Testing time for hayfever sufferers who may not make the grade

Research carried out in the UK in the last few years, during the May-June period when pollen counts are typically at their highest, revealed that children suffering hayfever symptoms – sneezing, a blocked or runny nose, itchy eyes, nose and throat, headaches and associated problems like sleeplessness – around exam time were 40 per cent more likely to drop a grade between their mock exams and final exams.

This figure rose to 70 per cent if they were taking sedating

antihistamine treatments, which can cause drowsiness. In one study, 28 per cent of students with hayfever were taking preparations that had a sedative effect.

Now a panel of UK experts has reviewed the evidence on exam performance in relation to poorly-controlled hayfever in teenagers, and they conclude that there needs to be greater debate on the question of whether students with hayfever are unfairly disadvantaged by being forced to prepare for and take crucial exams during the peak of the pollen season.

Writing in the August issue of Expert Review of Respiratory Medicine, authors Victoria Hammersley and Aziz Sheikh of Edinburgh University's Allergy and Respiratory Research Group, and Samantha Walker of the charity Education for Health, say uncontrolled hayfever (also known as seasonal or intermittent allergic rhinitis) can significantly reduce quality of life and interfere with both school attendance and exam performance.

They add that exam boards have recognised that other health problems can affect a student's exam performance and have introduced measures such as offering extra exam time for student with dyslexia. However, this is not generally the case with hayfever.

Hayfever is one of the most allergic problems in young people,

affecting 40 per cent of 13-14 year-olds, closely followed by asthma, which affects 30 per cent of young people. The effects on quality of life caused by hayfever are considered to be at least as severe as those of asthma – impairing sleep, leisure activities and academic performance.

One study which compared hayfever sufferers with a healthy control group showed that those with hayfever had increased difficulty with tasks that needed sustained attention.

A large case study involving 1,834 students looked at the relationship between hayfever, medication and the risk of unexpectedly dropping a grade in the summer exams compared with mock exam results taken in the winter months. Normal expectation is that students will achieve at least the same grades as in the mocks.

Results showed that students with hayfever on an exam day were more likely to drop a grade. The risk increased if they were taking a sedative antihistamine. Those with more severe hayfever were at even greater risk.

The authors believe that, while the science of the previous study is solid, further research is needed and in the longer term a review of courses and exam timetabling should be done to consider whether a winter exam period should be introduced to limit the impact hayfever may have on young sufferers' examination results.

They also suggest that more research is needed into better ways of managing the effects of hayfever on quality of life, improving diagnosis statistics, better education of both patients and health professionals and appropriate medication.

"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," says Dr Victoria Hammersley.

Under-diagnosis of hayfever remains a problem, with as many as 60 per cent of patients failing to consult their GP but instead seeking over-the-counter remedies. Many may not even recognise their symptoms as those of hayfever at all.

"As a group, hayfever sufferers are not well educated about the condition and they are often self-diagnosing, misdiagnosing and taking inappropriate medication," says Candy Perry of the charity Education for Health, which exists to improve the diagnosis, treatment and management of patients with long-term conditions through research and the education of health professionals.

"There needs to be a lot more discussion of how disadvantaged hayfever sufferers are and whether the exam period should be changed, and there also needs to be more specialist training of GPs and other health care professionals.

"But if you were a GP with only a finite budge for staff training,

there are always choices to be made, such as whether to put money into improving the care of patients who've suffered something like stroke, where there is a mortality issue, or allergy education which is seen as a quality of life issue.

"For young people with hayfever, perhaps if they realised they were putting their exam results at risk, more of them might seek appropriate help."