Hay fever

Hay fever (also known as rhinitis or allergic rhinitis) is an inflammatory, allergic reaction that causes cold-like symptoms such as a stuffy nose, runny nose, sneezing, and itching. Despite the name, it does not mean the affected person is allergic to hay or has a fever. Unlike a cold, hay fever is not contagious, as it is not caused by a virus.

Hay fever is an allergic response

Hay fever is often a seasonal allergy; it is an allergic response to indoor and outdoor allergens such as pollen, dander, and dust mites, to name a few.

Hay fever (rhinitis) can last anywhere from weeks to months, depending on what is causing the allergic reaction. Hay fever is the 5th most common disease in the United States.

Avoiding allergy triggers

The best way to treat allergic rhinitis without any procedures or medications is to limit exposure. By preventing yourself from coming into contact with your allergy triggers, you can alleviate your symptoms. In some instances, of course, this is not possible – so over-the-counter (OTC) medications can help.

Hay fever has different causes

Hay fever is caused when your immune system identifies harmless airborne substances as harmful, and produces antibodies. The next time you encounter the substances, the antibodies signal a histamine release that causes allergy symptoms.

Common causes

The most common causes of allergic rhinitis are:

  • Certain foods or spices, or a food allergy.
  • Certain medicines and overuse of topical nasal spray.
  • Changes in the environment.
  • Extreme temperature or changes in temperature.
  • Fumes and odors.
  • Hormonal changes.
  • Irritants such as strong odors and tobacco smoke.

Other allergy triggers

Other allergy triggers (like pollen) can exacerbate seasonal allergic rhinitis:

  • Grass pollen, common in late spring and summer.
  • Tree pollen, common in early spring.
  • Weed pollen, common in fall.
  • Seasonal pollen allergies from flowers.
  • Pet dander, dust mites, and cockroach waste can cause problems year round, but may worsen in winter when houses are closed up.
  • Spores from fungi and mold that can occur seasonally or year-round.

What are the symptoms of hay fever?

Allergic rhinitis symptoms include:

  • Fatigue.
  • Feeling like you have a cold.
  • General malaise.
  • Headaches, if hay fever is severe.

Nasal allergy symptoms:

  • Clear drainage.
  • Itchy nose.
  • Nosebleeds.
  • Prolonged nasal congestion.
  • Runny nose.
  • Sinus pain.
  • Sneezing, often from pollen or dander.
  • Stuffy nose.

Eye allergy symptoms:

  • Watery, red, or itchy eyes (allergic conjunctivitis)

Throat allergy symptoms:

  • Breathing from the mouth.
  • Coughing.
  • Itchy throat or itchiness in the roof of the mouth.
  • Snoring.
  • Sore throat from post nasal drip.

Ear symptoms:

  • Ear infections that keep coming back.
  • Swollen, blue skin under the eyes (allergic shiners, which are more common in children).

When to see your provider

Allergic rhinitis can often be handled at home, but it’s important to see your doctor if you experience the following:

  • Allergy medications do not work, or cause frustrating side effects.
  • You can’t get relief from your symptoms.
  • You have another condition that worsens hay fever, such as asthma, frequent sinus infections, or nasal polyps.

Child holding a stethoscope up to doctors chest while laughing

How is hay fever diagnosed?

Most often, the diagnosis is made by your healthcare provider based on a full health history and physical exam. In addition to the above signs, the healthcare provider may find:

  • Creases under the eyes.
  • Swollen tissues inside the nose.
  • Mouth breathing.

Your healthcare provider may also recommend the following tests:

Skin prick test. Small amounts of material are pricked into the skin of your arm or upper back. Your doctor may recommend you to an allergy specialist, who will observe any allergic reaction, indicated by a small bump (hive) at the site of the allergen.

Allergy blood test (RAST, or radioallergosorbent test). A sample of your blood is sent to a lab to measure your immune system response to specific allergens. The test will measure the amount of allergy-causing antibodies in your bloodstream.

Doctor conferring with patient

Treatments for hay fever

The best way to treat allergic rhinitis without any procedures or medications is to limit exposure. By preventing yourself from coming into contact with your allergy triggers, you can alleviate your symptoms.

In some instances, if this is not a possible solution, over-the-counter medications will be recommended to help. For severe symptoms, prescription medications may be necessary. Allergy medications have also proven to be beneficial, especially in combination with other allergy meds.

Medications

  • Antihistamines. Antihistamines can be administered in pill form, as an intranasal spray, or as eye drops to block the histamine reaction in the body when it encounters a normal allergen. They are used to prevent eye symptoms such as itching, as well as nasal symptoms such as sneezing and runny nose. However, antihistamine medications are less effective at treating congestion. Common antihistamines include Claritin, Zyrtec, and Allegra.
  • Decongestants. Over-the-counter decongestants can be found as liquids, pills, or nose sprays to relieve allergy symptoms. Common brands include Afrin and Sudafed. However, decongestants come with a number of side effects, and should not be used for more than two to three days at a time.
  • Nasal corticosteroid. Corticosteroids are prescription nasal spray medications used to treat hay fever, as they stop nose allergy symptoms such as nasal inflammation, nasal itching, and runny nose. They act as safe, long-term, and effective treatments, and rarely present side effects. Common brands include Nasonex, Rhinocort, and Flonase, to name a few.
  • Oral corticosteroid. Oral corticosteroids are similar to their nasal form, but taken as pills such as prednisone to relieve severe allergy symptoms. However, corticosteroids can cause serious side effects, and are usually only recommended for short periods of time.

Other treatments

  • Allergy medication or tablet. Under-the-tongue allergy medicine (sublingual immunotherapy) can be used as an alternative to allergy shots. Tiny amounts of an allergen are made into a pill, and are taken orally and dissolved in your mouth on a daily basis.
  • Allergy shots. Allergy shots are a form of immunotherapy that are most often used if medications can’t relieve your hay fever. Allergy shots are administered regularly over a three- to five- year period. They contain tiny amounts of allergens. Your body get used to the allergens, decreasing the need for medications. Allergy shots act as an effective treatment if your triggers include cat dander, dust mites, or pollen, and can help prevent children from developing asthma.
  • Nasal saline rinses (nasal irrigation). Saline rinses such as the Neti Pot cleanse your nasal passages with distilled, sterile saline solution to help ease nasal congestion. These rinses flush mucus and allergens from your nose, and can also help ease nasal itching.

Who is at risk for hay fever?

People with asthma are at a higher risk for rhinitis. Allergic rhinitis may be linked to asthma, but this link is not fully understood. Experts think that since rhinitis makes it hard to breathe through the nose, it’s harder for the nose to work normally. Breathing through the mouth does not warm, filter, or humidify the air before it enters the lungs, which can make asthma symptoms worse.


Woman and man jogging on park path

Asthma and allergies are also caused by many of the same chemical triggers in the body. Controlling allergic rhinitis may help control asthma in some people.

The following may also increase your risk of developing hay fever:

  • Atopic dermatitis (eczema). Although rash is not a main symptom of hay fever, people with eczema can notice flare ups.
  • Living in a high-allergen environment, such as one with lots of pollen or dander.
  • Having a mother who smoked during the first year of your life.

Frequently asked questions (FAQs) about hay fever

It can be difficult to tell whether you have a cold or hay fever since their symptoms are so similar. However, they have different onset and durations.

Common cold: Cold symptoms present as a runny nose with thick, often yellow discharge. Symptoms usually present three to five days after exposure to a cold virus, and last three to seven days.

Hay fever: Hay fever symptoms present as a clear runny nose with no fever, following immediate exposure to an allergen like pollen, with a duration for about as long as you are exposed to the allergen.

Hay fever cannot be fully prevented, but there are some lifestyle measures that can help reduce your symptoms or provide relief. These changes are based on their causes, including:

Pollen or molds

  • Close home entries such as doors and windows during pollen season in your area.
  • Use air conditioning or a humidifier in your house or car.
  • Use a high-efficiency particulate air (HEPA) filter in rooms where you spend most of your time.
  • Filter your home ventilation system and change it regularly.
  • Stay indoors on dry or windy days.
  • Do not hang laundry outside.
  • Avoid yard work such as mowing the lawn or raking leaves.
  • Avoid outdoor activity in the early morning, since pollen counts are the highest then.
  • If necessary, wear a dust mask when cleaning or gardening.

Pet dander

  • Prevent pets from going in your bedroom or on your furniture.
  • Bathe dogs twice a week, if possible.

Dust mites

  • Wash bedding frequently in hot water.
  • Use allergy covers on your mattress, pillows, or box springs.
  • Use an air conditioner or dehumidifier in the room to reduce humidity.
  • Use insecticide to kill dust mites on bedding, carpets, and furniture.
  • Remove carpeting where you sleep, if you are very sensitive to dust mites.
  • Vacuum frequently, or use a vacuum with an equipped HEPA filter.

Cockroaches

  • Block crevices and cracks where these pests can enter.
  • Clean your house frequently, making sure to empty the garbage and wash your dishes daily.
  • Sweep crumbs from surfaces, counter, and floors.
  • Store any food item in sealed containers.
  • Use a professional exterminator in the case of an infestation.

Allergic rhinitis can cause the following complications if not relieved:

  • Ear infection. Children with hay fever often develop a middle ear infection.
  • Sinusitis. Prolonged sinus congestion from hay fever makes it more likely that you may develop sinusitis, and infection or inflammation in the sinus membranes.
  • Worsened asthma. Hay fever can make your asthma symptoms worse, such as worsened coughing and wheezing.
  • Poor sleep. Hay fever symptoms can make it hard to sleep and stay asleep, leading to a generally unwell feeling and fatigue.
  • Reduced quality of life. Either from poor sleep or general hay fever symptoms, hay fever can interfere with enjoyment and daily life, or even absences from work or school.