Hay fever

Hay fever is the common name for allergic rhinitis. It happens when the nose and eyes come into contact with environmental allergens, such as pollens (from grasses, weeds or trees), dust mite, mould and animal dander.

Many people associate hay fever with spring, when airborne grass pollens are at their peak. This is known as seasonal allergic rhinitis, or spring hay fever. However, hay fever can occur at any time of the year. When symptoms last all year round, it is called perennial allergic rhinitis, which is usually a reaction to allergens such as house dust mites, mould, animal dander or allergens encountered at work.

Symptoms#

Signs and symptoms of hay fever can include:

• Runny nose
• Itchy nose
• Sneezing
• Itchy, watery eyes

In some cases the symptoms can be severe enough that a person cannot sleep or concentrate, and may feel tired or unwell.

Why hay fever happens#

The nose acts as a filter. The tiny hairs and mucus that line the nasal passages trap dust, pollens and other microscopic particles. In a person with hay fever, the immune system treats some of these trapped particles, such as pollen, as if they were dangerous and launches an “attack”. The nasal passages become inflamed and produce more mucus.

Diagnosis#

Identifying the allergen or allergens causing the symptoms is an important part of managing hay fever. Sometimes the cause is obvious. In other cases a doctor will consider your medical history together with the results of allergy tests (skin prick tests or allergen-specific IgE blood tests), which may require referral to a specialist. Only evidence-based allergy tests should be used.

Treatment#

Several medicines may help relieve the symptoms of hay fever. Ask your doctor or pharmacist for advice. You may be advised to try:

• Antihistamine tablets, syrups, intranasal sprays and eye drops (non-sedating) - these help reduce sneezing and itchy, irritated eyes. They are less effective for severe nasal blockage and dribble. Their advantage is flexibility: you can take them when you have problems and stop when you are well. Antihistamine eye drops can help control watery eyes caused by allergies.
• Intranasal corticosteroid sprays (INCS) - used for moderate to severe symptoms, these are among the most effective treatments for allergic rhinitis. They must be used regularly, as directed, to work. Brands vary in strength and effectiveness, so read the labels and check details with your pharmacist or doctor.
• Combined intranasal corticosteroid and antihistamine sprays - also useful for moderate to severe symptoms, these offer the combined benefits of both medicines.
• Decongestant nasal sprays - useful for quick relief, but should not be used for more than a few days, as long-term use can damage the lining of the nose. Some people should not use decongestants, so discuss them with your doctor or pharmacist first.
• Allergen immunotherapy (AIT), also known as desensitisation - some people may benefit from AIT, which exposes a person to gradually increasing amounts of an allergen to improve tolerance and reduce symptoms. This therapy may reduce the severity of hay fever symptoms. It should only be carried out under the supervision of a clinical immunology or allergy specialist.

Reducing your exposure to allergens#

To prevent or limit symptoms, reduce your exposure to known allergens.

House dust mite:

• Wash sheets, pillowcases and other bedding weekly in hot water.
• Cover the mattress, pillow and quilt with dust mite resistant covers.
• Remove sheepskins or woollen underlays from the bed and bedroom.
• Remove soft toys from the bedroom.

Pet dander:

• Keep pets out of bedrooms, and outside where possible.

Mould:

• Remove visible mould by cleaning with bleach or other mould-reduction cleaners.
• Ensure good natural ventilation, including extractor fans.
• Avoid working with garden compost or mulch, and avoid mowing lawns.

Pollen:

• Stay indoors where possible during the local pollen season, particularly on windy days or after thunderstorms.
• Avoid activities that increase exposure to pollen, such as mowing grass.
• Shower after outdoor activities where pollen exposure is high.
• Use re-circulated air in the car when pollen levels are high.
• Wear sunglasses to reduce the amount of pollen that gets into your eyes.
• Dry bedding and clothing indoors or in a tumble dryer.

Where available, check local pollen counts and forecasts to help you plan.

Hay fever and thunderstorm asthma#

The grass pollen season brings a seasonal increase in asthma and hay fever, and also the chance of epidemic thunderstorm asthma. People with hay fever, especially those who wheeze or cough with it, and people with current, past or undiagnosed asthma are at risk.

Epidemic thunderstorm asthma can be sudden, serious and even life-threatening. Keeping good control of your hay fever can help reduce your risk.

Key points#

• When symptoms occur all year round, this is known as perennial allergic rhinitis.
• Immediate symptoms of hay fever include itchy, watery eyes.
• Identifying the allergen or allergens is an important part of managing hay fever.
• Several medicines may help relieve the symptoms of hay fever.
• Allergen immunotherapy may reduce the severity of hay fever symptoms.

Where to get help#