Hay Fever and Allergies: Triggers, Testing and Treatment Options
Hay fever, known medically as allergic rhinitis, affects up to one in five people and brings sneezing, a runny or blocked nose and itchy eyes when the immune system overreacts to harmless airborne substances. Despite the name, it involves no hay and no fever. It can disturb sleep, concentration and performance at school and work, yet many people simply put up with it when effective treatment is available.
What triggers it
Seasonal allergic rhinitis occurs at particular times of year and is usually caused by pollen:
- Tree pollen, typically late winter and spring
- Grass pollen, late spring and summer, the most common trigger
- Weed pollen such as ragweed, late summer and autumn
- Outdoor moulds in damp conditions
Perennial allergic rhinitis occurs year-round and is typically caused by house dust mites, pet dander, indoor mould or cockroach allergens. Some people have both.
Symptoms
- Repeated sneezing, often in bouts
- Runny, itchy nose and a feeling of blockage
- Itchy, red, watery eyes (allergic conjunctivitis)
- Itchy throat and palate
- Post-nasal drip and cough
- Tiredness, headache and reduced sense of smell
- Dark circles under the eyes in children and a habit of rubbing the nose upward
A cold usually clears in a week or two and may include fever and aches. Hay fever persists as long as the allergen is around.
Links with other conditions
Allergic rhinitis is strongly associated with asthma, eczema and sinusitis. Uncontrolled nasal allergy worsens asthma, so treating one helps the other. A persistent blocked nose in a child may also signal enlarged adenoids.
Testing
If the pattern is unclear, or you want to confirm triggers, allergy testing can help. A skin prick test places tiny drops of allergen on the forearm and checks for a weal within 15 minutes. A specific IgE blood test measures allergic antibodies. A positive test alone does not prove allergy; it must match your symptoms.
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Reducing exposure
- Check the daily pollen forecast and limit outdoor activity on high days, especially in the morning and evening
- Keep windows closed during peak pollen times and use air filters if possible
- Shower and change clothes after being outside, and wash your hair at night
- Wear wraparound sunglasses outdoors
- Dry laundry indoors during the season
- Smear a thin layer of petroleum jelly around the nostrils to trap pollen
- For dust mites, use mite-proof covers on mattresses and pillows, wash bedding at 60°C weekly, reduce soft furnishings and keep humidity low
- For pets, keep them out of the bedroom and wash them regularly
Medicines that work
Intranasal corticosteroid sprays (such as fluticasone and mometasone) are the most effective treatment for nasal symptoms. They take several days to reach full effect, so start before the season peaks and use them daily, aiming the spray away from the nasal septum.
Non-drowsy antihistamines (cetirizine, loratadine, fexofenadine and others) relieve sneezing, itching and watery eyes. Older sedating antihistamines should generally be avoided in daytime, particularly when driving.
Antihistamine eye drops and sodium cromoglicate drops soothe itchy eyes.
Saline nasal rinses wash out pollen and mucus.
Decongestant sprays such as oxymetazoline should be used no longer than three days because longer use causes rebound congestion. Oral decongestants can raise blood pressure.
Leukotriene receptor antagonists are an alternative for those who also have asthma.
Allergen immunotherapy
For people whose symptoms are severe or poorly controlled, immunotherapy retrains the immune system to tolerate the allergen. It can be given as under-the-tongue tablets (for grass pollen, tree pollen and dust mite) or as a course of injections over three years. Benefits can last for years after finishing treatment. Treatment is supervised by an allergy specialist.
When to seek help
Visit your doctor if over-the-counter treatments do not control your symptoms, if your sleep or work is affected, or if you also wheeze or cough. Seek emergency help for any signs of a severe allergic reaction (anaphylaxis): swelling of the lips or throat, difficulty breathing, widespread hives, dizziness or collapse.
In summary
Hay fever is common and manageable. Combining trigger avoidance with the right regular medicine, started in good time, lets most people enjoy the season rather than dread it.
This article is for general information and is not a substitute for professional medical advice. If you are worried about your health or have symptoms, speak to a doctor or other qualified health professional.