About Hay Fever

Hay fever, also called allergic rhinitis, causes cold-like symptoms such as a runny nose, congestion, sneezing and sinus pressure. But unlike a cold, hay fever isn’t caused by a virus — it’s caused by an allergic response to indoor or outdoor airborne allergens, such as pollen, dust mites or pet dander. Some people have hay fever year-round. For others, hay fever gets worse at certain times of the year, usually in the spring, summer or fall. One of the most common allergic conditions, hay fever affects about one in five people.

For some people hay fever symptoms are a minor, temporary nuisance. But if your symptoms are more persistent, they can make you miserable and affect your performance at work, school or leisure activities. Finding the right hay fever treatment probably won’t completely eliminate your symptoms — but for most people, it makes a big difference.

Symptoms

Signs and symptoms of hay fever usually develop immediately after you’re exposed to specific allergy-causing substances (allergens) and can include:

  • Runny nose and nasal congestion
  • Watery or itchy eyes
  • Sneezing
  • Cough
  • Itchy nose, roof of mouth or throat
  • Sinus pressure and facial pain
  • Swollen, blue-colored skin under the eyes (allergic shiners)
  • Decreased sense of smell or taste

Hay fever symptoms that can interfere with your day-to-day activities and have an impact on your quality of life include:

  • Sleeplessness
  • Fatigue
  • Irritability

Your symptoms may start or worsen at a particular time of year, triggered by tree pollen, grasses or weeds. If you’re sensitive to indoor allergens such as dust mites, cockroaches, mold or pet dander, you may have year-round symptoms.

Although hay fever can begin at any age, you’re most likely to develop it during childhood or early adulthood. It’s common for the severity of hay fever reactions to change over the years. For most people, symptoms tend to diminish slowly, often over decades.

Is it hay fever? Or is it a cold?
Signs and symptoms can be different. Here’s how to tell which one’s causing your symptoms:

Hay fever Colds
Signs and symptoms Runny nose with thin, watery discharge; no fever Runny nose with watery or thick yellow discharge; low-grade fever
Onset Immediately after exposure to allergens One to three days after exposure to cold virus
Duration As long as you’re exposed to allergens Five to seven days

Causes

During a process called sensitization, your immune system mistakenly identifies a harmless airborne substance as something harmful. Your immune system then starts producing allergy-causing antibodies. The next time you come in contact with the substance, these antibodies recognize it and signal your immune system to release chemicals such as histamine into your bloodstream. These immune system chemicals cause a reaction that leads to the irritating signs and symptoms of hay fever.

Hay fever can be triggered by either seasonal or year-round (perennial) allergens. Many people have allergy symptoms all year long, but their symptoms get worse during certain times of the year.

Seasonal hay fever triggers include:

  • Tree pollen, common in the spring
  • Grass pollen, common in the late spring and summer
  • Weed pollen, common in the fall
  • Spores from fungi and molds, which can be worse during warm-weather months

Year-round hay fever triggers include:

  • Dust mites or cockroaches
  • Dander (dried skin flakes and saliva) from pets such as cats, dogs or birds
  • Cockroaches
  • Spores from indoor and outdoor fungi and molds

Hay fever doesn’t mean you’re allergic to hay. Despite its name, hay fever is almost never triggered by hay, and it doesn’t cause a fever.

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

  • Family history of allergies
  • Male gender
  • Birth during pollen season
  • Being a firstborn child
  • Exposure to cigarette smoke during your first year of life
  • Exposure to dust mites

Diagnosis

Your doctor will ask detailed questions about your personal and family medical history, your signs and symptoms, and your usual way of treating them. Your doctor will also perform a physical examination to look for additional clues about the causes of your signs and symptoms. He or she may also recommend one or both of the following tests:

  • Skin prick test. During skin testing, small amounts of purified allergen extracts are pricked into the skin of your arm or upper back and you’re observed for signs of an allergic reaction. If you’re allergic, you develop a raised bump (hive) at the test location on your skin. Allergy specialists usually are best equipped to perform allergy skin tests.
  • Allergy blood test. A blood test (sometimes called the radioallergosorbent, or RAST, test) can measure your immune system’s response to a specific allergen by measuring the amount of allergy-causing antibodies in your bloodstream, known as immunoglobulin E (IgE) antibodies. A blood sample is sent to a medical laboratory, where it can be tested for evidence of sensitivity to possible allergens.

Other health problems that often occur along with hay fever include:

  • Asthma. If you have asthma, you may have signs and symptoms such as difficulty breathing, shortness of breath, a tight feeling in the chest, coughing and wheezing.
  • Eczema. Also called dermatitis, this condition causes swollen, red or itchy skin.
  • Sinusitis. Prolonged sinus congestion due to hay fever may increase your susceptibility to sinusitis — an infection or inflammation of the membrane that lines the sinuses.
  • Ear infection. In children, hay fever often is a factor in middle ear infection (otitis media).

Treatment

There are a number of over-the-counter and prescription medications available that help relieve hay fever symptoms. They include pills, liquids, nasal sprays and eyedrops. Many people get the best relief from a combination of allergy medications. You may need to try several medications to identify what works best for you. Over-the-counter medications may be enough to relieve your symptoms; or, you may need a prescription from your doctor.

If your child has hay fever, talk with your doctor about the best treatment. Some medications are approved for use in children, while others are only approved for adults. If you want to try an over-the-counter medication for your child, be sure to read the labels carefully.

Medications for hay fever include:

  • Nasal corticosteroids. These nasal sprays help prevent and treat the inflammation caused by hay fever. For many people they’re the most effective hay fever medications, and they’re often the first medication prescribed. Examples include fluticasone (Flonase), fluticasone (Veramyst), mometasone (Nasonex) and beclomethasone (Beconase). Although these medications can start to work after a few days of treatment, you may not notice any improvement until after you’ve used them for a week or so. Nasal corticosteroids are a safe long-term treatment for most people. Side effects can include an unpleasant smell or taste and nose irritation.
  • Oral corticosteroids. Corticosteroid medications in pill form, such as prednisone, are sometimes used to relieve severe allergy symptoms. Because the long-term use of oral corticosteroids can cause serious side effects such as cataracts, osteoporosis and muscle weakness, they’re usually prescribed only for short periods of time.
  • Antihistamines. These oral medications and nasal sprays can help with itching, sneezing and runny nose, but have less effect on congestion. They work by blocking histamine, an inflammatory chemical released by your immune system during an allergic reaction. Older over-the-counter antihistamines such as diphenhydramine (Benadryl) and clemastine (Tavist) work as well as newer ones, but can make you drowsy. Newer oral antihistamines are less likely to make you drowsy, but are more costly than the older antihistamines. Over-the-counter examples include loratadine (Claritin, Alavert) and cetirizine (Zyrtec). Fexofenadine (Allegra) is available by prescription. The prescription antihistamine nasal spray azelastine (Astelin) starts to relieve symptoms within minutes of use. It can be used up to eight times a day, but can cause drowsiness. Side effects include a bad taste in the mouth right after use.
  • Decongestants. These medications are available in over-the-counter and prescription liquids, tablets and nasal sprays. Over-the-counter oral decongestants include Sudafed, Actifed and Drixoral. Nasal sprays include phenylephrine (Neo-Synephrine) and oxymetazoline (Afrin). Because oral decongestants can raise blood pressure, avoid them if you have high blood pressure (hypertension). Oral decongestants can also worsen the symptoms of prostate enlargement, making urination more difficult. Don’t use a decongestant nasal spray for more than two or three days at a time because it can cause rebound congestion when used longer.
  • Cromolyn sodium. This medication (NasalCrom) is available as an over-the-counter nasal spray that must be used several times a day. It helps relieve hay fever symptoms by preventing the release of histamine. Cromolyn sodium doesn’t have serious side effects, and it’s most effective when started before signs and symptoms develop.
  • Leukotriene modifiers. Montelukast (Singulair) is a prescription tablet taken to block the action of leukotrienes — immune system chemicals that cause allergy symptoms such as excess mucus production. It has proved effective in treating allergic asthma, and it’s also effective in treating hay fever. Possible side effects include headache. Less common side effects include abdominal pain, cough, dental pain and dizziness. Like antihistamines, this medication is not as effective as inhaled corticosteroids. It’s often used when nasal sprays cannot be tolerated, or when mild asthma is present.
  • Nasal atropine. Available in a prescription nasal spray, ipratropium bromide (Atrovent) helps relieve a severe runny nose by preventing the glands in your nose from producing excess fluid. It’s not effective for treating congestion, sneezing or postnasal drip. Mild side effects include nasal dryness, nosebleeds and sore throat. Rarely, it can cause more-severe side effects such as blurred vision, dizziness and difficult urination. The drug is not recommended for people with glaucoma or men with an enlarged prostate.

Other treatments for hay fever include:

  • Immunotherapy. If medications don’t relieve your hay fever symptoms, your doctor may recommend allergy shots (immunotherapy or desensitization therapy). Over a period of three to five years, you receive regular injections containing purified allergen extracts. The goal is to desensitize you to specific allergens, reduce your signs and symptoms, and decrease your need for medications. Immunotherapy may be especially effective if you’re allergic to cat dander, dust mites, or pollen produced by trees, grass and weeds. In children, immunotherapy may help prevent the development of asthma.
  • Nasal lavage. To help with irritating nasal symptoms, your doctor may recommend that you rinse your nose with salt water. Use an over-the-counter nasal saline spray or prepare your own saltwater solution using 1/4 teaspoon of salt mixed with 2 cups of warm water. Both can be extremely effective at relieving congestion.

Prevention

There’s no proven way to avoid getting hay fever — but you can prevent allergy symptoms by avoiding the things that trigger your reactions.

While the evidence isn’t clear yet, doctors think reducing a child’s exposure to allergy-causing substances such as dust mites may help delay or prevent hay fever. This may be especially true in children with a family history of allergies.

Minimize your exposure
It’s not possible to completely avoid allergens, but you can reduce your signs and symptoms by taking some steps to limit your exposure to them. It helps to know exactly what you’re allergic to so that you can take steps to avoid your specific triggers.

Pollen or molds

  • Close doors and windows during pollen season.
  • Don’t hang laundry outside — pollen can stick to sheets and towels.
  • Use air conditioning in your house and car.
  • Use an allergy-grade filter in the ventilation system.
  • Avoid outdoor activity in the early morning when pollen counts are highest.
  • Stay indoors on dry, windy days.
  • Use a dehumidifier to reduce indoor humidity.
  • Use a high-efficiency particulate air (HEPA) filter in your bedroom.
  • Avoid mowing the lawn or raking leaves, which stirs up pollen and molds.
  • Wear a dust mask when doing outdoor activities such as gardening.

Dust mites

  • Use allergy-proof covers on mattresses, box springs and pillows.
  • Wash sheets and blankets in water heated to at least 130 F (54 C).
  • Use a dehumidifier or air conditioner to reduce indoor humidity.
  • Vacuum carpets weekly with a vacuum cleaner equipped with a small-particle or HEPA filter.
  • Consider removing carpeting, especially where you sleep, if you’re highly sensitive to dust mites.

Cockroaches

  • Block cracks and crevices where roaches can enter.
  • Fix leaky faucets and pipes.
  • Wash dishes and empty garbage daily.
  • Sweep food crumbs from counters and floors.
  • Store food, including pet food, in sealed containers.
  • Consider professional pest extermination.

Pet dander

  • Remove pets from the house, if possible.
  • Bathe pets weekly. Using wipes designed to reduce dander also may help.
  • Keep your pet out of the bedroom.