New study finds link between Hayfever and exam performace

Healthcare professionals urged to reconsider their approach to hayfever management

Wednesday 13th June A new study published in the Journal of Allergy and Clinical Immunology has found that students who have allergic rhinitis symptoms on an exam day are 40% more likely to drop a grade in their GCSE exams, and this figure rises to 70% if they are taking sedating anti-histamines.1 Despite current guidelines advocating the use of widely-available non-sedating medication,2 28% of the students taking medication for their symptoms were on a sedating anti-histamine.1

The study, carried out by Education for Health, in collaboration with the University of Edinburgh and Imperial College London, is the first to look at the impact of hayfever on actual exam performance (as opposed to simulated conditions).

Hayfever has a peak age of onset in adolescence.3 Unfortunately, GCSE exams, which run from mid-May to the end of June, coincide with when the grass pollen season is at its height, and hayfever prevalence is at its greatest. Given the large numbers of young people affected, with as many as 63% of students in this study alone reporting hayfever symptoms, the findings are expected to prompt discussions on how to better manage hayfever symptoms in children before and during the exam season.

"We all need to remember in general practice that allergic rhinitis can commonly disturb sleep, reduce learning and cause tiredness, headache and malaise,” commented Dr Steve Holmes, Chair of the General Practice Airways Group (GPIAG) and GP based in Shepton Mallet, Somerset. “The effects of sedative antihistamines are well known. This paper supports the evidence for early and high quality treatment of allergic rhinitis, which often requires more than one therapy. In particular, sedative antihistamines medications should be avoided as this paper shows the worsening impact on examination performance, as a proven risk as well as the other sedative symptoms we see regularly."

“It is vital for young people that health professionals know about hayfever, are familiar with effective treatments and are doing everything they can to ensure that sufferers take them regularly during the pollen season,” commented Dr Samantha Walker, study lead and Director of Education, Research and Development at Education for Health.

1834 students aged 15-17 years participated in the study, and exam performances in mocks and final GCSE exams for the core subjects of Maths, English or Science were compared with responses to questionnaires on hayfever symptoms on the day of the exam. The normal expectation is that most children will either achieve their predicted grades or, with increased effort, improve on them when sitting the final exam. Any drop in grade is therefore unexpected.

The study found:
§ Young people who had hayfever symptoms on an exam day were 40% more likely to drop a grade between their mock and their final exams

§ This increased to 70% if they were on a sedating allergy medication at the time of their exams

§ Teenagers with severe hayfever, and a history of symptoms in previous years, were twice as likely to drop a grade1

§ 28% of those on hayfever medication in the study were on a sedating anti-histamine

§ This is despite the wide availability of non-sedating treatments and current treatment guidelines advocating their use over sedating medication.2

It is hoped that the results of this study will highlight that hayfever is not a trivial condition, and that the symptoms of it should be taken seriously by both sufferers and healthcare professionals. With the wide availability of both over-the-counter and prescription-only non-sedating medications that can effectively control symptoms, there should no longer be any excuse for hayfever impacting on school, work or other activities.

“Hayfever affects 1 in 4 people in the UK and is a distressing condition that may compromise what  for most of us is the best time of the year ' commented Professor Stephen Durham, Professor of Allergy at the Royal Brompton Hospital and President of the British Society for Allergy and Clinical Immunology (BSACI). “Unfortunately the condition is often trivialised not only by doctors and relatives, but  by the patients themselves. What this study tells us is that in addition to causing troublesome symptoms, hayfever may impair examination performance at a very important  time for teenagers and young adults.”

Symptoms of hayfever, which include nasal congestion, sneezing, runny nose, itchy eyes and poor smell can affect people 24 hours a day. The most troublesome symptom is nasal congestion, with 85% of people with hayfever suffering from it.4 This symptom in particular can have a major impact on the patient’s quality of life, notably, emotional function, productivity and the ability to perform daily activities. 40% of patients with hayfever report it has a moderate or severe impact on their sleep, correlating to an estimated 6 million people with hayfever in the UK experiencing sleep disturbance due to their symptoms.5

As well as the symptoms themselves, this high prevalence of sleep disturbance can also have a knock-on effect the following day, with daytime drowsiness affecting performance at work and in children, at school.5

Old-generation sedating anti-histamines can also lead to drowsiness, and have been found to have adverse effects on attention span, working memory, vigilance and speed, as well as higher levels of fatigue, lower levels of motivation, and lower levels of activity compared to placebo.6

Students who are concerned about whether they are on a sedating hayfever medication, or who do not feel their hayfever symptoms are under control, should speak to their pharmacist or GP regarding alternative medication.

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