In addition to warmer weather, the onset of spring and summer can bring sniffles, sneezes, itchy eyes and respiratory problems, courtesy of hay fever (also known as allergic conjunctivitis or allergic rhinitis). Some 3% of visits to general practitioners (GPs) in the UK are for allergic rhinitis, making hay fever a serious problem for which we need serious remedies (Sayin et al., 2013).

The problem for many of us is that the changing climate makes hay fever season unpredictable, so it is harder to take preventative measures. The weather can also have a significant effect on airborne pollen counts and the size of allergen fragments. Tiny pieces of allergenic material appear to be more common around the time of thunderstorms, for instance, and may make asthma symptoms worse for some people. Wet weather tends to mean lower rates of hay fever, however, so a summer washout isn't all bad news.

Hay Fever Symptoms – Who's Suffering and How?

Hay fever symptoms in April suggest a tree pollen allergy, while grass pollen allergies usually trigger symptoms in May. Weed pollens and fungal spores can also cause trouble, typically at the end of summer.

Symptoms of allergic rhinitis or conjunctivitis can vary dramatically in severity, with some people experiencing mild symptoms and others having symptoms severe enough to require serious medical intervention to protect airways. Children and young adults tend to have more pronounced symptoms, with severity decreasing into adulthood.

Given its impact on younger people, in whom the use of medications is restricted for good reason, allergen avoidance and natural remedies are important components of any hay fever management strategy.

Allergen Avoidance

Top tips for minimising or preventing hay fever symptoms include:

• Avoiding grass-based activities such as picnics, certain sports, camping and (of course) grass cutting
• Keeping pets who venture outdoors clean and clear of potential allergens
• Wearing wrap-around sunglasses
• Showering or washing hair after being outdoors in high pollen/allergen areas
• Keeping house windows closed and using an air filter system
• Keeping car windows closed and using an air conditioner with pollen filter
• Taking vacations by the seaside or in the mountains instead of in the countryside.

As alcohol increases levels of histamine (which plays a major role in bringing about hay fever symptoms) it is also good to avoid alcohol when the pollen count is high.

Treating Hay Fever

Antihistamines are the most common treatment for hay fever symptoms and generally have a good safety profile. However, some have been recalled due to heart problems associated with the drugs and others can cause drowsiness, making them unsafe or unsuitable for use when driving, working, or studying. Corticosteroid treatments also have potential side effects, especially in children.

Given these issues, it's no surprise that many people turn to natural remedies for hay fever symptoms. The remedies that appear most effective are those that modulate immune function, helping to prevent or downgrade hypersensitivity reactions to common allergens and decrease inflammatory responses.

Let's look at some of the most popular remedies for which there is at least some evidence of beneficial effects on hay fever symptoms.

Natural Hay Fever Remedies

Biminine

Biminine is a Chinese herbal formula consisting of 11 ingredients, including extracts of Chinese skullcap, Ginkgo biloba, horny goat weed, Schizandra chinensis, and Astragalus membranaceus.

In one randomized, double-blind, placebo-controlled study lasting 12 weeks, biminine was associated with decreases in serum immunoglobulin E (suggesting a decreased risk of hypersensitivity reactions), and had a beneficial effect on some allergic rhinitis symptoms (Hu et al., 2002). Interestingly, the treatment effect persisted for a whole year!

More recent research shows that biminine may help relieve allergic rhinitis symptoms in part for downregulating the production of some cytokine and upregulating activity and production of some immune system cells to support respiratory function (Zhang et al., 2009).

Butterbur (Petasites hybridus)

Butterbur has been studied in numerous randomized, placebo-controlled, double-blind trials, offering high quality evidence. Some trials show it is as effective as fexofenadine and cetirizine for reducing histamine and inflammation and relieving symptoms (Schapowal, 2002; Schapowal, 2005). Butterbur was also seen to help improve rhinorrhea, sneezing, nasal congestion, itchy eyes and nose, red eyes, and skin irritation in 90% of participants in one study (Schapowal, 2004; Käufeler et al., 2006).

Elderberry (Sambuca nigra)

Although there are no studies specifically looking at the effects of elderberry on allergic rhinitis, it does appear that the herb is useful for colds, influenza, and herpes virus infections due to its antioxidant activity and effects on immune function (Roxas & Jurenka, 2007).

Probiotics

Several studies show benefits for hay fever relief using probiotics, especially studies using Bifidobacterium longum, Lactobacillus paracasei, and L. casei. These seem to help reduce inflammatory cytokine production and modulate immunity, and may even help with house dust mite allergies (Nurmatov et al., 2012).

Quercetin

Quercetin is a polyphenol found in onions, apples, berries, grapes, some herbs, tea, and even wine! It is an antioxidant and has numerous effects on immune function.

Quercetin has been found to support antiviral activity and leukotrienes creation, inhibit histamine release, decrease pro-inflammatory cytokines, and suppress interleukin IL-4 production. It can also support better Th1/Th2 balance, and restrain antigen-specific IgE antibody formation, meaning that it may help prevent allergies from developing by calming down excessive immune system responses to common allergens (Mlcek et al., 2016).

Stinging nettle (Urtica diocia)

The leaves of stinging nettle contain serotonin, acetycholine, and histamine, which can inhibit inflammation related to allergic rhinitis (Roschek et al., 2009).

Vitamin E (as gamma tocopherol)

Gamma tocopherol is the primary form of dietary vitamin E and has been seen to have numerous beneficial effects on the nasal airspaces and tissues, including decreasing undesirable effects of allergens such as increased mucus production (Wagner et al., 2008).

Many other remedies have been proposed to help relieve hay fever symptoms, but those above have the most evidence supporting their use to combat sneezes and sniffles caused by allergic rhinitis.

References

Cingi, C., Conk-Dalay, M., Cakli, H., Bal, C. (2008). The effects of spirulina on allergic rhinitis. European Archives of Oto-Rhino-Laryngology, 265(10):1219–1223. 

Hu, G., Walls, R.S., Bass, D., et al. (2002). The Chinese herbal formulation Biminne in management of perennial allergic rhinitis: a randomized, double-blind, placebo-controlled, 12-week clinical trial. Annals of Allergy, Asthma and Immunology, 88(5):478–487.

Käufeler, R., Polasek, W., Brattström, A., & Koetter, U. (2006). Efficacy and safety of butterbur herbal extract Ze 339 in seasonal allergic rhinitis: postmarketing surveillance study. Advances in Therapy, 23(2):373–384.

Mao, T.K., Van de Water, J., Gershwin, M.E. (2005). Effects of a Spirulina-based dietary supplement on cytokine production from allergic rhinitis patients. Journal of Medicinal Food, 8(1):27–30. 

Mlcek, J., Jurikova, T., Skrovankova, S., Sochor, J. (2016). Quercetin and Its Anti-Allergic Immune Response. Molecules, May 12;21(5). pii: E623.

Nurmatov, U., van Schayck, C.P., Hurwitz, B., Sheikh, A. (2012). House dust mite avoidance measures for perennial allergic rhinitis: An updated Cochrane systematic review. Allergy, 67:158–65. 

Rautava, S., Kalliomäki, M., Isolauri, E. (2002). Probiotics during pregnancy and breast-feeding might confer immunomodulatory protection against atopic disease in the infant. J Allergy Clin Immunol, Jan;109(1):119-21.

Roschek, B., Jr., Fink, R.C., McMichael, M., Alberte, R.S. (2009). Nettle extract (Urtica dioica) affects key receptors and enzymes associated with allergic rhinitis. Phytotherapy Research, 23(7):920–926.

Roxas, M., & Jurenka, J. (2007). Colds and influenza: a review of diagnosis and conventional, botanical, and nutritional considerations. Alternative Medicine Review, 12(1):25–48.

Sayin, I., Cingi, C., Oghan, F., Baykal, B., & Ulusoy, S. (2013). Complementary Therapies in Allergic Rhinitis. ISRN Allergy, 2013, 938751. 

Schapowal, A. (2002). Randomised controlled trial of butterbur and cetirizine for treating seasonal allergic rhinitis. British Medical Journal, 324(7330):144–146.

Schapowal, A. (2005). Treating intermittent allergic rhinitis: a prospective, randomized, placebo and antihistamine-controlled study of Butterbur extract Ze 339. Phytotherapy Research, 19(6):530–537.

Schapowal, A. (2004). Butterbur Ze339 for the treatment of intermittent allergic rhinitis: dose-dependent efficacy in a prospective, randomized, double-blind, placebo-controlled study. Archives of Otolaryngology-Head and Neck Surgery, 130(12):1381–1386.

Zhang, S.Q., Shen, Z.Y., Hu, G.R., Liu, R., Zhang, X. (2009). Effects of Chinese herbal formula Biminne in regulating endocrine-immune function in mice with airway allergy. Journal of Chinese Integrative Medicine, 7(4):349–353.