Could my 'hay fever' actually be an irritation caused by something else?

If you find yourself battling symptoms like nasal congestion, sneezing, itchy eyes or a nagging dry cough this time of year, you are not alone.

More than 17 million South Africans suffer from hay fever (also known as allergic rhinitis), and according to a previous Health24 article, this number is increasing – especially with pollen production in Cape Town at a record high. This is according to Professor Jonny Peter, Head of the Allergy Unit at the University of Cape Town’s Lung Institute.

Allergy or irritant?

Hay fever symptoms are triggered by an allergic reaction to pollen from trees (mostly during spring) or grass (late spring or early summer). 

However, we often misdiagnose ourselves. What if the pollen count is low in your area and you're still experiencing unpleasant symptoms? Is it really a pollen allergy?

Besides pollen, there are other environmental factors such as dust, mould, pet dander and mites that can also cause an allergic reaction. But how can it be an allergy if you're battling with a runny or congested nose in the absence of these conditions? What's going on?

Here is where we need to differentiate between an “allergen” and an “irritant”.

How do allergies work?

Allergens can occur in anything from food to dust and are harmless, except when the immune system doesn’t "agree" with it and fights it. This causes a reaction, which works as follows:

An allergic reaction starts when an allergic person comes into contact with an allergen. The allergen enters the body and results in the formation of a specific type of antibody called IgE, which causes the body to react – this is known as sensitisation. This can be picked up in your blood with the help of a specific IgE test, or by performing a skin prick test.

The test therefore picks up the sensitisation, and not allergy as such. Sensitisation can lead to allergy, but in some cases the sensitisation is suppressed by other mechanisms in the body. This is called “innocent sensitisation”. If this is the case, a test will show that you’re sensitised, but not actually allergic. 

Once IgE antibodies are formed against a specific allergen, they bind to special cells that are found in your skin, lungs, nose and intestines (called mast cells) or in the blood (basophils). The antibodies "wait" in the cells, ready to fight the intruders.

As soon as you come into contact with said allergen, the antibodies start working – your body releases a chemical called histamine, which causes inflammation – hence those nasty symptoms. This is why an antihistamine may be prescribed to counteract seasonal allergies.

Allergic rhinitis refers to inflammation in the nose, caused by your reaction to an allergen.

But what about irritation?

Rhinitis refers to the inflammation of the nose that triggers symptoms such as congestion or a runny nose. Sometimes, however, the cause of your rhinitis is viral – better known as the common cold.

Other times, non-allergic rhinitis can be caused by things that simply irritate the lining of the nose without triggering an antibody response. This is known as vasomotor rhinitis and can be triggered by the following:

  • Cosmetics like aerosols, perfumes or hairspray
  • Paint fumes
  • Exhaust fumes
  • Extreme changes in temperature and humidity, or cold and windy conditions
  • Pool chlorine
  • Air pollution from factories
  • Cigarette smoke
  • Spicy foods, alcohol or dairy products

These substances are not allergens as they don’t adhere to antibodies to cause inflammation. Common allergens such as dust, pollen and pet dander can also trigger irritation, but in this case, there is no antibody protein – therefore it can’t be classified as an allergic reaction.

According to the Marshfield Clinic Health System, the exact bodily response behind this type of reaction isn’t entirely understood, but simply put, in high concentrations, any of these substances will simply irritate the nasal membranes that serve as a protective barrier between the environment and substances you inhale.

What basically happens, is that the blood vessels in the nose dilate when coming into contact with any of these irritants. This is a normal response, as it’s the nose’s job to “catch” any nasties before they enter your airways.

But some people are more sensitive to some of these substances, causing an exaggerated nasal reaction. Some people may react to strong perfume while others don't – we're all different in that way.  

How do I know if I have hay fever or irritation?

As allergies are diagnosed via blood tests and skin prick tests, a visit to an allergist will be able to confirm or rule out allergic rhinitis.

Your first move would be to start monitoring your symptoms – when do they flair up, what triggers them and what substances in your house or office environment could possibly trigger rhinitis?

Sometimes, you could have both allergic and vasomotor rhinitis as the symptoms mimic each other. If you find that the pollen count in your area is low, or if you don’t often experience a reaction from dust, pet dander or mould, it could be an irritant in your environment.

If you suspect allergic rhinitis, start by monitoring the pollen count via our weekly update on Health24, in conjunction with the UCT Lung Institute’s Allergy and Immunology Unit.

How do I treat rhinitis?

Rhinitis can drive you up the wall and make you feel like you are permanently suffering from a cold. Unfortunately there is no miracle cure for either allergic or vasomotor rhinitis – however, there are various ways to manage your condition:

  • See your doctor to help determine whether you have allergic or vasomotor rhinitis.
  • If the pollen count in your area is high, take precautions. Your doctor may also be able to prescribe an antihistamine or a nasal decongestant.
  • Keep windows closed and invest in a high energy particulate air (HEPA) filter to help remove pollen and dust.
  • Don’t leave laundry out to dry longer than it should, or hang it indoors if you have space – pollen will cling to your laundry.
  • If you suffer from irritation, avoid the triggers as much as you can. Your doctor can prescribe a nasal steroid or decongestant that may help.

Amid the highest recorded pollen counts in history, Health24 will be bringing you exclusive pollen count updates courtesy of the UCT Lung Institute's Allergy and Immunology Unit.

As the pollen problem worsens, precise and expanded monitoring becomes even more essential. And here's how you can help.

Image credit: iStock