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EVERY YEAR SOME PERSONS ARE AFFLICTED BY THE ALLERGIC REACTION KNOWN AS HAY FEVER


          Hay fever or or as it is medically termed allergic rhinitis may be seasonal or in the very unfortunate perennial.It is a localized anaphylactic reaction to  allergens such as pollen ,molds which produce spores,animal skin scales and house dust .This reaction can lead to nasal congestion and itchy nose,sneezing,nasal discharge ,runny and itchy eyes,earaches and headaches.Not all pollen cause allergy ,but tree,grass and weed pollen are the most frequent causes of allergic rhinitis.The main seasonal allergen is ragweed,followed by grasses.Trees are usually responsible for many spring allergy suffering,but this period is normally short.Grass pollens are usually responsible for symptoms in April,May and also in summer (June and July).However,weed pollens are usually prolific in August,September and October.Ragweed is not very troublesome in British Columbia and the prairies but is quite afflicting in eastern Canada.Although rainfall increases vegetative growth,the water may wash away most of the pollen out of the air.Wind speed and direction affect distribution of pollen ,as does land contour.
Approximately 10 percent of the population suffers from this affliction which may develop at any age ,and as much as 40% of sufferers may develop as early as 2 years of age.Five to nine percent of children may develop season allergic rhinitis .Individuals with perennial allergic rhinitis who suffer all year round tend to develop this condition later in life.Most persons with allergies suffer for the remainder of their lives ,however  some experience that their symptoms may lessen in severity with time.
   Normally,when potential allergens enter through the nose,pharynx,trachea(throat) and enter the lungs ,these particles become trapped in the mucus lining these passages and are removed by hairs( cilia ) in the nostrils and passageways ,moving them toward the pharynx where they are spit out or swallowed.Further,when these particles cause irritation to the passages and thereby cause sneezing which is a reflex action ,they  expel these particles resulting in cleansing of the passages.The sinuses ,which open into the nasal cavity ,are lined with mucus which is continually being swept into the nose by the associated cilia.But during an allergic reaction these sinus openings may become blocked, resulting in a stuffy nose.
    Allergic rhinitis is another auto-immune affliction whereby the body mistakenly recognizes an allergen as a hostile foreign body which it needs to defend itself against.This process commences with what is referred to as an initial sensitization.When the body first encounters a potential allergen ,it produces antibodies specific to these allergens(antigenic protein).These antibodies are of the immunoglobulin E class(IgE) of immunoglobulin antibodies.Also produced are basophils which circulate in the bloodstream:they are also involved in the process of producing vasoactive mediators.The IgE antibodies attach themselves to so-called mast cells,thereby sensitizing the person to that particular antigenic protein or allergen.Mast cells are the storage cells of substances called vasoactive mediators.After sensitization ,when a person is exposed to that specific allergen again, specific IgE antibodies to that allergen are  produced which then attach themselves via specific receptors on these mast cells and basophils in the nasal mucosa. The resulting breakup of these mast cells releases the vasoactive mediators which include histamine,prostaglandins,kinins ,leukotrienes ,thromboxanes etc.  The chemical mediators act on the blood vessels,goblet cells and mucosal glands  of the nostril  to produce the nasal symptoms of allergic rhinitis.For example,histamine produces capillary dilation resulting in adjacent tissue swelling and stuffy nose and histamine can stimulate various nerve endings which leads to the itchy sensation.When actions affect the eyes,runny and itchy eyes will develop.
  The common cold and vasomotor rhinitis sometimes can be mistaken for allergic rhinitis but if necessary an allergist can usually differentiate between them by employing skin testing.Symptoms of allergic rhinitis do not appear in a set pattern,but soon after encounter with an allergen the nose,pharynx and eyes start to itch with tearing,sneezing and runny nose soon to follow.Periods of nasal congestion,intermittent sneezing and runny nose last for at least half to one hour daily.Coughing and asthmatic wheezing may appear later in the season along with irritability,loss of appetite and insomnia. The severity of the symptoms is usually correlated with the amount of allergen which the person encounters,but every person develops his or her own sensitivity.In children ,serious ear infections can develop if there is chronic ear passage blockage.Stress resulting directly from the affliction or from other sources has been found to exacerbate allergic rhinitis.
       The most effective treatment for allergic rhinitis would be avoidance of the allergens,but avoiding the outdoors for most persons would be very difficult if not impossible.The pollen which reaches indoors and  dust can be reduced considerably by high efficiency electrostatic filters and by cleaning air ducts at least once yearly but is mostly reduced by closing doors and windows. Reducing humidity by using humidifiers can help prevent the growth of moulds and the propagation of house-dust mites.Children should avoid playing with hay or in open fields and areas with weeds.Sometimes a change of clothing when a person goes indoors can bring relief.
Fortunately,their are medications which can provide relief (but not cure) from the symptoms of allergic rhinitis.Persons should use medication to address only those symptoms which they are experiencing.Antihistamines of the H1 type(eg.diphenhydramine)  can be used to block the actions of histamine and thus reduce the symptoms of this vasoactive mediator.There are various chemical classes of H1 receptor antihistamines but they all have relatively the same pharmaceutical therapeutical actions with varying  onset of action ,duration,potency and extent of severity of side effects.Most of the over-the-counter antihistamines  cause drowsiness except that the newer agents cause far less and are sometimes called "no-drowsy "antihistamines because of their low to negligible sedating effect.It is preferable to use the "non-drowsy" (terfenadine and astemizole which lasts longer )type particularly when one expects to be doing things which require clarity and focus such as driving an automobile or using a hazardous piece of equipment.Sometimes these agents may lose their effectiveness over time and one might need to change to another type of agent which has a different action to obtain similar relief from their symptoms . Cromolyn sodium acts differently from H1 receptor antihistamines and does not have antihistaminic or anti-inflammatory activity but somehow inhibits mast cells from releasing the vasoactive mediators.Although antihistamines help to relieve runny nose ,itching, and sneezing they do not provide relief from nasal congestion;this requires the introduction of a decongestant.Decongestants can be either taken orally or applied nasally by spray.However,overuse of the nasal spray can result in a re-occurrence or rebound congestion which is usually more severe.Combination products of antihistamines,decongestants and pain killers abound.When allergic rhinitis does not respond to either antihistamines or cromolyn ,corticosteroids such as beclomethasone and flunisolide may be employed in the form of nasal sprays .These agents when used as directed can be very effective and long lasting.Finally,immunotherapy or hyposensitization  may be used in resistant cases by repeatedly injecting minute doses of an allergen(s) extract weekly or bi-weekly via subcutaneous injections until a dose is reached whereby the allergen is slightly more than what the person is likely to be exposed to in the environment and then the person will not experience allergic reactions when exposed to those allergens.  This method has several drawbacks,such as expense ,pain of injection,potential adverse effects and the fact that this therapy might have to continue for many years.
      When one suspects that they might be afflicted with allergic rhinitis ,it is wise to seek professional help to find a suitable therapeutic regime as early as possible.
 

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BCOCCA President - Neville Thomas

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As President of British Columbia Organization of Caribbean Cultural Associations, I am grateful for the opportunity to work on behalf of the Caribbean Community to identify and execute Community Building initiatives which embrace BCOCCA'S mandate.

 

 

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