An inevitable collision

An Inevitable Collision When asthma, hay fever, and COVID-19 collide

If there’s one thing that’ll ruin those warm, sunny days it’s allergies. And now there’s COVID-19 too. As COVID-19 is likely to be with us for a long time, it’s important to learn about the risks and how to keep allergies under control to prevent asthma episodes. There has never been a more important time to know what is in the air we are breathing.

This year’s pollen season could prove more troublesome during the pandemic as tree pollen counts start to surge throughout most of the country. While the spring and summer allergic burden escalates, patients’ immune and inflammatory pathways will be primed for hyper-reactivity as they are compounded by the additional challenges of the COVID-19 pandemic.

Prof Jonny Peter, who leads the UCT Lung Institute’s Allergy and Immunology Unit says the coronavirus could make allergy sufferers hyperaware of every sneeze and sniffle as some symptoms overlap. Allergies occur when the body’s immune system sees a substance (also known as an allergen) harmful and overreacts to it. Hay fever is activated by airborne allergens, such as pollen, which leads to a runny and itchy nose, scratchy throat, as well as allergic conjunctivitis in the eyes.

While COVID-19 and hay fever share certain symptoms, there are some key differences. In COVID-19, fevers, body aches and headache are common, but these are rarely associated with seasonal allergies. In contrast, an itchy nose or eyes and sneezing signal allergy symptoms and are not common in coronavirus infections.

Shared symptoms may include a runny nose or nasal congestion, an intermittent cough, sore throat and fatigue. In asthmatics, very high pollen counts may trigger exacerbations with shortness of breath or difficulty breathing in some individuals. Fortunately, coronavirus does not commonly trigger worsening asthma. If your symptoms do worsen, it’s advisable to consult your doctor, especially if you have a known sensitivity to pollen.

It’s also likely to have symptoms of both COVID-19 and seasonal allergies at the same time, which will affect each person differently. Some may experience mild symptoms, while others could have more severe symptoms.

SA’s pollen seasons vary across the country’s biomes, which is why the UCT Lung Institute is trying to establish pollen monitoring stations in all the provinces.

Pollen allergy sufferers who are allergic to both trees and grasses usually have the toughest time in September and October as it’s the time of year when grass and tree pollen overlap. That means a double dose of misery for people who are allergic to both.

The grass pollen season can last for up to nine months of the year in certain parts of the country like the highveld, which only comes to an end in May.

GOOD TO KNOW

If you are among the 17.5 million South Africans that suffer from nasal allergies, visit pollencount.co.za for the latest pollen counts countrywide to help you better manage your condition during the pollen season. Also visit saaqis.environment.gov.za for real-time information on air pollution across South Africa. Be sure to address your allergies, so you can make the most of this beautiful time of year and enjoy the weather!

Q & A WITH PROF JONNY PETER

Prof Peter answers some of the burning questions allergy sufferers have that will help them to manage their condition better during the pandemic:

Q: Does having hay fever/allergic rhinitis pose an increased risk of severe COVID-19 complications?

A: No. Current research does not indicate that allergic rhinitis or even well-controlled asthma increases either the risk of being infected with Coronavirus or the chance of developing severe disease. In fact, there have been reports that allergic rhinitis and some treatments used for allergic diseases may be protective, although the data is still emerging.

Q: Will wearing a mask reduce hay fever symptoms?

A: Perhaps. I think it is going to be an interesting aspect of the current pandemic and maybe a silver lining. Masks may offer some protection against seasonal allergies since they can prevent larger particles from being inhaled.

However, smaller pollen particles are still likely to get through the covering, therefore masks should not be your only form of protection. Keep in mind that pollen is a fine powder, microscopic in size, and can travel deep into the nose and lungs. The higher the concentration of pollen in the air, the greater the chance of an allergic reaction. It’s also important to wash your mask after each use, because it could be carrying pollen.

Q: Does COVID-19 exacerbate asthma symptoms?

A: Emerging data suggests that this is unlikely. There are several viral infections that are a common cause for asthma exacerbations, including the common cold rhinoviruses and the respiratory syncytial virus (RSV). Interestingly, the SARS-CoV-2 or COVID-19 virus does not seem to be a major driver of asthma exacerbations. However, always remember to wear a mask in public to prevent the transmission of the Coronavirus.

Q: Is there a way to reduce hay fever symptoms during the pandemic?

A: It is impossible to completely avoid exposure to pollen. However, there are several options available both over-the-counter, and by prescription to manage allergies during the pandemic. Your doctor might prescribe a combination of medicines and treatment options such as antihistamines, corticosteroid nasal sprays and inhalers to keep your symptoms controlled.

SEASONAL ALLERGIES OR CORONAVIRUS?

The coronavirus outbreak is happening at the same time as many seasonal allergies. How can you tell the difference?

STOP THE SNEEZING

More symptoms shouldn't mean reliance on more medication. The best way to combat allergies is to find out exactly what’s sparking them, take charge, and reduce your exposure to the allergen when possible.

In some cases, over-the-counter medications and reducing exposure aren’t enough. You should make an appointment to see your doctor for any persistent allergy symptoms that do not respond to over-the-counter antihistamines. >>

SEASONAL ALLERGIES

advice

The best way to combat seasonal allergies is by enlisting the help of over-the-counter medications, such as antihistamines. Or, if you use antihistamines frequently, it may be time to switch up the routine and try a steroid nasal spray. These sprays reduce inflammation, making it harder for allergens to reach the receptors in your nasal tissue that trigger reactions.

Sources: • Press release Issued by Meropa Communications on behalf of the UCT

Lung Institute • The Real Pollen Count at www.pollencount.co.za • www.nps.org.au/consumers/managing-hay-fever#breastfeeding-andantihistamines • www.cheshiremed.org/health-wellness/article/dealing-spring-pollenallergies • www.everydayhealth.com/coronavirus/allergies-or-covid-19-here-show-to-tell-the-difference/ • www.canadiem.org/spring-is-here-differentiating-covid-19-fromseasonal-allergies/ • www.cdc.gov/coronavirus/2019-ncov/need-extra-precautions/peoplewith-seasonal-allergies-faqs

You can take these 8 steps to reduce your exposure to tree pollen:

Start taking allergy medicine before pollen season begins.

Learn about the trees in your area and when they produce the most pollen. For example, oak tree pollen is highest in the morning. If you are allergic to oak pollen, save your outdoor activities for later in the day.

Check the pollen counts for your area. The Real Pollen Count (www.pollencount.co.za) is a website updated weekly by SA palynologists, people who study particles in the air, and is part of UCT’s Lung Institute of Allergy and Immunology Clinic. The lowest pollen counts are usually in the late afternoon to early evening.

Limit time outdoors when pollen counts are high and avoid activities such as moving the lawn or raking leaves that will stir up pollen.

Keep windows and doors closed in the morning to midday when pollen counts rise.

Using a portable air filter in one or more rooms in your home will also help to filter pollen and dust. Use a high efficiency particulate filter (HEPA) for best results.

Rather use a tumble dryer to dry clothes and bedding as pollen can stick to sheets and towels when hung outside.

Change and wash clothing you’ve worn during outdoor activities and wash your skin and hair to remove pollen.

WATCH THAT RASH. Protect your health.

Your skin acts as a barrier; protecting you from extremes of temperature, damaging sunlight, harmful chemicals or organisms, and injuries.

WHAT IS A FUNGAL SKIN INFECTION?

Fungal infections of the skin are common. They affect more than 20-25% of the world’s population.1,2,3 There are millions of species of fungi. They live in the dirt, on plants, on household surfaces, and on your skin.4 Fungal skin infections can happen anywhere on your body.

WHAT ARE THE MOST COMMON FUNGAL SKIN INFECTIONS?

Some of the most common are ringworm, athlete's foot, jock itch and yeast infections.4

• Ringworm gets its name because of its appearance although no actual worm is involved. Ringworm develops on the top layer of the skin and normally begins as a flat scaly area, which may be red and itchy.

The ring may be uneven, resembling the wavy outline of a worm.5,6 • Athlete’s foot is contagious and can also spread to other parts of your body. Athlete’s foot usually occurs

between toes causing soggy, scaly skin that can split, but it can also occur on the soles of feet, where it may cause blisters or thickened skin, or the skin may even be scaly, dry, red and flaky.7,8,9 • Jock itch is usually found in the inner thigh, buttocks or groin area, and is more common in adult males but can also occur in females. Jock itch causes a red, scaly, itchy and often ring-shaped rash. The border may include small, raised blisters. Jock itch is contagious and can spread from person to person or be picked up from contaminated clothes and towels.7,10,11 • Skin thrush and Pityriasis versicolor are yeast infections. Skin thrush usually appears as a flat, red rash with sharp, scalloped edges and possible small blisters, with smaller patches of similar rash nearby. This infection is often hot and itchy or painful and the skin may become cracked and sore. It is usually found in skin folds such as the armpit, groin, under breasts or between fingers. Pityriasis versicolor is pink or pale to dark brown, sometimes scaly patches, which develop gradually and may eventually form larger patches. These itchy patches are pale on dark skin and dark on light skin and usually found in adolescents and young adults on the trunk, shoulders, neck, upper arms or back.12-17

To treat all of the above fungal infections, use a topical antifungal cream such as Terbane cream – available from your Local Choice pharmacy without prescription.18 The active ingredient in Terbane cream is fungicidal, i.e. it kills the fungus, as opposed to fungistatic, i.e. inhibits the growth of the fungus, like some other antifungal creams. Terbane Cream works within a short treatment period (once or twice daily for usually 1 – 2 weeks), is effective and well tolerated and can maintain the cure over many months reducing the risk of recurrence.18-23

For more information visit www.terbane.co.za

References: 1. Skin. National Geographic Society [online]. Accessed Sep 2020. Available at: www.nationalgeographic.com/science/health- and-human-body/human- body/skin/ | 2. Anatomy of the skin. National Cancer Institute – SEER training [online]. Accessed Sep 2020. Available at: training.seer.cancer.gov/melanoma/anatomy/ | 3. Havlickova B, Czaika VA, Friedrich M. Epidemiological trends in skin mycoses worldwide. Mycoses 2008;51(Suppl 4):2-15 | 4. Fungal Infections of the Skin. WebMD [Online]. Accessed Sep 2020. Available at: www.webmd.com/skin-problems-and- treatments/guide/fungal-infections-skin#4 | 5. BMJ Best Practice. Patient information from BMJ. Ringworm of the body [online]. Accessed Sep 2020. Available at: bestpractice.bmj. com | 6. Ringworm (body). Mayo Clinic Patient care and Health information [online]. Updated 17 Nov 2017. Accessed Sep 2020. Available at: www.mayoclinic.org/diseases - conditions/ringworm/home/ovc - 20232303 | 7. BMJ Best Practice. Dermatophyte infections [online]. Accessed Sep 2020. Available at: bestpractice.bmj.com | 8. BMJ Best Practice. Patient information from BMJ. Athlete’s foot. Accessed Sep 2020. Available at: bestpractice.bmj.com | 9. NHS Choices. Athletes foot [online]. Updated April 2017. Accessed Sep 2020. Available at: www.nhs.uk/conditions/Athletes-foot | 10. Mayo Clinic: Patient care and health information. Jock itch [online]. Updated Dec 2018. Accessed Sep 2020. Available at: www.mayoclinic.org/diseases-conditions/jock-itch/ symptomscauses/syc-20353807 | 11. US Pharmacist. Cutaneous Fungal Infections [online]. Updated Nov 2016. Accessed Sep 2020. Available at: www.uspharmacist.com/article/cutaneous-fungal-infections | 12. Yeast Infection Skin Rash. Emedicine.Health [online]. Reviewed Nov 2017. Accessed Sep 2020. Available at: www.emedicinehealth.com/yeast_infection_skin_rash/article_em.htm | 13. Candidiasis of the skin (Cutaneous candidiasis). Healthline Medical. Reviewed Oct 2016. Accessed Sep 2020. Available at: www.healthline.com/health/skin/cutaneous-candidiasis | 14. Tinea versicolor. Mayo Clinic Patient care and Health information [online]. Reviewed Nov 2017. Accessed Sep 2020. Available at: www.mayoclinic.org/diseases-conditions/tinea-versicolor/basics/ definition/con-20024674 | 15. Pityriasis versicolor. NHS Choices [online]. Reviewed July 2015. Accessed Sep 2020. Available at: www.nhs.uk/conditions/pityriasis-versicolor/ | 16. British Association of Dermatologists. Pityriasis versicolor. Patient information leaflets. Updated Nov 2017. Accessed Sep 2020. Available at: bad.org.uk/leaflets | 17. BMJ Best Practice. Pityriasis versicolor. Accessed Sep 2020. Available at: bestpractice.bmj.com | 18. Terbane cream approved Package Insert, Feb 2016 | 19. Korting HC, Tietz HJ, Brautigam M, et al. One week terbinafine 1% cream (Lamisil®) once daily is effective in the treatment of interdigital tinea pedis: a vehicle controlled study. Med Mycol. 2001;39(4):335-40 | 20. Medical definition of Fungicidal. MedicineNet [online]. Accessed Sep 2020. Available at: www.medicinenet.com/script/main/art.asp?articlekey=25387 | 21. Definition of fungistatic. The Free Dictionary [online]. Accessed Sep 2020. Available at: medical- dictionary.thefreedictionary.com/fungistatically | 22. Evans EG. A comparison of terbinafine (Lamisil) 1% cream given for one week with clotrimazole (Canesten) 1% cream given for four weeks, in the treatment of tinea pedis. Br J Dermatol. 1994;1,30(suppl 43):12-14 | 23. Elewski B, Bergstresser PR, Hanifin J, et al. Long-term outcome of patients with interdigital tinea pedis treated with terbinafine or clotrimazole. J Am Acad Dermatol. 1995;32(2 Pt 1):290-2