How to treat HayFever (a surgeon explains)

[@hmbeachable]

Thankyou for these videos Vik! I'm a dentist in Melbourne, Australia and I've been referring heaps of my allergy and sleep apnea patients to your channel. It's giving almost the whole world access to an amazing quality of health information. I've learnt so much from it too. Absolute legend!

[@gloriasaliba3395]

I agree VIk is marvellous I’ve also learnt so much about my sleep apnea and allergies I’m from Sydney :)

[@DurhamHearingSpecialists]

Thanks for the info, I'm suffering bad this year for some reason. Will look into immunotherapy (sounds scary but I fill in crosswords with a pen so am used to living life on the edge).

[@MultiKinster]

Could someone please explain the step-by-step process of getting immunotherapy through a GP? I've asked my GP for a referral, but they refused, which is quite disappointing

[@execbum1]

The other big problem with anti-histamines, which no doctor ever warned me about, was withdrawal pruritis i.e. severe itching from coming off anti-histamines when I had developed anti-histamine dependence. After years on Cetirizine, initially prescribed by an ENT years ago, I decided to see if I could come off the allergy meds, only to suffer the most extreme itching and burning skin for about 2 months. I was never told that this was even a risk and I definitely wouldn't have taken them had I known how severe my suffering would be.

[@VikVeerENTSurgeon]

Thank you for pointing this out. Much appreciated

[@MrJosephmasters]

Rare but severe soundings side effect. Probably not very well known about by most doctors - but it should be! Thank you!

[@goldenultra]

I tried it once made me feel weak and tired. Trying more natural remedies now

[@Jeff.Slavich]

You're the best! I sure wish you were in the US. I'd schedule immediately. I recently went to an allergist and he spent about 6 minutes with me. Took about 30 seconds to look up my nose and that instrument cost me $700 with a $400 office visit. Oh, and no relief. Terribly frustrating.

[@VikVeerENTSurgeon]

Sorry to hear that - The vast majority of doctors aren't like that. I am sure if you asked around you would find someone perfect.

[@syllabubble]

Are immunotherapy treatments the same as desensitization? I had two courses of the latter, for my hayfever, when I was much younger and it worked very well. About twenty or so years later, the hayfever returned and now I live in a rural environment and it's the worst it's ever been. Today it was so bad that saline spray, piriton and otrivine didn't stop it at all. (Strangely, having a little food does a bit - something I don't understand at all). I've been thinking of getting re-tested for allergies to define what I'm allergic to and maybe having some more desensitization, but if what you described is what is offered now, I'm not sure about it. When I had it, each time it was a course of weekly (subcutaneous, I think) injections of the allergens, I think for 8 or maybe 12 weeks, the dose of each one increasing each time.

[@arianoori5924]

You are a life-saver Vik. Thanks so much for your videos. I have a deviated septum and when the pollen level is high I can barely breathe through my nose.

[@MrJosephmasters]

Another awesome video. Thanks from a UK GP! You mentioned Dymista but not Ryaltris! (my precriing preference). Apparently less bitter and also cheaper. I also wonder if there's a suggested order for trialing/combination the various different treatments. Is it useful to think of the options as part of a treatment "ladder" where you can step-up or step down? Or is that too simplistic/constraining and you'd prefer to tailor your treatments based on individual patient characteristics (similar to your approach with sleep apnoea)?

[@VikVeerENTSurgeon]

You've got me beat there. I didn't know about Ryaltris, but it looks awesome! Thank you. Love it. And you got me too on changing my treatment plan for each patient and I think that's because I'm too stupid to remember ladders. My wife (GP) seems to retain so much info in her head, I just can't do it.. I do like having tools on my bag of tricks and using what feels right at the time. Sorry if it is confusing. Great post - thank you

[@munk0821]

Hi I suffer from autoimmune inner ear disease. One of my triggers is hay-fever, my immune system then attacks the cochlear protein in my ear. I take methotrexate but do you think immunotherapy would help. Many thanks Mat

[@EmsThaBreaks441]

Have you any experience with H4 antihistamines - and why are they not used in the UK? (You should also tell people to keep their medication next to their drinks' cabinet or fridge).

[@hooch3668]

What about Nasonex (mometasone furoate)? Great video mate!

[@vanessabe1115]

Hey, sorry if I bother you but I wanted to ask you a quick question if you have time. So I had an eardrum perforation which healed but with a missing layer so the healed eardrum was more thin and now after one year I got an ear perforation in the same area again, my question is can the eardrum heal itself again even if one layer is missing and it's more thin?

[@Rossiyaikitaj]

Hi doctor, i am been on antihistamine for over half a year now and I saline spray my nose every single time. However, I only have symptoms when I am in London, I have absolutely no symptoms when I was travelling around Europe and Japan. Does it mean I should consider moving out of London? But my job is in London though....

[@Justin9503238275]

I have mucosal thickening, inf turbinate hypertrophy and deviated septum and now allergic bronchitis. What do you suggest. Taking steroid inhaler and antihistamine. But no big relief.

[@shy6892]

Also add a steroid nasal spray

[@RebelRobot01]

If you are taking both a antihistamine nasal spray, like Azelastine, and a steroid nasal spray, like fluticasone, for hay fever, for hay fever, is there a particular order you should take them in and a certain amount of time you should wait before taking the second spray?

[@tomburke198]

My wife is having problems with her gp surgery, she’s has seasonal hayfever but it’s quite severe and having a massive impact on her life. They keep referring her to just go and pick up antihistamines and are refusing to go any further with helping her, any advice ?

[@MrDelg0020]

My pancreas seems to flare up when I take antihistamines, get super drowsy and sleepy, and body feels tingly all over - what do you think is going on?

[@adoxographer]

I had horrendous hayfever since I was a child. I undertook three years of desensitisation with Oralair. That, combined with saline rinses, has made 90% of my symptoms disappear (and I live in Melbourne, Australia, one of the worst places in the world for hayfever).

[@zohaibmuhammad6263]

This year my allergy is so bad that nothing works at all. I have been taking Fexofenadine 120 mg supposed to be very strong antihistamine but unfortunately that didn’t work too. I use Beconase before I go out but I don’t think it has ever helped.

[@mj897]

How is it this year?

[@carolannhill3748]

I constantlyfeel as if i have a glob of mucous above my soft palaye. I am sure it is related to my sinuses and nothing i do is getting rid of it

[@hellie_el]

❤❤❤ is there any benefit to wearing a mask (covid style) while outside?

[@VikVeerENTSurgeon]

Good question! I'm not sure. pollen is quite small so you would need to wear the tight fitting masks rather than the simple surgical masks ( FFP3 ), but i guess you would still have eye problems unless you were desperate enough to wear googles all day?

[@hellie_el]

@@VikVeerENTSurgeon :D :D :D

[@susibul5320]

Useful information here, thank you.

[@VikVeerENTSurgeon]

Glad it was helpful!

[@LuigiPapino]

Is there any evidence that keeping the windows closed improves life quality? Closing the windows will lead to build up of CO2 and any other indoor pollutants, and I think it's making my symptoms worse.

[@VikVeerENTSurgeon]

It won't cause CO2 build up, but it might make the house warmer. I would consider opening the windows when the pollen count is low to get the best of both worlds. It really depends on how bad your Hayfever is and if you also have house dust mite allergy.

[@LuigiPapino]

@@VikVeerENTSurgeon and where did you get this information? Everything i read from the various ventilation association and sensors in my home say the opposite

[@VikVeerENTSurgeon]

I'm sorry I can't find any evidence that says that the increase in atmospheric CO2 at ground level at night (because the temperature drop) affects our sleep clinically. You would need to be in a small almost airtight room to make CO2 level rise so much that it would affect your breathing. If I find a good paper confirming if you are right I'll post it here for you. I can only find stuff from companies that are trying to sell products. I'll keep looking as it's an interesting question. Thank you

[@plumeria66]

If you have central air system to keep air circulated like hospitals do, then it works. Hospitals don’t have pollen inside. I know from experience.

[@blackdandelion5549]

Let's talk about it. The sleep study you are referring to was done in the Netherlands and only had 17 participants (students from the school) and was not a double blind study. The participants were all documented sleeping in a room with ALL doors and windows closed by the amount they moved during their sleep, temperature, background noise, and even humidity. The volunteers were also asked to sleep with all of the doors and windows open and the same measurements were taken. In conclusion many scientific peers found that the study simply showed that a room has more CO2 when a human is present in it and all doors to any other room in the home is closed and all windows are closed while when a human is not present during the daytime the CO2 levels dropped in the room as did the temperature of the room and other variables as we humans breathe, produce moisture to cool ourselves, we make noise, and produce CO2. The author of the study of only 17 volunteers made a huge deal out of it and it was printed in the daily mail and article headlines read things like "Open window will help you sleep by stopping CO2 build up" - Daily Mail Title Nov 17th, 2017 when peer reviews actually said "Typically, carbon dioxide levels rise during the night when people are sleeping, especially if the door and windows are closed. The concentrations then fall during the day if the room is unoccupied." and then there is the extremely small set of people in the experiment. The research I found does not state if they reported prior issues with sleep before the study, but the study was done by Dr. Asit Mishra of Eindhoven University of Technology. Magically this sprouted many "fixes" by technology and sales of new items to help with the CO2 in your home and your sleep. The study also only included 2 nights, one with the participants doors/windows open and the other with doors/windows shut. Another study went on to later state that many other variables are not taken into account that affect our sleep such as emotional state, life events, health and emotional stresses, etc. If you are considerably worried about CO2 instead of buying new technologies I suggest doing what the fine doctors did and open the door to the rest of your home and/or use a fan in your bedroom to have a continuous flow of air if central air with a quality filter is not an option. Please feel free to look up the actual study yourself. A previous study was also done at Copenhagen School of Design and Technology. Eindhoven University of Technology is the only one of these school to have anything to remotely do with anything you could call medical and it has a program that is for a Biomedical Engineering Degree AKA the application of engineering principles and design concepts to medicine and biology for healthcare purposes. I hope this clears up ALL studies that have been done in this area and how they have not been done in actual sleep labs nor under any sort of clinical medical supervision and with exceptionally small test pools for the most minimal time possible. Open your door and turn on a fan. @VikVeerENTSurgeon

[@marleywyatt-garciacalbio9736]

What if i just burn the inside of my nose so that the cells stop producing snot and the hairs cant push it down to make my nose run

[@pictlandpickers1171]

My hay fever is horrendous only grass pollen. I sneezed about 30 times this morning. Washed my face and eyes instantly turn red and itchy

[@everetmauiman5321]

Hey hello aloha from Maui Hawaii I love all your you tube videos awesome videos keep on making awesome videos I love it this very informational videos thanks for all this videos right now I am suffering from loss of hearing in my right ear i have fuild in my middle ear i had clean my ears with hydrogen peroxide then 30 later I couldn't hear to well I would some information on this problem aloha brother from Maui Hawaii 🤙🏽🤙🏽🤙🏽🤙🏽🤙🏽 sorry to tell you my name my name is Everet aloha brother brother

[@andrewcollins8774]

Beconaise I believe is a good spray. I am on zirtek 24/7 which stops my hay fever now. Have other allergies as well so zirtek works great for me. And I get the sterimar hay fever spray. But my nose blocks because of Cpap anyway.

[@VikVeerENTSurgeon]

Great ! just be careful not to use the beconase too much as it can't really be given for more than 3 months.

[@andrewcollins8774]

@@VikVeerENTSurgeon Thanks I Don’t use it much. Btw I’m on your waiting list for London ENT as I’m having Cpap complications using it. I’m going to try to get my doctor to send another request for Queens Romford as it’s nearer. Thank you for your patience and Time sharing your expertise.

[@lardyman2]

I take fexofenodine, which has been wonderful for me as it gets rid of most of my symptoms. The nasal spray gets rid of the rest, though with the high heat, I have been taking extra showers and using eye drops as still getting dry eyes.

[@VikVeerENTSurgeon]

Great news! If you are well controlled there is no reason to consider immunotherapy. Hope the prevention tips were useful. Thanks for commenting

[@lardyman2]

​@VikVeerENTSurgeon its controlled, but the constant level of drowsiness for about 8 months of the year brings its own issues.

[@VikVeerENTSurgeon]

might be worth swapping the oral antihistamine for a nasal spray instead? speak to your doctor about it - it would mean you can come off the thing that makes you drowsy? just a suggestion?

[@lardyman2]

@@VikVeerENTSurgeon booked a GP visit to discuss options. :)

[@Lux-Aeternum1]

Anecdotally my hay fever completely went away after I started a low carb diet. This time of the year was usually torture for me. I had to use an inhaler twice a day for most of my life.

[@saml147]

Nice, how low carb roughly? What plants do you still eat?

[@SuperScaryTurtle]

one important question that could actually help i think is when it is the perfect time to take tablet (for example before bed to avoid any exposure in the mornings because its hard to deal with hay fever plus u have to wait for the pill to start working)also how long is the pill effective for and same question for nasal spray etc..

[@blackdandelion5549]

It depends on the medication in question and the spray in question. I can tell you that after a talk with my GP my prescription antihistamine tablets came in a 24 hr and a 12 hr version. I tried the 24 hours version, but felt like they gave out by 18 hours and would wake up with a stuffy nose or go to bed with one. So we switched to two 12's for all day comfort and I need to take it at least 30 min before going outside in the am so during personal prep of washing face, getting dressed, eating breakfast, etc. in the am. Then for a nasal spray the gentleman mentioned doing it right after brushing your teeth and my GP told me the same thing. When we brush our teeth with mint and then we gargle with mouthwash if we feel like we may have a bit of phlegm and we blow our nose out in the morning really well these things really open up the nasal passage ways so that when you spray and do the little "sniff" to get it fully up your nose it has time to work while you are getting dressed and gets you the most coverage as your nostrils are clean and open. You likely groom your hair, maybe lotion your face/makeup, and get dressed and such after so the medicine has plenty of time to work before you leave your home and are exposed to pollens/allergens.

[@Alexanderthegreatdrummer]

For anyone considering buying an air purifier for allergies (as i did) make sure it is a true HEPA filter and NOT a "hepa-type" filter. The difference in filtration is huge and hepa type filters are worthless in my opinion.

[@chazlon5061]

Great topic

[@saml147]

What about local honey? Does that actually work?

[@Rose-jz6ix]

Local organic honey worked on my husband and those who followed the one teaspoon a day everyday. It isn't a quick cure.