A (2:35)

Choose your poison, pollen or snakes.

B (2:38)

Yeah. And there's some evidence, some evidence that where you grow up determines your hay fever. And if you escape that, then you escape your hay fever.

A (2:45)

Norman, you are cutting our grass, as it were.

B (2:48)

I'm sorry, yeah. Giving you advance notice of what we're going to talk about on today's. What's that rash?

A (2:54)

The show where we answer the health questions everyone is asking. So, yeah, the questions that we've got this week, there's more than one. Cathy lives in Southwest Wa and hay fever season is starting. She's blaming their peppermint trees and hay fever sufferers are looking around for local honey. Kathy's asking, does raw local honey actually help alleviate hay fever? And Tim has a more general question saying, with the outbreak of hay fever season, I'm hoping you might do an episode on demystifying hay. Hay fever. And here we are.

B (3:27)

I think the starting point, Tegan, for demystifying is getting a bit into the history of hay fever.

A (3:31)

Oh, yeah. And it's such a good little story as well. Talking about it as hay fever. That's obviously one word for it. Pollinosis is another one. It used to be called rose fever because it came on at the start of the rose season and some people thought that the scent of the roses caused the symptoms. One fella called it Cataris east of us, meaning summer Qatar. But in the usa, a different person called it Autumnal Qatar. So basically a lot of reaching for an explanation for these terrible symptoms.

B (4:02)

Yeah. We're not talking about catching a flight on a certain airline in Nepal, we're talking about Qatar.

A (4:10)

Qatar, as in. Yeah.

B (4:11)

COUGHING AND SPLUTTERING and the physician you're talking about is John Bostock, who in 1819 first described it.

A (4:17)

Yeah. So John Bostock described the case of a patient who he called jb.

B (4:24)

What a coincidence.

A (4:26)

I wonder what. Yeah. Anyway, so poor JB was 46 years old. He was basically, since he had been 8, he had had attacks from about the middle of June each year. Heat and fullness in the eyes, also mucus and disgustingness. And shall I tell you some of the remedies that he tried to help alleviate these symptoms?

B (4:45)

Go on.

A (4:45)

I mean, given the time, the obvious one, bleeding and purging didn't do any good. No. Neither did blisters. I don't know how he got these blisters going, I don't know.

B (4:55)

There were various ways of raising blisters, often along with cupping.

A (4:59)

Oh, okay, right. Bark, as in the bark of the cinchona trees. Quinine. He also tried opium and mercury and other things. Nothing worked.

B (5:10)

Yeah. So it's not surprising that poor old Dr. Bostock, assuming that he was the same as JB, didn't get any better.

A (5:15)

Yeah, poor Dr. Bostock and JB were a bit like Clark Kent in Superman. So, yes, it was him. The one thing he did find worked was confining himself to the house. So basically staying away from being outside, which is a bit sad and depressing, but does make sense given that you and I know that his symptoms were caused by pollen.

B (5:33)

Indeed. And still today, avoiding the allergen, the thing that causes your allergy, is one of the ways that you manage this process.

A (5:41)

Yeah. And others. From Bostock onwards, there were other people who looked into this as well, and a lot of them were people who were themselves sufferers of hay fever. One fella put sticky patches on kites to collect the substances that were around in the air and realised it was.

B (5:57)

Oh, you should have told your daughter that she could have put some sticky tape up on her kite.

A (6:01)

I had just enough pollen, I didn't need any more things. And he was a correspondent of Charles Darwin's and they compared notes of how to basically dilute the pollen to figure out how to much was needed to elicit a response. So some really interesting science there by some pretty famous historical scientists.

B (6:19)

So what we're talking about here is rhinitis, a runny nose associated with other symptoms. So hay fever is allergic rhinitis, which can either be seasonal or it can be perennial. In other words, it's year round but still allergic. Seasonal hay fever is much more likely to be what you got in the grass on the Isle of Wight. And it's pollens, particularly grass pollens and perennial rhinitis that's more likely to be the same sort of triggers as asthma. And it's like dust mites, those little insects that live in your house. Cockroach droppings and animal fur. Those tend to be the causes of perennial rhinitis rather than the pollen.

A (7:02)

So I guess the question is, so many of us are exposed to pollen if we have ever been outside before, and dust mites if we've ever been inside before. Why is it that some people seem to suffer from these so much more than others?

B (7:15)

Well, there are a trio of allergic diseases called atopic diseases. There's Hay fever, allergic rhinitis, there's eczema and there's asthma, and they go together. Some people can get all three, some people can just only get one. There's almost certainly a genetic propensity and genetic. Researchers have gone to and fro over the years about the genetic pattern that may or may not be associated with allergic diseases. But there's no question that there is a genetic susceptibility. It does tend to run in families, but sometimes that's environmental as much as genetic. There are other risk factors for particularly hay fever and asthma. One is smoking. So if a mother smokes in pregnancy or a baby is exposed to secondhand smoke, they are more likely to develop atopic diseases, particularly hay fever and asthma. It just changes the way the respiratory tract works and can change it developmentally inside the womb. That's actually West Australian research that discovered that there's exposure to allergens in the first year of life. Because what happens here with hay fever is there's a breakdown in the surface lining of the nose in particular. And these pollens then get in. They trigger an immune response from certain white blood cells, and then that immune response triggers an antibody response. So certain other white blood cells produce an antibody called. Which is specific to that allergen. If it's pollens, it's specific to those pollens. And that ige. The purpose of that is to get to cells called mast cells, which line your respiratory tract, and they are full of histamine.

A (9:06)

Okay, I know what a histamine is because I know what an antihistamine does.

B (9:09)

That's right. And when the mast cells release or burst open with the histamine, then you're triggering a response in the arteries, a response from cells which prod. It even triggers a neurological response in the trigeminal nerve. And that's the nerve which transmits sensory information back to the brain from the face, from the eyes, from the upper jaw, from the lower jaw. It can trigger that. And hay fever is associated with migraine, with headaches, and with other conditions as well. So it's not just an immune disease. It's not just a vascular disease. It's actually a neurological disease as well, where a lot of your body is triggered to try and get rid of these allergens.

A (9:54)

It's so undignified, and it affects so many people. Is there any? I know I always ask about evolutionary biology, but, like, what is the basis of this from a survival point of view? Because it feels very unconducive to living.

B (10:07)

Out in Nature, you can only assume that it's a reaction of the body to get rid of these allergic substances. It's all about mucus, sneezing and flushing it out, your eyes watering. You know, a very simplistic description, but there are protective factors. So first of all, not being in an environment where you experience tobacco smoke as a child, but also in the first year of life, if you are exposed to pets, and the more pets the better, the less likely you are to develop atopic disease.

A (10:39)

That feels counterintuitive.

B (10:41)

Well, it's all about training. One of the reasons I went into this long description of the immune system is that that response I just described is actually a response more tuned to parasitic diseases rather than allergy. And the theory here is that the immune system doesn't get properly trained in the first six months of life, maybe even the first year of life. And therefore you have an immune system that's all dressed up and nowhere to go. But allergy, and it used to be thought it was about hygiene. And if you're exposed to dirt, then that trained your immune system. It's actually much more refined than that. It's being exposed to allergens early in life to train the immune system. And the immune system just becomes less twitchy and less likely to develop atopic disease. So kids growing up on farms, they can still get atopic diseases, but it's much less likely than kids growing up in cities. So some people say you recreate the farm environment in a city home. You can by having, and it doesn't matter which pets.

A (11:45)

So we did do an episode on pet allergies, which you can go back and listen to. We'll put the link to that in the show notes for this episode as well. So I guess let's say you've missed the boat. You haven't been able to prevent developing this allergy, this hay fever allergy to start with. What are the best ways of managing it?

B (12:04)

Don't get on a plane to Heathrow late May.

A (12:08)

I got that one wrong, really.

B (12:10)

There's been research. I actually tried to find the paper on it for the show, but I couldn't find it. But I did a story on this many years ago where, and I think it was West Australian research which showed that people who move from Perth to the east coast or from east coast to Perth pretty much like me. In my experience, they lost their symptoms when they moved state.

A (12:31)

I would have thought it would be the other way around. Like I would have thought that you would be more attuned to your natural environment and that something foreign would be more of a trigger. But you're saying it's the opposite?

B (12:41)

No, Remember I said that IgE was specific. In other words, the IgE, these antibodies are trained to the pollens that you're exposed to. And it may well be that the antibody response just ignores those allergens that you might get in Melbourne versus Perth. You're speculating here as to why that's the case, but that might well be. So in other words, it's more that your immune system's been trained to certain allergens rather than you've got this disease called hay fever.

A (13:10)

So then what are the best treatments?

B (13:12)

Well, if you can avoid the allergen, if you know what it is, but that's hard in springtime when there's all these pollens around. Non sedating antihistamines. So the newer antihistamines, because remember I said the mast cell bursts open and produces histamine which causes a lot of these symptoms. If you can nip that in the bud with an antihistamine, then you can control it. Sometimes that's not enough, particularly with perennial rhinitis. And you can use nasal sprays with small doses of steroid in them and they can help a lot. And by the way, if you've got severe asthma and rhinitis, research in Melbourne has found that your treatment of your asthma becomes much easier if you treat the rhinitis. There's also newer anti immune system drugs that can be used as well. And there's anti allergy immunotherapy where you give the specific allergen to see if you can train the immune system to become less twitchy. And that comes to the question from Kathy about honey.

A (14:12)

Yeah. So this idea of raw local honey, maybe there's the pollen in it, but it sounds like from your description that shouldn't work. What does the research show us?

B (14:22)

The theory is solid, which is that if you're exposed to the pollens to which you've grown up with and to which you're allergic and the bees have created the honey from that pollen, then maybe that's a form of immunotherapy. Unfortunately, there's very little research to suggest that it's effect. We've located our paper in the Annals of Saudi Medicine where everybody was given an on sedating antihistamine and one group was given honey for four weeks and the control group got honey flavored corn syrup as placebo. There was increased benefit in those who were taking the honey. They all benefited from the antihistamine, it seems, although that wore off after time and there didn't seem to be a risk of anaphylaxis, of a serious allergic reaction in taking the honey. So that's good news. But the way they conducted the study could have been better. And you wouldn't hang your hat on just one study.

A (15:17)

Right. So the science behind the study, a little sticky perhaps, but there wasn't really any harm. And I guess, of course, the only caveat around honey is for babies under one, it's not recommended, especially if it's unpasteurised, because there is a health risk for young kids.

B (15:32)

So for Kathy and Tim and anybody who's got seasonal allergic rhinitis, you can actually get from your pharma, have a chat to your pharmacist, you can actually get these antihistamines over the counter. Talk to your doctor about inhaled topical corticosteroids. If that's not helping, you would grade up. In other words, you wouldn't jump to the stronger drugs until you've worked out whether or not antihistamines do work. There's also a drug that actually inhibits the mast cells themselves and it's a drug that used to be used a lot in children with asthma called chromoglycate. And it doesn't have the side effects of steroids. That's sometimes worth trying and just work up from there. Be very careful about using nasal sprays, which are decongestions. You could end up being worse.

A (16:16)

And a little bit of honey on your morning porridge.

B (16:18)

That's exactly right.

A (16:20)

Sounds like a recipe for good health. So send in your emails thatrashbc.net au.

B (16:26)

See you next week.

A (16:26)

See you then.