For millions of Britons, this time of year heralds the start of hay fever season, which means months of misery as their lives are blighted by constant sneezing, runny noses and itchy, watery eyes.
Whether you’re one of the unlucky ones – and to what extent – has always been thought to be a mix of genetics and environment, with people living in urban areas suffering worse than those in rural areas, for example.
And while pollen is considered public enemy number one for many sufferers, they may not be solely to blame.
Groundbreaking new research now suggests that another element is at work: the bugs in your nose.
Thanks to advances in science, many of us are now aware that our gut microbiome—the gut soup of trillions of bacteria, viruses, and even fungi—plays an extremely important role in our health.
For millions of Britons, this time of year heralds the start of hay fever season, which means months of misery. file image
This microbial mix is now recognized by scientists as essential for supporting the immune system and controlling a range of conditions, including inflammatory bowel disease, obesity, heart disease, food allergies and dementia.
A diverse range of insects and a healthy balance of good and bad bacteria are essential.
Now scientists have found that the mix of bacteria in the tissues lining our nasal passages may be just as important when it comes to hay fever.
Hay fever develops in the spring and summer (although some people get it year-round) when pollen from grasses and trees makes contact with the immune cells that line the mouth, nose, eyes and throat.
In sufferers, the body mistakes the pollen particles for an infection and responds by flooding the area with histamine, a chemical released into the bloodstream to try to flush out the invading organism. It is this histamine surge that causes the symptoms.
Over-the-counter remedies provide relief in about 60 percent of cases. These include antihistamine tablets (such as cetirizine and loratadine), which bind to histamine receptors in the nose and throat and block the effects of the histamine rush.
Corticosteroid nasal sprays such as beclomethasone (brand name Beconase) and fluticasone (Flixonase) also help by suppressing the immune system response. If that doesn’t work, patients can be prescribed Grazax – a tablet made of grass pollen that melts under the tongue and gradually teaches the immune system not to overreact. However, the drug is only available at a small number of specialist NHS allergy clinics.
But could changing the bacterial composition of the nasal cavity be an alternative?
This relatively new area of research gained more attention in January when a paper published in the journal Nature Microbiology revealed that the type of bacterial cocktail you have in your nose can determine whether or not you get hay fever.
Researchers from the US National Institute of Allergy and Infectious Diseases in Maryland and Shanghai Jiao Tong University in China compared the nasal microbiomes of 55 adults with hay fever to those of 105 healthy volunteers.
They found that the recruits with hay fever had much lower numbers of bacteria and 17 times the amount of one type of bacteria: Streptococcus salivarius.
One of the first insects to colonize all of our mouths and noses from birth, it is thought to play an important role in building the immune system early in life. But in hay fever sufferers, levels appear to be too high – and further tests have shown why. When researchers took cells from the lining of volunteers’ noses, exposed them to pollen, and then placed them in a dish next to S. salivarius and other nasal bacteria, S. salivarius immediately attached to the cells of competing bacteria.
The reason for this was proteins on the beetle’s surface, which for some reason ended up in the pollen-bearing cells.
Once the bacteria attach themselves to the cells of the nasal cavity, they stimulate the cell’s production of proteins that promote inflammation, while also stimulating the immune system to activate histamine release, leading to sneezing, watery eyes and a runny nose.
Basically, this particular bacteria appears to increase the immune system’s response to the presence of pollen, making hay fever symptoms much worse.
Researchers now plan to study ways to lower levels of the rogue bacteria without eradicating healthy nasal bacteria at the same time.
And some research already suggests there’s a way to do that—by taking probiotic supplements, just like many people already do for a healthy gut.
One such study in 2022, led by scientists at the National Institute of Integrative Medicine in Melbourne, Australia, recruited 40 severe hay fever sufferers during the hay fever season; Half took a probiotic powder daily, which they sprinkled on food or dissolved in water, while the other were given a placebo powder containing mostly cornstarch. The powder, a commercially available product in Australia, contained a variety of probiotics also commonly found in over-the-counter supplements available in the UK.
The most important were Lactobacillus reuteri GL104, Lactobacillus plantarum LP128, Lactobacillus rhamnosus MP108 and Bifidobacterium lactis B1-04.
The results, published in the journal Frontiers in Nutrition in May 2022, showed a significant reduction in symptoms in the probiotic group compared to those using the placebo.
They also reported better sleep and less daytime sleepiness (a common symptom of hay fever), while blood tests showed the group had more anti-inflammatory cytokines (proteins released by the immune system) compared to pro-inflammatory cytokines.
Dr. Karin Ried, director of research at the National Institute for Integrative Medicine and a scientist involved in the study, said that while taking the probiotics in powder form will affect the bacterial mix in the gut, it will also affect the nasal area. “Probiotics taken orally work primarily on the gut,” she told Good Health.
“But metabolites [by-products produced when probiotics are broken down in the gut] enters other parts of the body via the bloodstream and therefore has an indirect effect on the nose.’
The key to success, she added, is to take probiotics about three weeks before the start of hay fever season to give the gut microbiome enough time to respond properly.
The results are partly consistent with a small British study from 2013 in which 60 hay fever sufferers were divided into two groups: one group drank a daily drink with a probiotic for 16 weeks, and the other group was given a placebo.
The study, conducted at the University of East Anglia and published in the journal PLOS One, showed a significant reduction in nasal tissue inflammation (a key component of hay fever) in the probiotic group due to bacterial changes.
But the patients hardly reported any significant changes in their hay fever symptoms. Still, the researchers concluded in their report: “This is strong evidence of how the gut microbiome can influence distant cells, such as those lining our nasal passages.”
Some research even suggests that our nasal bacterial profile is created in the early years of life and determines whether we suffer from hay fever from childhood.
A 2018 study from the National University of Singapore, published in the Journal of Allergy and Clinical Immunology, looked at nasal swabs from 122 babies in their first 18 months of life. her nose
British allergy experts admit that research into the nasal microbiome offers new insights into how hay fever develops, but warn that it is too early to say whether it will change treatment.
“This has caught the attention of the allergy community,” says Professor Adam Fox, pediatric allergy consultant at Guy’s and St Thomas’ Hospital in London.
“But the truth is that we still know very little about it. For example, we cannot say with certainty whether the nasal microbiome of people with hay fever is like that because they have hay fever or whether it is the cause of hay fever.”
An unusual example of this new interest in nasal bugs is the transplantation of mucus from the noses of healthy donors into the noses of patients with chronic rhinosinusitis. This condition, which affects almost one in ten adults in the UK, is often linked to severe hay fever: it occurs when the nasal passages become inflamed and blocked, allowing bacteria to grow and causing painful sinus infections.
Treatment often includes antibiotics and sometimes surgery to clear the blocked sinuses.
But researchers at the University of Queensland in Australia are currently conducting a study involving 60 volunteers, using nasal mucus transplanted from healthy strangers as an alternative to drugs and surgery. The idea stems from stool transplants used by the NHS to combat C. difficile infection.
Researchers say the study, due to end in 2025, could pave the way for a whole new approach to treating a condition estimated to affect ten million Britons.
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Crystal Leahy is an author and health journalist who writes for The Fashion Vibes. With a background in health and wellness, Crystal has a passion for helping people live their best lives through healthy habits and lifestyles.
