Allergic rhinitis (hay fever): symptoms, triggers and treatment

Many people notice sneezing, an itchy nose and watery eyes at the same time each year. This is often allergic rhinitis, commonly called hay fever. This article explains what it is, what triggers it, how it is diagnosed and how symptoms are managed, using information from the NHS, MedlinePlus and the US FDA.

1. Introduction

Allergic rhinitis is a group of nose symptoms that start when a person who is sensitive to an allergen (something that triggers an allergy) breathes it in. Common triggers include pollen, dust, mould and animal dander, which is tiny flakes of skin and hair ^{[2, 4]}. When pollen is the trigger, the condition is usually called hay fever or seasonal allergy ^{[2, 3]}.

The NHS describes hay fever as a common allergy, and says its symptoms can be eased with self-care and medicines ^[1].

2. Causes and risk factors

Hay fever is an allergic reaction to pollen, a fine powder made by plants ^[1]. MedlinePlus explains that the pollen usually comes from plants spread by wind, such as trees, grasses and ragweed, while flowers pollinated by insects rarely cause it ^[2]. Which plants matter most differs from person to person and from region to region ^[2].

Weather affects how much pollen is in the air. Hot, dry, windy days tend to carry more pollen, while cool, damp or rainy weather washes it to the ground ^[2]. The NHS notes that symptoms often peak from late March to September in the UK, especially on warm, humid, windy days ^[1]. The FDA adds that tree pollen is common in early spring, grass pollen in late spring and early summer, and weed pollen in late summer and autumn ^[4].

Allergies often run in families. MedlinePlus says the risk is higher if both parents have allergies, and higher still if the mother does ^[2].

3. Signs and symptoms

The NHS lists these common symptoms ^[1]:

• Sneezing and coughing
• A runny or blocked nose
• Itchy, red or watery eyes
• An itchy throat, mouth, nose or ears
• Loss of smell
• Headache or pain around the sides of the head and forehead
• Tiredness

MedlinePlus says that later symptoms can include a stuffy nose, clogged ears, a sore throat, dark circles and puffiness under the eyes, and irritability ^{[2, 3]}. Postnasal drip, which is mucus running down the back of the throat, can also occur ^[3].

A cold usually clears within one to two weeks, while hay fever can last for weeks or months ^[1]. This difference can help tell the two apart.

4. Diagnosis and tests

A health care provider usually reaches a diagnosis from a physical examination and your symptom history, such as the time of day, the season and contact with pets or other triggers ^{[2, 3]}. Skin testing is the most common way to find the trigger. If skin testing is not possible, a blood test that measures allergy-related substances may be used ^[2].

5. Treatment and management

The doctor decides what is right for each person. The main options described by the sources are below.

Avoiding triggers

MedlinePlus says that limiting contact with the pollen that triggers symptoms is the best approach, although avoiding it completely is often not possible ^[2]. The NHS suggests these steps ^[1]:

• Put petroleum jelly around the nostrils to trap pollen.
• Wear wraparound sunglasses, and consider a hat.
• Shower and change clothes after spending time outdoors.
• Keep windows and doors shut as much as you can.
• Vacuum often and dust with a damp cloth.
• Avoid cutting grass, drying clothes outside and keeping fresh flowers indoors.
• Avoid smoking and smoky places.

The NHS links to a pollen forecast, and MedlinePlus links to guidance on using pollen counts to manage symptoms ^{[1, 3]}.

Medicines

According to the FDA, the main medicine types are antihistamines, nasal corticosteroids, decongestants and immunotherapy ^[4].

• Antihistamines block histamine, a chemical that causes sneezing, a runny nose and itchy, watery eyes. They come as tablets, liquids, nasal sprays and eye drops. Some cause drowsiness, which can affect driving or using machinery, and the NHS says you can ask a pharmacist for non-drowsy options ^{[1, 2, 4]}.
• Nasal corticosteroid sprays reduce swelling and congestion in the nose. MedlinePlus describes them as the most effective option and says they work best when used regularly ^[2]. The FDA lists possible side effects such as nose stinging and nosebleeds ^[4].
• Decongestants can relieve a blocked nose and are often used for a short time ^[4]. MedlinePlus says not to use nasal decongestant sprays for more than 3 days, and the FDA says using them for more than a few days can cause rebound congestion, which means the stuffiness gets worse ^{[2, 4]}.
• Saline nasal rinses can clear mucus. MedlinePlus says to use distilled, sterile or boiled-and-cooled water ^{[2, 3]}.
• Immunotherapy gradually trains the body to tolerate an allergen. It can be given as injections over several years or as tablets under the tongue that are started months before the season ^{[2, 4]}. The NHS says a doctor may refer you for it if other treatments do not work ^[1].

Always read the Drug Facts Label on any non-prescription medicine ^[4], and tell your doctor or pharmacist about everything you take.

6. Prevention and self-care

Daily habits can lower how bad hay fever feels ^[1]. The FDA suggests staying indoors when symptoms are severe, keeping windows closed at home and in the car, and showering before bed to remove allergens from skin and hair ^[4]. MedlinePlus adds staying indoors in air conditioning if possible during pollen season ^[2].

7. Special groups

Children. MedlinePlus says some children grow out of allergies as the immune system changes ^[2]. The FDA advises reading the label carefully before giving any non-prescription medicine to a child and speaking with a provider if a child needs a nasal steroid spray for more than two months of the year ^[4].

People with asthma. The FDA says seasonal allergies can trigger or worsen asthma and lead to sinus or ear infections, so consult a health professional if asthma flare-ups or these infections occur ^[4].

People with mental health history. MedlinePlus notes that one prescription medicine group, called leukotriene inhibitors, can cause anxiety or low mood in some people, so discuss any such history with a provider first ^[2].

8. When to see a doctor

See a doctor or pharmacist if your symptoms are getting worse or do not improve with pharmacy medicines ^[1]. MedlinePlus also advises contacting a provider if symptoms are severe, if a treatment that worked before stops working, or if symptoms do not respond to treatment ^[2]. Speak with a health professional if you use a decongestant for more than two to three days ^[4].

In an emergency, call your local emergency number (112 in India, 911 in the United States). The NHS says anaphylaxis, a severe allergic reaction, is an emergency, with signs such as difficulty breathing or struggling to breathe, wheezing or noisy breathing, or sudden swelling of the lips, mouth, throat or tongue ^[5].

9. Conclusion

Allergic rhinitis, or hay fever, is a common pollen allergy that causes sneezing, an itchy or blocked nose and watery eyes. Avoiding triggers, using suitable medicines and getting a proper diagnosis can make the season easier. Choose treatments with a doctor or pharmacist, and keep them informed of everything you use.