Diagnosis And Treatment Of Hay Fever
( Originally Published 1943 )
UP TO now the reader has learned much about the background and causes of hay fever. There are many approaches to its treatment. This is true of all diseases that do not have a simple, satisfactory cure. Treatment takes two forms—symptomatic treatment, which tries to relieve the symptoms without getting at the underlying cause of the trouble, and specific treatment, which tries to find the cause and either eliminate it or immunize the patient to it. Both methods may be used together in cases where neither is entirely successful.
The two types of remedies used in symptomatic treatment are local applications and internal medicines. The latter are taken by mouth or injected for the effect they have on the whole body. The local applications are usually in the form of eye drops or washes, and nose sprays or jellies.
The eye preparations are nearly always mildly alkaline water solutions. Common salt, baking soda, boric acid, sodium biborate, and glycerine are all used extensively, alone, or in combination, to make a soothing wash. Epinephrine (adrenalin) is sometimes used to reduce the redness of the eyes. Doctors frequently prescribe cocaine be-cause its anesthetic action is very comforting to hot, itchy eyes, but the narcotic laws do not permit this to be used in proprietary preparations commonly sold in drug stores. A little camphor may be added to give a sensation of coolness.
NOSE SPRAYS AND JELLIES
Ephedrine is the drug most used in nose sprays and jellies. It has the power of shrinking the swollen lining of the nose, making breathing easier. Several drugs chemically similar to ephedrine are available if preferred—propadrine hydrochloride, neosynephrine, privine, to mention a few. Some people feel that one of these gives them greater or longer relief than another. Whatever the drug, it may be used in a salt solution or an oily solution, with or without an antiseptic, to be sprayed up the nose, or in a jelly to be squirted up. Benzedrine, also chemically similar to ephedrine, vaporizes easily and is sold in an inhaler tube that can be carried around quite conveniently. None of these is too satisfactory, for after the initial shrinking and relief the mucous membranes usually swell worse than before. Special mention should be made of a commercial product called Estivin, which can be bought at all drug stores. This is an extract of rosa gallica, a variety of sweet-brier. One or two drops are placed in each eye three or more times a day. The fluid is very soothing to the eyes of many and as it passes down the tear ducts into the nose it also gives some relief there. It is far from being a perfect remedy and it does not help some people at all, but to a large number of sufferers it gives considerable relief.
DRUGS USED FOR THEIR SYSTEMIC ACTIONS
Ephedrine, again, is the drug most commonly used by mouth. It causes constriction of the blood vessels of the skin and mucous membranes, relieving congestion, and relaxation of the air passages, helping those that have an asthmatic tendency. Epinephrine (adrenalin) does the same thing but more completely than ephedrine; it has the disadvantage of having to be given by hypodermic injection. Ephedrine and most of the drugs like it have the unpleasant characteristic of making the pulse quicken and the heart pound and cause a feeling of shakiness in the arms and legs. If enough is taken, the hands and knees will actually have an uncontrollable tremor. Most of the hay fever and asthma remedies on the market have ephedrine in them together with a sedative to counteract these unpleasant sensations. The effects of both ephedrine and epinephrine are short lived and the drugs must be repeated frequently if more than just temporary relief is desired. Also, after they have been used over a long period of time, they gradually lose their effectiveness and become useless. Their indiscriminate use is not without an element of danger, especially in people with high blood pressure.
Recently there has been much publicity about the oral use of potassium chloride, histaminase, and vitamin C for the cure of hay fever. It has been fairly well proved that the first two do not help. There is no reason for suspecting that vitamin C will turn out to be a miracle drug either, but such a claim has been made and there has not yet been enough time to find out. The use by injection of "Colon "Metabolin," widely publicized in 1942, has been shown to be without value.
There are several methods of "ionizing" or "cauterizing" the mucous membranes of the nose that are highly recommended by some practitioners. The use of these is not widespread and it is the writer's opinion that such methods seldom accomplish a cure for hay fever, may do permanent damage to the nose, and are better left alone.
Specific therapy depends on finding the factor causing the hay fever and then either avoiding it or else building up a resistance to it in the patient so that it will no longer bother him. Avoidance of the troublemaker is by far the best treatment there is; it works one hundred per cent of the time. This subject has already been taken up in detail, so will not be repeated here. Unfortunately not everyone with hay fever is so situated that he can go away for a month or more on an ocean voyage or a trip to the mountains. .
If you are one who has to stay at home, you may be able to obtain some relief by using one or more of the mechanical devices designed to prevent the contact of pollen with the respiratory tract by removing it from the air you breathe.
There are two general types of air filters, those designed to be worn by the patient and carried around with him and those designed to filter the air in a room. Several makes of both types do fairly good jobs and have the official approval of the American Medical Association. Masks have been designed that fit over the patient's nose and mouth, so that all inhaled air must pass through the filter pads built into them. The pads must be changed frequently or pollen will be drawn through. Little nasal filters, which fit up into the nares, are also on the market; these are held together by a section of a ring which passes below the nose from one nostril to the other. All these filters must be carefully fitted to the face or nostrils to prevent leakage of air around them if they are to be effective. The disadvantages of them are many. When removed for changing of the filter pads, pollens get into the nose and hay fever results; it may take quite a while for this to subside after the contrivance is put on again, during which time the patient must undergo hay fever without benefit of handkerchief. The eyes are not protected and the itching, which to some patients is the most distressing manifestation of the disease, continues unabated. The masks which fit over the face give one the general appearance of an English bulldog, which is not conducive to placidity of mind in a person who desires to remain inconspicuous. The intra nasal filters are less conspicuous, but exhibit a ring reminiscent of the toreador's victim. And these filters have the added weakness of not covering the mouth.
Before the war, several excellent "air conditioners" were on the market. These either recirculated the air in the room, cooling and dehydrating it, or else. brought in fresh air from the outside, filtering it as well. To the best of our knowledge, there was only one that removed all the pollen, which it did by precipitating it electrostatically as the air was drawn between two charged plates. Of the other "conditioners," some made no pretense of filtration while others did a fairly good but not complete job of it. These units were designed to "condition" one room and were semi-portable. Elaborate plants for conditioning the air for the whole house were also available, but they had to be built into the house and could not be installed easily in a house already in existence.
The disadvantage of these machines is that for the most part they do not filter the air completely; some pollen re-mains. They are expensive and most people could not afford them. Also, to obtain relief, it is necessary for the person to be confined in one room; if you have to take a vacation, why take it in one room? Most of the machines make an appreciable noise which is not pleasant to have with one constantly. Despite these disadvantages, there is much to be said for the air conditioner. The worst symptoms of hay fever usually come during the evening and early morning when it is entirely practical to be in one's room. By giving the patient a good night's rest, he may be enabled to avoid much of the fatigue that is often associated with hay fever. The hay fever sufferer usually feels better in a dry cool atmosphere than in a warm humid one. At present, such machines can not be purchased. But when the war is over, they will again be on the market and doubtless in improved and cheaper models.