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Runny nose, puffy eyes... it's summer again!

IT'S already expected to be one of the worst years for hay fever sufferers with many supermarkets claiming to have run out of own-brand antihistamines.

An estimated 12 million people across Britain suffer from hay fever, and many of those will already be gearing up for another bout of seasonal sneezing.

The hay fever season - unlike the British summer - never seems to fail to live up to expectations; and according to John Collard, clinical director at Allergy UK, who has spent years working with sufferers, now is the time to start taking the tablets.

"If you wait until the runny nose and sneezing have started then it's going to be much more difficult to control," he explains. "You should be taking the medication two to three weeks before you normally get the symptoms."

If you are allergic to pollen then you'll know what he's talking about. But that doesn't mean his advice will be easy to follow.

With a bewildering array of hay fever remedies on the market, it's hardly surprising that somewhere between squirting nasal spray and swallowing antihistamines - not to mention paying for them - many sufferers feel it could be easier to have done with it and sneeze their way through summer.

For those who are struggling, you might be surprised how far a diary, the facts and some patience, will go towards solving the problem.

John says: "Everyone tends to link hay fever with grass pollen which is around from mid-May to the early September. But while it's fair to say that more people are allergic to grass pollen than anything else, quite a lot are also allergic to tree pollen.

"The earlier trees start to pollinate in February/March, and certainly by April you're going to be affected. Then after the grass pollen starts to die down, you have weed and shrub pollen. You can be affected from now, right through until the end of autumn."

It's a long slog for the afflicted, who might be tempted to ask, why me? You have your family to blame for your aversion to early evening strolls (when pollen is at its thickest), says John.

"Hay fever is an inherited condition. Most people will be okay for the first few years of their life, then they'll get triggered and develop the allergy. Any sort of stress on the system - like an infection, mental stress or exposure to a lot of grass pollen - can trigger this inherited tendency.

"Then your body starts making antibodies that react when they come into contact with pollen, and make chemicals like histamine, from which you get hay fever symptoms. The chance of an allergy appearing diminishes as you get older. By the time you get to your 50s, it's pretty unlikely."

Drugs for combating allergic reactions, like antihistamines, are now commonplace in most medicine cabinets. But sadly, taking one every day will not guarantee you can breathe more easily.

"Hay fever has a two stage reaction," says John. "The histamine produces the immediate symptoms that you associate with hay fever; sneezing, itchy nose and red, itchy, watery eyes. They come on quickly, last a few hours and then settle down again. But there are also chemicals from our immune system which cause more delayed symptoms, such as the blocked-up nose, headaches, stuffiness and puffy eyes. While anti-histamines will counteract the effect of histamine, they won't do much to deal with the inflammatory symptoms.

"Steroids work much better," he adds. "Most people with hay fever will need antihistamines, a steroid nasal spray and often eye drops so they're treating the whole thing effectively."

But according to John, this message doesn't always get passed on. And, in addition, people don't understand how the drugs work.

"The GP will sometimes just give someone an antihistamine, rather than all three together. And different antihistamines work differently on different people. So if you try one and it doesn't control your symptoms - don't give up, try another. It's worth trying a few to find one that suits you. People often give up on the treatment too quickly."

Once you've found your perfect dose, John says, it's also important not to underestimate the allergy's debilitating effects.

"Everyone tends to think about allergies in terms of those which have life-threatening reactions - like anaphylactic shock. But far more people are affected by everyday allergies which can still have a huge effect on their lives.

"Having a runny nose, a headache, itchy eyes and not being able to sleep makes life miserable. And you're not necessarily going to feel 100 per cent if you're taking medicine to control your symptoms."

John advises his patients that, in order to tackle their allergies, they need to understand them.

"Knowing about pollen helps. Trees produce their pollen in two year cycles. Last year there was less birch tree pollen, so this year they will pollinate more heavily.

"Also, pollen is released first thing in the morning on a warm and dry day. It goes up into the air and then comes down in the evening when it cools down, so you might want to think twice about your evening walk.

"Or if you do go, wash your hair and change clothes when you come back indoors, to keep the pollen levels down in your house.

"And wear wrap-around sunglasses to help keep pollen out of your eyes."

In addition to conventional medicine, and practical tips, there are many other remedies available to sufferers, which range from simple herbal mixtures to injections. And in each case John says it's important to weigh up the pros and the cons.

"Things like a butterbur, which is a shrub that some experts say can produce the same results as antihistamines, and even local honey have been said to help. So these alternative remedies are certainly worth a try.

"De-sensitisation is another more extreme method," he continues. "Throughout a series of injections, the patient is gradually desensitized to pollen. It certainly can be helpful for people who can't control their symptoms with medication or by avoidance, but it is quite a hassle.

"There are long waiting lists and only the worst people get referred. Also, because there aren't many places do it, you'll have to travel quite a long way every month to get to the injections. So it's a big thing to take on."

Other remedies include phototherapy, during which red light slows down the immune reaction and inhibits histamine and the use of air purifiers to remove indoor pollen, or you could try echinacea.

7:00pm Tuesday 13th May 2008

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