before they reach your nose, the potential for side effects is much greater. With nasal sprays, the medication is delivered straight to the surface where it is needed. Simple paracetamol can be used to help with the more generalized discomfort that colds can bring – sore throats, aches and pains.

For allergic nasal congestion: 

The primary aim is to reduce exposure to the allergen: for example, avoid cutting the grass and outdoor activities in high pollen count months. And reduce exposure to house dust mite with appropriate covers on mattresses, pillows and bed covers and eliminate cockroaches.

Steroid based nose sprays are the treatment of choice, and the newer formulations have been approved for use in children. Some specialists recommend that prior to using a steroid nasal spray you wash the lining of the nose with a saline-based irrigation  - like Fess – so that the surface is cleaned of debris to allow better penetration and efficiency of the steroid spray. It is very important that you are committed to daily treatment for 3 weeks to really get on top of the problem, otherwise the nasal lining never fully recovers and symptoms will recur quickly. Once on top of the problem, intermittent use of the spray will help you control the allergic symptoms far more easily. Non sedating anti-histamines can also help with hay fever but need to be taken with caution if taken with other medications: they can help sneezing, runny nose and itching but have no effect on nasal congestion.

As in all cases of uncertainty whether the problem is viral or allergic in origin, always seek medical advice before taking any medications, especially if you have ongoing medical conditions or are taking medications for heart, or blood pressure conditions.

And by the way: antibiotics do not have the slightest effect on viruses and are a complete waste of time in treating them.

Article written by Dr. Duncan Jefferson. More articles here. For more information on health care and private health cover, visit HBF Insurance at www.hbf.com.au.

The content of these articles is not tailored for any particular individual's circumstances. The author does not take into account your physical condition, medical history or any medication you may be taking. Any advice or information provided by the author cannot replace the advice of your health care professional. The views expressed in this article are those of the author and do not represent those of HBF unless clearly indicated.

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