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Many of us are affected by allergies, from the dreaded hay fever - the scourge of the summer - to much talked-about food allergies such as lactose and gluten. Dr Mike Dilkes, one of Harley Street's top Consultant ENT Surgeons, and Alexander Adams, reveal their top tips for living with and treating an allergy.
The book is now available in print and as an audio book.
If you need help on allergy-related issues, please feel free to contact Mike at his surgery. We have various articles and information on allergy across this website which you may find helpful:
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Hay fever and allergies are common problems, particular during the summer months. Here Mike Dilkes looks at allergy, hay fever and the things you can do to prevent and manage hay fever.
By far the most common allergies are those triggered by particles in the air that we breathe. From dog hair to dust mites and pollen, these inhaled allergies affect up to a third of adults globally. Unlike ingested (eaten) or skin allergies, sufferers’ symptoms can be triggered simply by a deep breath.
But, before we look into this further, just what is an allergy?
In a nutshell, it’s when the body’s immune system overreacts to a normally harmless substance.
Mast cells, which are a type of immune system cell, mistakenly release a cascade of chemicals that are actually supposed to fend off infections.
The most potent of these chemicals is histamine, which is responsible for the uncomfortable symptoms of an allergic reaction such as sneezing, runny nose and itchy, irritated and watery eyes.
It also causes a build-up of mucus in the tubes that supply air to the lungs. These reactions are designed to purge the body of harmful ‘invaders’ such as bacteria or poisons. But, in an allergy sufferer, non-threatening substances, such as grass pollen, evoke the same severe reaction a poison would.
In the case of inhaled allergies, it occurs when the substance – we call them, collectively, allergens – comes into contact with the tissues inside the mouth, nose, and throat, and eyes. The soaring temperatures during the recent Easter Bank Holiday saw millions struck down, thanks to the most common culprit: pollen. This is commonly known as hay fever, or allergic rhinitis, among doctors. While many bask in the glorious spring sunshine, the one-in-five Britons who suffer hay fever avoid it like the plague, dreading the start of months of misery.
Symptoms are usually worse during the summer months – between late March and September – when the pollen count is at its highest. While widespread, it’s no trivial matter: hay fever is linked to poor sleep: 57 per cent of adults and 88 per cent of children with the condition have sleep problems, leading to daytime fatigue and decreased cognitive functioning. In fact, research shows that two million drivers have accidents, near misses or experience loss of vehicle control as a direct result of their symptoms.
The good news? There is something you can do about it.
IS IT HAY FEVER – OR A COLD?
Many of the symptoms of hay fever are similar to those of a cold or flu, such as blocked, runny nose, cough and exhaustion. But there are a few tell-tale signs that are unique to the allergy.
Itchy eyes, for instance, do not occur with colds, like they do in hay fever. And if sniffles come with aching limbs, it’s most likely a cold, not hay fever.
Cold symptoms also dissipate after a week or two whereas hay fever persists for at least six weeks. The vast majority of hay fever sufferers will guess correctly that their symptoms are linked to pollen count, and self-diagnose.
The general advice is to note what symptoms you have, when they occur, how often and in what situations. This information can then be presented to a pharmacist who will be able to confirm that hay fever is the culprit and recommend over-the-counter treatments. Otherwise, common sense rules apply: check online weather reports for pollen counts and stay inside when the count is high.
For most people, this is enough to keep symptoms at bay. But for an unlucky few, the sniffles are relentless, making any outdoor activity an arduous task. So, if you are really suffering, your first port of call should be your GP, who may be able to offer stronger medication or recommend other approaches.
HOW TO STOP HAY FEVER FROM STRIKING
Key to preventing a flare-up of symptoms is knowing what you have to steer clear of.
While avoiding cats, if pet fur is a trigger, might be easy, it’s almost impossible to avoid all pollen without moving somewhere mountainous, dry and arid. Thankfully, there are effective methods to minimise exposure, keeping symptoms at bay.
It’s essential you are proactive – adhering to these vital steps will significantly minimise the impact of your symptoms.
1. Allergy-proof your home
Pollen counts are highest in early morning and early evening, so keep windows closed at these times. Sealed stone or tiled floors are preferable to carpets, and avoid rugs. Vacuum regularly and consider having a dust filter fitted to your vacuum cleaner. Always dust with a damp cloth so the dust is absorbed.
2. Always shower before bed
Pollen and other triggers get trapped in our hair during the day, eventually making their way into our airway. If you don’t shower at night, you essentially incubate yourself in the thing you are trying to avoid for eight hours. Launder your pyjamas and bedding regularly, too, to get rid of the dust and pollen that may accumulate.
3. Honey won’t help hay fever
Don’t believe the old wives’ tale that a spoonful of honey prevents allergic reactions to pollen. Many tout that honey contains pollens, which means a teaspoon grants the body early exposure, dampening the immune response. This is false: honey does not contain grass and tree pollen.
Honey is in fact made by honeybees from the nectar of flowers and plants, not pollen.
4. Don’t remove your nose hair... or pluck eyebrows
These hairs serve a very important function in preventing allergens in the air from entering the body.
Hypersensitive nasal hairs act as a defensive wall against inhaled allergens, and can trigger sneezing to expel any particles before they are inhaled. Likewise, particles get trapped in the eyebrows, preventing them from entering via thin membranes in the eye. But don’t panic, light trimming of unruly brows and protruding nasal hairs is fine, just as long as you don’t wax or remove the hairs completely.
THE LADDER OF ALLERGY TREATMENT
In theory, treating hay fever should be pretty straightforward: block the immune response and stop the effects of histamine in its tracks. But this line of attack often isn’t necessary, given the surprising impact of non-drug treatments.
This is why it is best to use what I call the ‘ladder of intervention’, trying one measure at a time.
If one method of treatment doesn’t work, move on to the next. Different people will respond differently to each stage of the ladder.
Work your way from number one to eight, stopping when you find an intervention that works for you.
1. Sniffing salt water
Using salted water to remove dust, pollen and debris that collects in the nose is an effective way of alleviating cold-like symptoms. This is easily achieved with a plastic device called a neti pot, which flushes out the nasal cavity. You can get them from many High Street chemists. For a detailed explanation on how this works, see the box below. Try doing it first thing in the morning and last thing at night. Research shows that thinning the mucus in your nose with water removes the allergens that cause irritation.
2. Simply use Vaseline
A thin layer of petroleum jelly rubbed around nostrils helps prevent particles entering the nasal passage. Essential at night, it also works fantastically in conjunction with the salt water washout or nasal sprays.
3. Antihistamine and sprays
Antihistamines reduce or block the histamine chemical, reducing bothersome symptoms. They are available as a nose spray and eye drops over the counter. Steroid nose sprays, available on prescription, are similarly useful as they dampen the immune system, reducing the over-reaction.
4. Mast cell stabilising sprays and eye drops
A substance called sodium cromoglycate can stop mast cells from releasing histamine, preventing symptoms. It is only effective for allergies that affect the nose, eyes or lungs and can be particularly impactful when used in combination with antihistamine and steroid sprays. The medication is available as a spray, drops and in inhaler form over-the-counter.
5. Antihistamine tablets
Stronger antihistamines are available in tablet form – both drowsy and non-drowsy types. Some are available over the counter, but the strongest require a GP prescription. When reading a label, check for the following active ingredients if looking for the drowsy type: chlorphenamine, hydroxyzine and promethazine. For non-drowsy: cetirizine, loratadine and fexofenadine.
6. Anti-asthma drugs
Anti-inflammatory medication for asthma, called anti-leukotriene, can be helpful for hay fever and other inhaled allergies, but is only available on prescription. The tablets block the chemical leukotriene. This is released by the body when allergens strike, which causes inflammation in the nose and airways.
7. Steroid tablets
Steroids work by reducing the inflammation in the lungs, nose or throat, caused by the overactive immune system. Tablet-form steroids are usually intended for short-term use due to common side-effects such as vision problems, joint pain, anxiety or loss of appetite.
If you experience any of these, contact your doctor straight away.
Don’t worry, these symptoms are only temporary, but a GP may decide to make small changes to dosage and drug type.
8. Immunotherapy: A dose of what you’re allergic to
Administering a tiny dose of the substance you’re allergic to is said to desensitise the immune system to it, reducing the adverse reaction. This type of treatment is high risk and usually only considered by a GP in severe hay fever or other inhaled allergies once all other options have failed. It is an arduous course, taking several years.
Once you stop, symptoms that were reduced significantly can start to reappear. Few qualify for it on the NHS and those who go privately will pay £9,000 for a three-year course.
Mike first wrote this article for the Mail on Sunday - you can see the hay fever article here.
To find out more about hay fever and allergies, either contact us or find further information on our website:
Allergy treatments >>>Allergy frequently asked questions>>>Allergy truths and myths >>>Contact us to discuss allergy >>>
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To coincide with the launch of Mike Dilkes's latest book, Stop Allergies from Ruining Your Life, today the Mail on Sunday launched a series of articles written by Mike on the topic of allergies.
The 8-page pullout, covers a range of allergy-related topics, including hayfever management and prevention. You can read Mike's articles on allergies on the Daily Mail website. In this blog we offer an extract from the series which looks at the 'ladder of allergy treatments' which covers eight steps you can go through to manage allergies
Ladder of Allergy Treatments
Work your way from number one to eight, stopping when you find an intervention that works for you.
1. Sniffing salt water
Using salted water to remove dust, pollen and debris that collects in the nose is an effective way of alleviating cold-like symptoms. This is easily achieved with a plastic device called a neti pot, which flushes out the nasal cavity. You can get them from many High Street chemists. F
2. Simply use Vaseline
A thin layer of petroleum jelly rubbed around nostrils helps prevent particles entering the nasal passage. Essential at night, it also works fantastically in conjunction with the salt water washout or nasal sprays.
3. Antihistamine and sprays
Antihistamines reduce or block the histamine chemical, reducing bothersome symptoms.
They are available as a nose spray and eye drops over the counter.
Steroid nose sprays, available on prescription, are similarly useful as they dampen the immune system, reducing the over-reaction.
4. Mast cell stabilising sprays and eye drops
A substance called sodium cromoglycate can stop mast cells from releasing histamine, preventing symptoms. It is only effective for allergies that affect the nose, eyes or lungs and can be particularly impactful when used in combination with antihistamine and steroid sprays. The medication is available as a spray, drops and in inhaler form over-the-counter.
5. Antihistamine tablets
Stronger antihistamines are available in tablet form – both drowsy and non-drowsy types. Some are available over the counter, but the strongest require a GP prescription. When reading a label, check for the following active ingredients if looking for the drowsy type: chlorphenamine, hydroxyzine and promethazine. For non-drowsy: cetirizine, loratadine and fexofenadine.
6. Anti-asthma drugs
ANTI-INFLAMMATORY medication for asthma, called anti-leukotriene, can be helpful for hay fever and other inhaled allergies, but is only available on prescription. The tablets block the chemical leukotriene. This is released by the body when allergens strike, which causes inflammation in the nose and airways.
7. Steroid tablets
Steroids work by reducing the inflammation in the lungs, nose or throat, caused by the overactive immune system. Tablet-form steroids are usually intended for short-term use due to common side-effects such as vision problems, joint pain, anxiety or loss of appetite. If you experience any of these, contact your doctor straight away. Don’t worry, these symptoms are only temporary, but a GP may decide to make small changes to dosage and drug type.
8. Immunotherapy: A dose of what you’re allergic to
Administering a tiny dose of the substance you’re allergic to is said to desensitise the immune system to it, reducing the adverse reaction. This type of treatment is high risk and usually only considered by a GP in severe hay fever or other inhaled allergies once all other options have failed. It is an arduous course, taking several years.
Once you stop, symptoms that were reduced significantly can start to reappear.
Few qualify for it on the NHS and those who go privately will pay £9,000 for a three-year course.
If you need help on allergy-related issues, please feel free to contact Mike at his surgery. We have various articles and information on allergy across this website which you may find helpful:
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What you need to know about allergy. 5 myths and 5 truths about allergy.
Myths
1) You can catch allergy from someone else. Wrong! Allergy is not transmissible from one person to another. It is a disorder of our immune system, and is from our genes.
2) Allergy is a killer. Well it can be, but it is extremely rare. The vast majority of people with allergy, whether it be food or pollen, will just find it a nuisance.
3) Allergy gets worse with age Wrong! Allergy often improves or even disappears as we get older.
4) Short haired or hairless animals/pets dont trigger allergy. Wrong! Its not the hair that we react to in allergy, but the proteins in the animals saliva, which they use to groom and clean themselves.
5) Allergy and intolerance are the same! Wrong! Particularly when thinking about food allergies and intolerances, symptoms are similar but the underlying mechanism is very different.
Truths
1) Allergy is easily treated Yes, the mainstay of allergy treatment is with antihistamines and steroids, either as sprays, inhalers, creams or tablets.
2) Allergy can cause asthma and loss of sense of taste. Yes, allergy is one of the main causes of asthma, and in these patients polyps can appear in the nose, which block the passage of inhaled air to the smell receptors - so sense of smell is lost, and with that the sense of taste also.
3) Mouth tingling and swelling when eating can be caused by birch pollen allergy? Yes, this is oral allergy syndrome, and occurs particularly when birch allergy sufferers eat food containing hazelnut - as it cross reacts with the birch pollen antibody. People often mistake this for anaphylaxis - but it's not.
4) Allergy is genetic - you can inherit it Yes, there is an increased incidence of allergy in the children of allergic parents.
5) Allergy can make you blind? Yes. severe atopic keratoconjunctivitis, which is an allergic eye disease, can lead to blindness.
Want to know more about allergy?
Visit our allergy information page >>>Understand costs for allergy treatments >>>Visit our allergy frequently asked questions page >>>Allergy problem? Contact us >>>
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There are many potential causes of a blocked nose, so the method of curing a persistent blocked nose will vary. That said, here are some tips to help sufferers consider a course of action.
Curing a persistent blocked nose can be easy or difficult depending what the cause is – so you need to see an ENT surgeon asapThe easiest problem to solve is rhinitis caused by allergy, as this can respond very well to medication such as steroids or antihistamine. Identifying the allergen can also help, blood and skin prick tests along with taking a thorough history are how you do this. Salt water sprays and douches are also useful.The toughest problem is extreme allergy – nasal polyps, which completely block the nose, cause loss of taste and smell, and are linked to asthma. Surgery is usually not curative and a cocktail of drugs is required to keep them at bay. Monoclonal antibodies may be useful but are in the trial period.Medium sized problems include a deviated nasal septum and septum adhesions, along with chronically enlarged turbinates. They respond well to surgery, under either local or general anaesthetic.Other causes include perennial non-allergic rhinitis and sinus tumours. The latter are rare and usually present with bleeding, blockage and pain. The former may respond to steroids and/or surgery.
If you want to learn more about issues related to blocked nose, take a look at ourblocked nose guideor contact us.
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The treatment of tonsil stones is one of the most common procedures we perform at the Mike Dilkes ENT Laser Surgery. So what are the signs of tonsil stones, how do they appear and what can you do about them?
1. Tonsil stones form when cracks (crypts) and holes appear in the tonsils, usually due to expansion and contraction during tonsillitis, often several years previously. They are usually in the top of the tonsil, hidden behind the flap of tissue in front of the tonsil. They can occur anywhere in the tonsil though.
2. Food that you are chewing enters these cracks and holes, the chewing and swallowing motion forces it deep into the tonsils where it is compressed into a ball and lodges.
3. The lodged food decays, causing a bad taste and smell. As it decays it crumbles and becomes liquefied or soft, whereupon it is expelled from the cracks and holes at now has a soft consistency. This can set off tonsillitis as an inflammatory response occurs around the decaying food.
4. Some tonsil stones harden within the crypts and can stay present for many months, and can be seen on cross sectional imaging – CT scanning is the best – where they show as calcified lumps.
5. Tonsil stones can be treated by the patient using water jet instruments to flush them out, or cotton buds etc – this can make the tonsil bleed and can be quite uncomfortable.
6. Laser Tonsillectomy under local anaesthetic is usually enough to remove all of the holes and cracks, which go right to the deep parts of the tonsil, yet leave a small amount of tonsil tissue behind, so that the function of the tonsils – to recognise infection and help produce antibodies etc - is retained.
Related Links:
Find out more about tonsil stones >>>Read our guide to tonsillectomy >>>Watch our laser tonsillectomy video >>>Understand the costs of tonsillectomy >>>Get in touch if you need help with tonsil stone problems >>>
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Over the years, Mike has made many media appearances discussing his pioneering work in the fields of laser tonsillectomy and providing help for people to stop snoring.
Previously dubbed the ‘the patron saint of snorers’, this week Mike was interviewed by the Times newspaper. Mike summarised some of the findings of his book, Stop Snoring the Easy Way, giving advice on ways to tackle snoring.
You can read Mike Dilkes' top tips for tackling snoring in the Times. And if snoring is a problem for you - or more particularly the person who shares your bed - you can find out more about how to stop snoring on the various resources we have across this website.
Want to improve your sleep and manage issues like snoring? Here is a list of articles and advise which may help with snoring:
Understand sleep and snoring >>>Buy Mike's book on managing snoring >>>Frequently asked questions regarding sleeping >>>All our blogs on snoring >>>Fees for snoring treatments >>>Contact us to discuss sleep, snoring and sleep apneoa >>>
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We had the pleasure of sitting down with Expert Consultant General Ear Nose and Throat Surgeon Mr Mikes Dilkes, to find out about Laser Tonsillectomy and how the latest innovative developments can help patients resume back to their normal lifestyle in record time.
Tell us a bit about yourself and where you currently practice I qualified in 1985 after training at St Mary’s Hospital, Paddington and since worked in various Hospitals within ENT across London and Bristol before being appointed to St Bart’s Hospital in 1996 where I resided until last year. Outside of my role I enjoy sports, in particular sailing and football – I’m a big Chelsea Fan and take great pleasure seeing them play at Stamford Bridge. I currently practice at , and Holly House Hospital.
Following your love of sports, you have worked closely with high profile sporting organisations as an ENT consultant, how was this? I’ve been fortunate enough to work for the England Cricket team, the British Association and the Amateur Boxing Association to name a few. It’s fantastic to be able to treat our finest athletes and see them return to their profession stronger and fitter than before.
In what circumstances is Laser Surgery performed? Laser surgery is performed to treat a wide range of conditions, this includes throat cancer, tonsils and facial moles. Over the course of my career I have have performed over 4,000 laser procedures for a wide variety of conditions – with laser surgery being one of my specialties.
What are the benefits of a patient having Laser Tonsillectomy Surgery? Tonsillectomy surgery performed by traditional means, is one of the most painful operations in surgery and can be associated with life threatening bleeding. Recent developments in laser technology, using state-of-the-art facilities mean that the tonsils can now be removed whilst preserving their capsule. This procedure I have pioneered is called intracapsular laser vaporisation tonsillectomy and takes around 20 minutes to perform and is completed using a operating microscope and mircomanioputaor.
What is the general recovery time for a patient who has had tonsillectomy surgery with the Mike Dilkes ENT Laser Surgery? The general recovery time for a patient is around seven days for Tonsillectomy surgery with the patient being discharged after 4 hours. If a patient receives painkillers, it’s possible for them to resume back to normal duties after 48 hours – which sees them being able to eat relatively normally throughout the healing process. Patients will return for a follow up after four weeks.
Are there any complications associated with Intracapsular Laser Vaporisation Tonsillectomy? Significant bleeding is extremely rare with only 0.2% of patients recorded after receiving surgery. My re-admission rate with complications is 0% here at The London ENT Unit.
This article was initially published by the Hospital of Elizabeth's & St John under the title: Pioneering Laser Tonsillectomy with Mr Mike Dilkes
Book an appointment to see Mike >>>
Learn more about Laser Tonsillectomy
The Tonsillectomy Guide- a simple guide to all aspects of tonsillectomy including diagnosis, approaches to the operation, the procedure and recovery from tonsillectomy
Frequently asked questions - short, sharp answers to common tonsillectomy questions
- overview of laser procedures available
Laser tonsillectomy video- short video which illustrates the laser tonsillectomy operation
How much does laser tonsillectomy cost- understand the costs associated with private treatment for a tonsillectomy operation
Tonsillectomy for children - considerations for the operation for children
Tonsillectomy and private medical insurance - understand how to use your medical insurance for a tonsillectomy operation
NHS or private tonsillectomy? - understand the pros and cons of each approach
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Tonsillectomy is a common operation which helps free people from pains associated with a range of throat-based problems. Whether you are looking for tonsillitis treatment, suffering from inflamed tonsils or issues such as quinsy, tonsil stones, sleep apneoa or snoring, tonsillectomy can be a very effective treatment.
At Mike Dilkes ENT Laser Surgery, we have developed expertise in all aspects of ENT, but are one of the most renowned consultancies with regards laser tonsillectomy. Laser tonsillectomy is substantially less painful and quicker to recover from than standard tonsillectomy.
We have a wide range of information and resources on our website to help you understand laser tonsillectomy. So, please explore the following resources if you think you may benefit from a tonsillectomy operation:
The Tonsillectomy Guide - a simple guide to all aspects of tonsillectomy including diagnosis, approaches to the operation, the procedure and recovery from tonsillectomy
Frequently asked questions - short, sharp answers to common tonsillectomy questions
- overview of laser procedures available
Laser tonsillectomy video - short video which illustrates the laser tonsillectomy operation
How much does laser tonsillectomy cost - understand the costs associated with private treatment for a tonsillectomy operation
Tonsillectomy for children - considerations for the operation for children
Tonsillectomy and private medical insurance - understand how to
NHS or private tonsillectomy? - understand the pros and cons of each approach
If you think you may need a tonsillectomy operation, or simply want to discuss your symptoms, please contact us.
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One third of the UK population suffers from sleep problems. In a recent two-part television show on Channel 5, Eamonn Holmes and Ruth Langsford attempt to cure their own sleep issues and offer a range of sleep related tips.
Having previously appeared on their Good Morning show, Mike Dilkes was called in to help on the show. Mike was set to work with a patient hailed as being one of the world's loudest snorers. The patients snoring emitted noises equivalent to a low flying jet according to one expert who measured the snoring sounds.
Mike diagnosed the patient with sleep apneoa and put her on a course of action to improve the quality of her sleep.
You can watch both programmes on My5. Mike appears on episode 2.
Want to improve your sleep and manage issues like snoring?
Understand sleep and snoring >>>Buy Mike's book on managing snoring >>>Frequently asked questions regarding sleeping >>>Contact us to discuss sleep, snoring and sleep apneoa >>>
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