Crucial exams take place during adolescence in most societies, which can have a major impact on an individual's career trajectory. In a Guest Editorial appearing in the August issue of Expert Review of Respiratory Medicine, a team of UK experts review the evidence of the disease burden associated with hayfever and summarize recent evidence suggesting that poorly controlled hayfever can adversely impact on exam performance. Authors Victoria Hammersley and Aziz Sheikh of Edinburgh University's Allergy & Respiratory Research Group together with Samantha Walker of the charity Education for Health draw upon these data to reflect on the question of whether students with hayfever are unfairly disadvantaged by being forced to prepare for and sit examinations during the peak of the pollen season. 

Uncontrolled hayfever (also known as seasonal or intermittent allergic rhinitis) can significantly reduce quality of life and interfere with attendance through school absences. There is also some evidence pointing to the fact that exam preparation and performance may be adversely affected by allergic rhinitis, particularly if patients are taking sedating medications. 

Examination boards have recognized that health problems can impact a student's ability to perform in exams and in response have introduced measures that acknowledge this - for example, offering extra exam time for students with dyslexia. However, this is  not yet generally the case in relation to students with hayfever. Consequently, in the UK for example, critical examinations for children aged 15-18 years old still take place over a 6-week period during May and June when grass pollen counts are typically at their highest. 

"Hayfever may impair examination performance at a very important time for young people." notes Hammersley, "More research is needed to develop better ways of managing the impact hayfever can have on quality of life." 

Delivery of optimal care - defined pragmatically as timely and accurate diagnosis of hayfever and related co-morbidities, education and empowerment of patients towards effective self-management and appropriate pharmacotherapy - must represent the mainstay approach to tackling the disadvantage that many young people with hayfever currently experience, as Walker points out, 

"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." 

However, in those with therapy-resistant disease, there is also the need to consider hayfever as a mitigating factor, both in relation to exam preparation and when sitting exams.  Furthermore, tree pollens tend to peak from late February to the middle of May in the UK, when students are likely to be revising for their exams. The author's believe that, in the longer-term, a review of course and exam timetabling should be undertaken to involve consideration of a winter month examination period to limit the impact hayfever may have on young sufferers' examination results.  

The full article is available at http://www.expert-reviews.com/loi/ers/4/4