Hay Fever (allergic rhinitis): symptoms, causes, and treatment

Hay fever: what is it?

Hay fever  ( allergic rhinitis ) is an allergic reaction to tiny particles in the air called allergens [1]. Another name for this condition is seasonal allergic  rhinitis . Hay fever most commonly occurs between late March and September, which is why it is called  seasonal [1]. Rhinitis means inflammation of the mucous membrane of the nose. Therefore, taken together, seasonal allergic rhinitis means an inflammation of the mucous membrane of the nose, which is caused by allergens and that occurs during specific times of the year [1].

Symptoms of hay fever can include:

sneezing and coughing [2]
itchy nose, throat, mouth and ears [2]
loss of smell [2]
pain around your temples and forehead [2]
headaches [2]
earache [2]
fatigue (tiredness) [2]
itchy, red or watery eyes and a runny nose [2]
nasal congestion [1].

In people who have asthma, hay fever can also cause other, worse symptoms [2]. These include:

a tight feeling in your chest [2]
shortness of breath [2]
wheeze and cough [2]

Hay fever can also lead to complications such as sinusitis and middle ear infections [1]. These can be uncomfortable and distracting.

This disease does not pose a serious threat to health, but it can have a significant effect on your quality of life [1]. Many people find it more difficult to work, to concentrate on tasks, to drive, and to get a good night's sleep when they have symptoms of hay fever [3].

Hay fever is very common and  children who have hay fever also have other allergies [4]. In children, boys are affected more often than girls [6]. In adults, men and women are affected equally often [6].

Hay fever: causes

Causes, or triggers of hay fever can include tree  pollen , which is more common in early spring, and grass pollen, which is more common in late spring and early summer [3]. As the  pollen count  rises, numbers of cases of hay fever increase and existing cases become more severe. Spores from fungi and mould can be either seasonal or year-round and these can also cause hay fever [3]. In hay fever, the  allergen  (the substance you are allergic to) is pollen. The condition can also be caused by spores, pet fur, dust mites , mould, insects and airborne chemicals and pollution. Allergen exposure causes your  immune system  to react like it would do if it were coming into contact with a harmful substance [3].

Allergic reactions such as hay fever and hives are linked to an antibody produced by the body called immunoglobulin E (IgE) [5]. Each IgE antibody reacts against certain specific types of pollen (or other allergens), but not others [5]. So, for example, a person could have in their body, the type of IgE antibody that reacts to grass pollen, but not the type that reacts to a certain type of tree pollen. This is why different people are sensitive to different types of pollen [5].

When a susceptible person comes into contact with an allergen, their body starts producing large quantities of IgE [5]. The next time that person encounters that same allergen, they might have an allergic reaction [5]. Symptoms of allergic reactions vary from person to person, depending on several factors [5]. These include the type and amount of allergen that was encountered and the ways in which a person’s immune system reacts to that allergen [5].

Hay fever: diagnosis and how to treat it

Hay fever is often treated by  allergy  medications, which should relieve your symptoms. Some of the most common allergy medications are called antihistamines [2], as they work by blocking a substance called  histamine , which the body produces during an allergic response. Antihistamines come in many forms including eye drops, nasal sprays, pills, liquids and inhalers [1]. As some old generation antihistamines can cause drowsiness, they should not be taken if you are going to drive or operate machinery.

A further treatment for hay fever is steroid nasal sprays [2]. You take these by spraying them into each nostril.

Immunotherapy is another treatment for hay fever [1]. This treatment works by helping your body learn to tolerate allergens [1]. This is a specialist immunology treatment that might not be available everywhere.

Hay fever: when to see a doctor and recommendations

One of the first HCPs that you consult about hay fever symptoms might be a pharmacist. Your pharmacist should be able to make a diagnosis of hay fever from your description of your symptoms [2]. In some cases, your pharmacist might advise you to speak with a doctor (your GP), as you might need allergy testing.

You will only need to make an appointment with your GP if :

Your symptoms are getting worse [6]
You experience any complications of hay fever [6]
You have other severe medical conditions such as nasal polyps, asthma or frequent sinus infections that could be made worse by hay fever [3]
Any treatments you take for hay fever  don't provide relief or cause severe side effects [3].

Your GP might refer you to an immunologist for allergy testing. This testing should show whether pollen is causing your allergy symptoms, or whether these symptoms are caused by other substances such as house dust mites, animals or certain foods.

There are two main types of allergy tests: a skin prick test and a blood test [1]. In a skin prick test, an immunologist will place pollen on your arm and then they will prick the surface of your skin with a needle [1]. If your skin starts to become red, itchy or irritated in the area around where it was pricked, this could be an allergic reaction that could confirm you have hay fever [1].

In a blood test, a sample of blood is taken from a vein in your arm. The blood will then be tested for the presence of the IgE antibody [1]. If your blood tests positive for the IgE antibody, this might confirm that you have hay fever [1].

From your pharmacist, you can buy over-the-counter treatments such as antihistamines, nasal sprays and eye drops [7]. GPs can write a prescription for medications, while pharmacists can only sell you over-the-counter treatment. Pharmacists also issue prescription-only items, once you have received your prescription from your GP. Pharmacists can answer questions that you may have about prescription and over-the counter medicines as well [4].

During dry, windy weather, when the pollen count is usually highest, stay at home or stay indoors as much as you can [2]. This will help you to avoid exposure to pollen. If you get effective treatment for your hay fever, with the right dosage of the right medicine, you will be able to go to work [7].

Wearing sunglasses can prevent pollen from getting into your eyes [1]. This can reduce symptoms of hay fever [6]. Take a shower and change your clothes after being outdoors to remove the pollen on your body [7].

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