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  • AutorenbildMichael Mutter

Hay fever and diving

Hay fever is one of the most common allergic diseases. According to the literature, up to 25% of the population in Switzerland are affected, including many divers.


Walensee. Image template: Karin Aggeler

The cause of hay fever is that the immune system reacts erroneously to harmless pollen and produces specific antibodies that release hormones that cause inflammation (e.g. histamine) upon renewed contact with pollen. Within minutes or seconds, these lead to the typical symptoms such as swollen nasal mucous membranes, runny nose, conjunctivitis of the eyes, etc.


Hay fever can occur all year round.

Hay fever usually occurs seasonally. However, as some plant species flower all year round or several times a year, it can also manifest itself all year round. In addition, many other allergens trigger hay fever, which is why it is not necessarily tied to one season. Cross-allergies to certain foods also occur, as the protein structures of pollen and certain foods are similar.


Seasonal triggers are e.g.

  • Willow, alder (January to March)

  • Birch (April to May)

  • Grasses (June to August)

  • Mugwort and plantain (August to September)


Examples of year-round (perennial) triggers:

  • House dust mites

  • Mould spores (in damp environments)

  • Animal allergens (cat, horse etc.)

  • Food (e.g. birch-kiwi-celery cross-allergy)

  • Occupational allergens (e.g. flour for bakers)

Crucial: Know your triggers.

The diagnosis can usually be made on the basis of the symptoms and medical history. It is important to recognise the triggering allergens. Various skin tests (e.g. prick) and antibody tests in the blood (RAST) are used for this purpose. If necessary, provocation tests can be carried out in which the allergen is introduced into the nose and the symptoms as well as the extent of nasal congestion are measured.


Beware of barotrauma!

The main problem with diving is barotrauma, which is caused by the swollen mucous membranes, as with a cold. All paranasal sinuses are at risk, including the middle ear, if the Eustachian tube is blocked. For this reason, consistent treatment of hay fever is essential to maintain fitness for diving. For divers, the problem is that hay fever can change floors over time and manifest itself as asthma in the bronchial tubes.


Basis for therapy: avoid triggers

The basis of the therapy is based on avoiding the allergens (as far as possible). If year-round triggers are involved, such as a house dust mite or animal hair, bedrooms must be sanitised or contact with animals (e.g. horses) must be avoided. This can go as far as changing jobs in the case of occupational hay fever (e.g. bakers). The good news for divers is that allergens are immediately eliminated underwater (as long as the breathing gas is not contaminated). However, diving with a blocked nose is forbidden.


Good news: holidays by the sea can help.

Changes of location, such as holidays by the sea or in the mountains, also help to avoid allergens. People who are severely affected in Switzerland can be completely symptom-free by the Red Sea. Also a mountain lake weekend in the Engadine could bring relief, depending on the allergen sensitisation.


A long-term measure is desensitisation. The aim is to slowly habituate the body to the allergen, which is usually injected under the skin at regular intervals. It also helps to prevent hay fever from spreading to the bronchial tubes and thus causing asthma.


Consistently use decongestant sprays

Antihistamines are frequently used for treatment. They block the inflammatory effect of the allergy-triggering tissue hormone histamine and are used once a day in tablet form or several times a day as a nasal spray. They are very effective against sneezing and burning eyes, the effect on the swelling of the nasal mucosa is somewhat less pronounced. The disadvantage of older antihistamines in tablet form in particular is that they cause drowsiness. Unfortunately - as with all medications! - we do not know how they work under hyperbaric conditions. There is a risk of premature or excessive rapture of the deep or increased oxygen toxicity. They should therefore not be used when diving.


For divers: caution with systemic antihistamines

Topical cortisone sprays are highly recommended for divers. They have a very good decongestant effect on the nasal mucosa and thus ensure adequate venting of the sinuses. Their disadvantage is their delayed onset of action, which is why they must be used early and preventively. The effect of modern cortisone preparations is limited almost exclusively to the nasal mucosa. They are not absorbed by the body, which is why no side effects in the organism are to be expected. For this reason, they can - and should! - be dived with.


Conclusion

Hay fever is very common. As it can potentially cause severe barotrauma due to the swelling of the nasal mucosa, divers with corresponding symptoms should seek counselling and treatment. It is often possible to avoid the allergens that trigger hay fever by choosing a favourable holiday destination, thus avoiding the occurrence of hay fever to ensure diving without any problems. If this is not possible, hay fever should be treated consistently, even preventively, with sprays that decongest the nasal mucous membranes in order to maintain fitness for diving. Because hay fever often goes hand in hand with asthma, or it develops over the years, it must also be consistently searched for and treated.

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