Hay fever: immunotherapy and other treatment options

Completely exhausted, Lena toddles into the bathroom. She has hardly slept, her nose is blocked, her eyes are itchy and puffy red. The seven-year-old has had hay fever since last year, and when the birch pollen flies, the symptoms are particularly bad.

«The first symptoms around the time children start school are now almost typical for the onset of hay fever,» says Dr Miriam Hoernes, a paediatric allergist with a practice in Zurich. «Hay fever has increased significantly in recent decades and patients are getting younger and younger.»

How do anti-allergic medications help?

Even if hay fever symptoms are comparatively harmless, they should be treated by a doctor at an early stage. «On the one hand, the symptoms are a major burden on children's everyday lives,» says Hoernes, «on the other hand, it can lead to a «change of stage», in which the allergic rhinitis develops into allergic asthma.»

As with any allergy, hay fever patients should also avoid contact with the allergy-causing substance. In practice, however, this is not always possible. «In order to alleviate hay fever symptoms, anti-allergic medication in the form of antihistamine eye drops and nasal sprays containing cortisone are available for children , which work well locally,» explains Hoernes. «In addition, the active ingredient antihistamine can also be taken as tablets, juice or drops to quickly and permanently suppress the occurrence of allergic symptoms caused by the body's own release of histamine throughout the body.»

What are the side effects of conventional medication?

However, like any medication, anti-allergic drugs can also cause unwanted side effects. «Nasal sprays containing cortisone can change the nasal mucosa in the long term and allergy tablets can make you tired,» says Prof Ursula Wolf, Director of the Institute for Complementary and Integrative Medicine at the University of Bern. «That's why it makes sense to know about other treatment options that help with very few side effects and can be used as a supplement or alternative to treatment with conventional medication.»

«A herbal medicine made from butterbur, for example, has proven to be particularly effective against hay fever,» explains Wolf. «It works in a similar way to antihistamines, but makes you much less tired.» Homeopathic preparations can also be used. «In young children in particular, a significant improvement in symptoms can be observed after just two to three days.» The Institute Director has also had positive experiences with an anthroposophical medicine based on lemon and quince extract. «In one study, an improvement in symptoms was measured in two thirds of patients,» says Wolf. «In addition, acupuncture can also alleviate hay fever symptoms well and with few side effects.»

Childlike imagination supports the effect of hypnosis

What is less well known is that hypnosis is also used to treat hay fever symptoms. «The effect is based on autosuggestion, i.e. self-influencing,» explains Dr Heinz Rüegg, a specialist in general internal medicine with a certificate of competence in medical hypnosis. «Children in particular, with their natural fantasy and imagination, respond amazingly well, which can alleviate symptoms.» However, hypnosis cannot cure the allergy itself.

If you really want to do something about the causes of hay fever, the only option so far is specific immunotherapy (SIT), also known as hyposensitisation. In this comparatively complex treatment, the body is gradually acclimatised to the allergy-triggering substance with the aim of weakening the allergic reactions and, at best, eliminating them completely. This is also referred to as an allergy vaccination. «SIT can be carried out on children from the age of five,» explains Hoernes. «As children have an immune system that is still learning, they generally have fewer side effects than adults.» There is also evidence that early desensitisation reduces the risk of further pollen allergies and the development of allergic asthma.

«The respective allergen is injected into the upper arm in increasing doses once a week for nine weeks.»

Dr Miriam Hoernes, paediatric allergist about SIT

Immunotherapy is always started in the largely pollen-free period from October to January. «If possible, there should be an interval of two to three months until the next flowering period of the pollen causing the symptoms,» says the allergy expert. «The respective allergen is then injected into the upper arm in increasing doses once a week for nine weeks.»

How long does the therapy last?

SIT can be carried out all year round or, in the case of pure pollen allergy sufferers, as a pre-seasonal short-term therapy. «We prefer the shorter option for children with pollen allergies,» says Hoernes. «To be on the safe side, children should remain in the practice for about 30 minutes after each injection for observation. Physically strenuous activities such as sport, sauna etcetera are taboo on this day.»

In year-round therapy, the build-up treatment is followed by a monthly refresher until the therapy is completed. In short-term therapy, the nine-week treatment is not repeated until the following autumn/winter. «To achieve the desired effect, both forms of treatment must be carried out for at least three consecutive years ,» emphasises Hoernes.

As an alternative to immunotherapy with injections, the allergens can also be administered in the form of tablets or drops. This sounds favourable at first, but it also has its pitfalls. « The drops or tablets must be kept in the mouth under the tongue for two to three minutesin order to be effective,» explains Hoernes. «Many children find this quite difficult, especially with the drops.» In addition, the drops or tablets must be taken daily throughout the pollen season. «Thirdly, allergic reactions can occur in the mouth, throat and gastrointestinal tract in the form of itching,» adds the allergist. «Many patients then prefer to opt for treatment with injections.»

Symptom control can also have a lasting effect

SIT is generally well tolerated and has been proven to be effective. «According to our experience in practice, 25 per cent of patients no longer experience any symptoms, up to 25 per cent experience significantly fewer symptoms and a further 25 per cent experience at least slight improvements,» says Hoernes. Only a quarter of treated patients feel no effect at all. «In principle, it is possible to repeat the specific immunotherapy with a possibly more suitable substrate in a different composition,» explains Hoernes. As an alternative to this treatment, patients have the option of combating the symptoms. Ursula Wolf: «Especially when using complementary medical procedures, the symptoms often improve from year to year.»

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Further information:

Allergy Centre Switzerland aha! www.aha.ch

Alternative therapies for hay fever

The most important complementary medicine options for the treatment of hay fever. All therapies are recognised and their effectiveness has been proven in small studies.

Hypnosis:

• Methode: Psychotherapeutische Heilmethode, bei der ein Trancezustand erreicht wird, in dem das Unterbewusstsein angesprochen werden kann.

• So funktionierts: Über die Vorstellungskraft werden in diesem Zustand positive Bilder und Gefühle erzeugt, mit deren Hilfe allergische Symptome auch im späteren Wach­ zustand gemildert oder ganz ausgeschaltet werden können. Wann starten? Zu Beginn der Pollensaison.

• Kosten: Medizinische Hypnose durch einen Arzt/eine Ärztin übernimmt die Grundversicherung.

• Übrigens: Für Kinder besonders geeignet, da sie noch einen natürlichen Zugang zu Fantasie und Vorstellungskraft haben.

Phytotherapy:

• Methode: Pflanzenheilkunde.

• So funktionierts: Tabletten oder Kapseln zum Einnehmen aus dem Gesamtextrakt der Blätter der Pestwurz. Für Kinder ab 12 Jahren geeignet.

• Wann starten? Etwa vier Wochen vor dem erwarteten Auf­treten der Beschwerden.

• Kosten: Übernahme durch die Grundversicherung. 

• Übrigens: Phytotherapeutische Arzneien sind besonders gut verträglich, da sie nicht wie konventionelle Medikamente nur auf einem Wirkstoff basieren, sondern als Vielstoffgemisch den Gesamtextrakt der Pflanze/des Pflanzenteils enthalten.

Homeopathy:

• Methode: Nach dem Ähnlichkeitsprinzip von Hahnemann entwickelte Therapie, wonach Stoffe, die ein Leiden auslösen, in potenzierter (stark verdünnter) Form genau diese Beschwerden heilen. 

• So funktionierts: Zur Akutbehandlung von Heuschnupfen gelten u. a. die Globuli, Tropfen oder Tabletten «Luffa», «Allium Cepa», «Euphrasia» und «Galphimia» als hilfreich.

• Wann starten? Beim Auftreten der Beschwerden.

• Kosten: Übernahme durch die Grundversicherung bei ärzt­licher Behandlung.

• Übrigens: Neben der Akuttherapie mit Einzelmitteln haben sich auch Komplexpräparate bewährt, die mehrere Wirkstoffe in einem Mittel vereinen.

Anthroposophic medicine:

• Methode: Geisteswissenschaftliche Erweiterung der Schul­medizin, die den Menschen und die Entstehung von Krank­heiten auf insgesamt vier Ebenen betrachtet.

• So funktionierts: Zur Behandlung von Heuschnupfensymp­tomen hat sich vor allem ein Medikament aus Zitronen­ und Quittenextrakt bewährt, das gespritzt, inhaliert bzw. lokal als Nasenspray oder ­salbe verwendet wird.

• Wann starten? Etwa ein bis zwei Monate bevor die Beschwerden auftreten.

• Kosten: Übernahme durch die Grundversicherung. Kosten der Heileurythmie übernimmt die Zusatzversicherung.

• Übrigens: Vor allem bei Kindern gelten auch spezielle Bewegungsmuster aus der Heileurythmie, einem Teilgebiet der anthroposophischen Medizin, als sehr hilfreich.

Acupuncture:

• Methode: Komplementärmedizinisches Verfahren der traditi­onellen chinesischen Medizin (TCM).

• So funktionierts: Stimulation von Akupunkturpunkten durch Nadeln, Laser oder Samen.

• Wann starten? Etwa vier Wochen vor dem erwarteten Auftreten der Beschwerden.

• Kosten: Übernahme durch die Grundversicherung bei ärztlicher Behandlung.

• Übrigens: Bei Nadelangst kann die Akupunktur auch mit speziellen Samenpflastern durchgeführt werden, die aufs Ohr geklebt werden.

This helps to reduce the pollen load

• Pollenschutzgitter an Fenstern und Türen anbringen.

• Abends duschen und die Haare waschen.

• Tagsüber getragene Kleidung nicht im Schlafzimmer ablegen.

• Kleidung nicht im Freien trocknen.

• Durch Nasenduschen die Pollen aus der Nase entfernen.

• Im Freien eine Sonnenbrille tragen, um die ­empfindlichen ­Augen ­zu­ schützen.

• Häufig ­staubsaugen­ oder ­besser ­noch­ Böden­ feucht aufwischen.
• Bei ­heissem,­ trockenem ­und­ windigem­ Wetter­ mit hoher Pollenkonzentration geschlossene Räume bevorzugen.
• Pollenfilter ­fürs­ Auto­ einbauen­ lassen ­und ­die­ Fenster während der Fahrt geschlossen halten.
• Pollenflugvorhersage­ beachten.

How does hay fever develop?

Hay fever is caused by a hypersensitive immune system that incorrectly categorises certain harmless plant pollen from trees, flowers and grasses as dangerous. As a result, contact with the allergy-triggering pollen leads to an excessive immune reaction. This releases large quantities of inflammatory substances, especially histamines, into the body. These trigger the unpleasant allergic symptoms that mainly affect the mucous membranes of the nose and eyes in the case of hay fever.

Read more:

• Hohe Lebensqualität trotz Allergien Einseitige Ernährung? Stress beim Essen auswärts? Tipps und Strategien für das Leben mit Allergien.

• Akupunktur für Kinder ohne Nadeln Akupunktur? Bitte nicht, und schon gar nicht für Kinder? Es gibt eine sanfte Alternative: Shōnishin. Die Heilmethode kommt ganz ohne Piekser aus und wirkt effektiv.