Everything you need to know about allergic rhinitis including symptoms, medicines and treatment advice.
Hay fever, also known as allergic rhinitis, is one of the most common allergy problems in the UK affecting around 1 in 5 people. With frustrating symptoms including sneezing, a runny nose and itchy eyes to contend with, if you are a hay fever sufferer the onset of summer and the smell of freshly cut grass might fill you with dread.
But if hay fever is plaguing your life, don’t suffer in silence! Dr Louise Wiseman looks at the symptoms, causes, diagnosis and treatment options for hay fever:
What is hay fever?
Hay fever is an allergic reaction to grass or tree pollen in the air that predominantly affects the upper airways. It is named ‘hay fever’ as the most common cause is grass or hay pollen but the medical term is seasonal allergic rhinitis – inflammation of the nasal lining, or seasonal allergic rhinitis, because symptoms tend to occur at the same time every year.
Pollen is a the fine powdery grain-like substance produced by plants, flowers or trees in order to fertilise others of the same species. Hay fever sufferers are sensitive (allergic) to pollen, causing their immune system to react to it by releasing chemicals (such as histamine) from cells in the nose and eyes that trigger inflammation and the usual symptoms of hay fever.
When plants bloom in the spring and summer months, levels of pollen in the air, leading to more cases of hay fever. In the UK, around 20 per cent of people are affected – typically developing first in young children or teenagers – with most cases being diagnosed before the age of 20. Children with hay fever can go on to suffer from it as adults but the condition often gradually improves over time in many cases. Hay fever is more common in people with a history of asthma or eczema (atopy) and many sufferers have a family history of allergy or hay fever.
Types of hay fever
The actual pollen that triggers hay fever will vary between sufferers and people can react to more than one, which is why you might suffer in different months. Tree pollens tend to affect people from March to May while grass pollen levels are highest from May to July. Weed pollens typically are higher between March and October. (Living in a coastal region can reduce hay fever symptoms in some people as sea breezes help to blow pollen inland.)
Hay fever symptoms
Common symptoms of hay fever include:
- Runny nose (rhinorrhoea) or a blocked, sore nose
- Itchy nose, palate or throat
- Postnasal drip (a sensation of fluid running down back of throat and then needing to swallow frequently)
- Watery or itchy eyes (this is the called allergic rhinoconjunctivitis)
- Loss of sense of smell
- Headacheand congestion
- Tiredness or lack of energy
- Asthma-like symptoms (coughing, wheezing, shortness of breath)
- Sinus pressure or discomfort
How is hay fever diagnosed?
Most cases of hay fever are easily diagnosed by a GP or pharmacist and it is uncommon to require a consultation with an Allergy or ENT specialist to make the diagnosis. Investigations for hay fever are not usually necessary.
Skin prick tests may be organised in the local hospital for specific allergies if appropriate and a provocation test (where the nose is exposed to allergens to see the reaction) or a blood test can be used but in general the vast majority of hay fever cases are simply diagnosed from the history and symptoms alone.
How does hay fever differ from a cold?
Both hay fever and colds can have similar symptoms but the main difference is that with a cold there is often a temperature and aching of the muscles. Hay fever begins immediately after exposure to the allergen whereas with a cold, symptoms only start up to 72 hours after being exposed to a cold virus.
Hay fever begins immediately after exposure to the allergen whereas with a cold, symptoms start 72 hours after being exposed to a virus.
Hay fever symptoms also usually last many weeks, but a cold should settle after a few days, and the runny nose seen in hay fever is thin and watery in nature unlike the thicker, sometimes discoloured mucus with a cold.
Sinusitis (infection in the sinus cavities of the face) causes pain and pressure in the cheeks and forehead, typically with a temperature, some swelling or flushing to the cheeks, occasional toothache and a feeling of being unwell.
11 hay fever treatment tips
To reduce symptoms, try our 10 hay fever treatment tips. In the first instance, exposure to pollen should be minimised as much as possible. Although it is almost impossible to avoid pollen completely, you can limit exposure to it with simple hay fever prevention measures:
- Keep windows closed during affected months, especially first and last thing in the day when the pollen count is at its highest. (A high pollen count is a reading above 50)
- Invest in an air purifier.
- Change your clothes when you go home, as pollen clings to fabric.
- Shower before bed to remove pollen from your body and hair.
- Avoid leaving clothes to dry outside on high pollen count days (a count above 50).
- Be mindful of local pollen count and plan outside activity on lower count days.
- Try a nasal allergen barrier balmaround the nostrils to help stop pollen entering.
- Get someone else to mow the lawn, or try a filtration face mask to reduce pollen from entering your nose.
- When travelling use ‘in car circulation’ with windows closed, rather than drawing air in from outside. In-car pollen filters are also available.
- Wipe pets down with a damp microfibre cloth when they come indoors in order to remove pollen stuck on fur.
- Wear wrap around sunglasses when outside.
Hay fever medicines
If medication is required there are a number of medicine options for hay fever sufferers including antihistamines and steroid treatments. For the best advice, speak to your GP or pharmacist. Treatments include antihistamine tablets and nasal sprays, steroid nasal sprays, and eye drops
Many hay fever cases only need simple antihistamine treatment as these reduce the allergic response that causes hay fever symptoms (histamine is what triggers these). Examples of non-sedating antihistamine tablets available from a pharmacy or on prescription include:
Sedating antihistamines such as chlorphenamine can work well but cause sleepiness that can affect driving and ability to operate machinery and so most people now prefer to take a non-sedating type.
Antihistamine nasal sprays are effective at easing symptoms such as sneezing, itching and a runny nose within 15 minutes of using them, and are most effective if symptoms are mild. They can used every day to prevent symptoms developing.
Steroid nasal sprays and drops
Slightly more severe hay fever cases may need steroid-based treatment and these can be used in addition to antihistamines. Steroids reduce nasal inflammation in moderate to severe cases of hay fever but it can take several days for a steroid spray to have its full effect. These can also often reduce the eye symptoms of hay fever although it is not exactly clear why this should be the case. They are available from pharmacies or on prescription from your doctor. Examples of steroid sprays and drops for hay fever include:
Hay fever medicines for children
To treat hay fever in children, the aim is to reduce pollen exposure and control any symptoms on the safest, most tolerated combination of treatment. These can include:
- Azelastine nasal spray: licensed in the UK for children over the age of 6.
- Non drowsy antihistamines: these are often prescribed for children but only over two years of age.
- Sodium cromoglycate: eye drops can be used.
- Montelukast tablets: these are licensed to treat hay fever symptoms in people over the age of 15 (but can be used in treating asthma from the age of 6 month).
Other hay fever medicines
The following medicines and treatments may be prescribed for hay fever. Always speak to your GP or pharmacist before trying anything new:
- Combination steroid and antihistamine sprays:such as Dymista, used in moderate to severe hay fever cases if treatment with antihistamines or steroids is inadequate by themselves.
- Ipatropium nasal sprays:these help to reduce watery nasal discharge.
- Oral steroids: these may be given in severe cases in exceptional circumstances, but can have side-effects and are only given for very short courses. They can be used alongside nasal steroid/antihistamine spray.
- Mast Cell stabilisers (Chromones): mast cells are part of the immune response and release histamine. Eye drops such as Sodium cromoglycate, nedocromil and lodoxamide can help ease eye symptoms. Nasal spray forms can also help but must be used regularly 4 to 5 times a day. This is however one of the meds thought safe in the first three months of pregnancy.
- Antihistamine eye drops:antazoline, azelastine and epinastine work quickly but these are not advised for more than 6 weeks in a row.
- Leukotriene receptor antagonists: tablets such as montelukast are given for relief of hay fever in adults and children with asthma but are usually reserved for more severe cases.
- Decongestant nasal dropsand sprays: these can be bought over the counter but are not recommended for more than a few days use as they can cause ‘rebound’ nasal congestion after only 5 days of use and make things worse when stopped.
- Allergen specific immunotherapy: this is a consultant-initiated hospital treatment for very severe cases only where the patient is gradually exposed to the allergen (in this case pollen) – under the tongue or as injection just under the skin – in very low, gradually increasing doses over a three year period. The idea is that the gradual exposure desensitises the body, even if it does not completely eradicate hay fever and can have beneficial effects long after treatment ceases. This is very carefully governed by a hospital allergy specialist as there are risks involved.
Hay fever and pregnancy
If you are pregnant or breastfeeding you will normally be advised to avoid antihistamines – a local steroid nasal spray is usually recommended first if treatment is required. There is limited data on the safety of non-drowsy medicines in pregnancy and they are thought to pass in breast milk. Discuss it with your doctor before taking any medication during pregnancy.
Alternative remedies for hay fever
For alternative hay fever remedies, the following may provide some relief:
Acupuncture has been found to be effective for some people, reducing the response to an allergen and promoting a sense of wellbeing. It is usually advised to have this well before the season commences.
- Nasal balms
These block pollen particles from entering the nasal passages and so can help reduce their entry into the body.
- Air purifiers
Air purifiers should have the Allergy UK seal of approval and these tend to have a HEPA filter.
- Saltwater nasal sprays
Washouts administered by spray pump or squirt bottle can be purchased over-the-counter to wash out pollen. There is limited research to evaluate the small benefit, but it is thought if used correctly it cannot cause harm. These are considered to be safe for adults and children.
When should you see your doctor about hay fever?
If you think you have hay fever and have tried over-the-counter remedies with minimal success, ask your GP for advice regarding further treatment. For children, a new suspected diagnosis should be discussed with the GP and any other allergy or atopy related illnesses should be carefully managed. Consider seeing your doctor if;
- Medication from the pharmacist is not helping, or if it is causing side effects
- Your symptoms are affecting your quality of life or are severe
- You have another condition (such as asthma) that is worsening your hay fever symptoms
- Your symptoms occur all year round
- Your symptoms are worsening.
What are longer-term effects of hay fever?
For many people, their hay fever is relatively mild and short-lived, either clearing away by itself or with simple anti-allergy treatments. However, having hay fever for several weeks or longer can cause symptoms such as chronic fatigue, irritability, reduced academic performance, lack of smell, dark circles (‘shiners’) under the eyes, chronic headaches and a sore throat. These can all be a sign that the hay fever is not being controlled and needs stronger treatment.
Hay fever medicine tips
To get the best from your hay fever medicine try the following:
✔️ The key to success with hay fever is regular use of your medicine to stay on top of your symptoms and using the correct techniques with drops and sprays.
✔️ A preventative treatment should be started around two weeks before your hay fever season typically starts. Any new treatment should be reviewed every couple of weeks to see if it is working.
✔️ Any chest symptoms such as wheezing or shortness of breath that are not improving should be reported urgently to your doctor.
✔️ If a treatment works for you and is well tolerated, your doctor is likely to advise continuing it until the end of the season.
⚠️ If you experience breathing difficulties always speak to a health professional urgently or call 999.