Hayfever is an allergic reaction to pollen. When tiny particles of pollen come into contact with the immune cells that line the mouth, nose, eyes and throat, triggering an allergic reaction. This means that the body overreacts to something that it perceives to be a threat – in this instance pollen, which is mistaken for an infection. The immune system wrongly releases chemicals designed to limit the spread of infection and, in doing so, sets off symptoms like itching, swelling, watery eyes and a runny nose.

Symptoms, ranging from mild to extreme, include itchy eyes, sore throats, runny noses and sneezing and can have a significant impact on the patient’s quality of life. In children, this can affect concentration at school and exam performance, while adult sufferers often feel less focused, are less productive and also experience sleep difficulties. Reactions to grass pollen can, in some instances, also trigger asthmatic episodes.

The first possibility is that allergic rhinitis could be caused by allergies other than grass pollen. This is particularly likely if symptoms are experienced all-year round or at other times of the year besides late spring to late summer. It is therefore vital that the symptoms are carefully assessed, a detailed personal history is taken and allergy testing is carried out. While the majority of hayfever sufferers are sensitive to grass pollen, some instead react to pollen from trees. It is therefore vital that the allergen culprit is correctly identified. If the allergy is not to grass pollen, treatment with grass pollen immunotherapy such as GRAZAX would not be effective and the cost of the treatment would be wasted. If the symptoms are more persistent and not just confined to the warmer months, symptoms could be caused by something else like dust or animal fur. A small minority of people experience symptoms that cannot be explained by allergies – this is known as non-allergic rhinitis. An important part of the evaluation process will be to confirm that symptoms are indeed caused by an allergen and that sublingual immunotherapy would therefore be a suitable treatment. Professor Stephen Till says: “when we assess a patient at Smart Allergy Solutions, we will seek to confirm the most appropriate treatment, including whether sublingual immunotherapy is a suitable option.”

It begins in May and runs through to August, with the season generally peaking between mid-June and mid­-July.

Most patients receiving sublingual immunotherapy report an improvement in symptoms and less use of traditional treatments, such as antihistamines and steroid nasal sprays. In addition, using sublingual immunotherapy from an early age may actually prevent new allergies developing and also reduce the likelihood of getting asthma – which is eight times more likely in children who suffer from hayfever.

One of our team of specialist allergists will take a medical history and perform a skin prick test in order to confirm that you are allergic to grass pollen. Sublingual immunotherapy is generally recommended where symptoms are not adequately controlled by standard medications and affects quality of life and functioning (such as social activities, work or sleep). If you suffer from asthma, the doctor will also confirm that it is well controlled enough for you to receive the treatment.

Sublingual immunotherapy comes in dissolvable tablet or liquid forms manufactured by different companies. The tablet form is used at Smart Allergy Solutions because this is the only kind that is fully approved by the Medicines and Healthcare products Regulatory Agency in the UK. The tablet is placed under the tongue where it dissolves within 10-20 seconds. The first dose will be given under close supervision and the immunotherapy is then taken daily.

The benefits of taking sublingual immunotherapy will only be apparent once the allergen season begins. Symptoms should be milder during the first season. If sublingual immunotherapy is initiated, you will be advised to still continue other hayfever medications (see below: ‘What are the alternatives?’), although research suggests immunotherapy patients need and use these medications less.

Usually, your treatment will ideally start at least three months before the normal onset of symptoms and continue all year round for three years. Improvements in symptoms would be expected from the first year of treatment, but research suggests that this benefit will continue for some years beyond the end of the course.

A number of manufacturers supply sublingual immunotherapy vaccines for grass pollen and other allergies. The Medicines and Healthcare products Regulatory Agency has provided authorisation for grass pollen, tree pollen and house dust sublingual immunotherapy vaccines. Treatments are on offer for other allergens (such as cat and dog) but they are not licensed in the UK. They may be available on a named patient basis if there is a clinical need. If you think this may benefit you, please contact us at info@allergyrhino.com

Sublingual immunotherapy frequently causes mild itching and swelling in the mouth a few minutes after it is taken, but this usually stops occurring within a few weeks of the course. Antihistamines can be taken beforehand during this period. Occasionally some patients develop abdominal pain and diarrhoea. Knowledge of the safety of this treatment is based on multiple studies from around the world. Most patients tolerate sublingual immunotherapy well and severe reactions are uncommon. Studies from Europe report that side effects are seldom troublesome enough for the patient to stop the treatment.

There is very limited access to sublingual immunotherapy on the NHS at present. If you wish to be considered for option please discuss this with your NHS GP or specialist.

Standard allergy medicines suppress the symptoms, such as anti-histamines and steroid based medicines, such as nasal sprays are helpful treatments that will provide relief for many patients. For those with more troublesome hay fever, using these medications remains advisable but often will only provide partial relief from symptoms. These treatments also only work when they are taken and do not reduce the long-term severity of the underlying allergy. Slow release steroid injections are strongly advised against by allergy specialists due to the risk of long term side effects. Immunotherapy is the only treatment which affects the underlying cause of an allergy. Where immunotherapy is recommended, this is additional to standard hay fever medications although clinical trials show that immunotherapy patients need less of these medications over time.

Like all medicines, sublingual immunotherapy can potentially cause side effects. In the early stages of treatment it is common to experience mouth itching and an irritating sensation in the throat within a few minutes of taking the dose. This is a mild allergic reaction and in most cases settles down within 20 minutes of starting treatment. Simple over-the-counter antihistamines, such as cetirizine or loratidine, can help alleviate symptoms and can be taken before the immunotherapy dose to reduce the risk of side effects if preferred. Other common side effects (which may affect up to one in 10 people) include: headache, prickling sensation or numbness of the skin, mouth or tongue, eye or ear itching, eye, nose or mouth inflammation, asthma symptoms, shortness of breath, cough or sneezing, dry throat, nasal discomfort, stuffy or runny nose, swelling of lips or tongue, stomach pain or discomfort, mouth blistering, heartburn, itching, tiredness, fever and chest discomfort. These generally occur in the first week of taking the medication and tend to be mild to moderate and short-lived. Stop taking sublingual immunotherapy immediately and consult a doctor if you experience any of the following: Rapid swelling of face, mouth or throat Difficulties in swallowing Difficulties in breathing Hives Voice changes Worsening of existing asthma Severe discomfort

If both you and the doctor agree that treatment is required, various treatments will be offered to you depending on the history and severity of your allergy which may include; antihistamines, nasal sprays, and sublingual immunotherapy. You will be counselled on how to use each one of your treatments effectively, if immunotherapy is an appropriate treatment, you will then be given the first dose during the appointment under the doctor’s supervision to ensure it is taken correctly. Detailed instructions on continuing with the three-year course will be provided. Following your appointment, you will be required to pay a one-off fee for the first three months’ supply of the medication. We will then take monthly payments and supply the medication, through a GPhC accredited pharmacy, on a quarterly basis to you until the end of the course (36 months). For immunotherapy, once the first dose is administered in the surgery, you will be required to continue each day at home. This simple process involves putting the sublingual immunotherapy tablet under the tongue to dissolve. Regular use increases the tolerance of the immune system towards pollen and the treatment recommendation for this is 3 years. The three-year course can commence at any time but depending on the allergen this is most effective when started at least three months before the appropriate pollen season. Once the patient commits to the course and pays for the first six months of treatment, Allergy Rhino will guarantee a price freeze for three years. You will receive a monthly email from Allergy Rhino, as well as a web-based questionnaire to complete at the end of each hay fever season. Allergy Rhino will automatically inform your GP of the initial results and about the course of treatment.

In the majority of cases, we find that our system of email contact (info@allergyrhino.com) works well and you can also use our contact form on our website to get in touch. You can also call our doctor at 0207 362 1023 if you have any questions.

Chemist Click is our partner pharmacy Contact details: T: 01923549040 A: Cardinal Point, Park Road, Rickmansworth, WD3 1RE W: www.chemistclick.co.uk