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Hay fever

Dr Karen Martin
Reviewed by Dr Karen MartinReviewed on 19.10.2023 | 9 minutes read
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Hay fever – also known as seasonal allergic rhinitis - is an allergy to pollen, usually from grass or trees that can cause symptoms in either your eyes, nose or throat. In some sufferers it can cause a whole body response with a combination of symptoms, leaving you feeling pretty fed up and reluctant to embrace the great outdoors. It can also end up interfering with your work, study and sleep.

Pollen is a dust-like particle, carried on the wind and by insects such as bees to pollinate more plants. Proteins in pollen can trigger an inflammatory response where an immune-fighting substance called histamine is released from mast cells in the body. This is helpful in protecting you from certain irritants, but hay fever and other allergic reactions occur because your histamine release mechanism goes into overdrive. Hay fever is very common, affecting around 1 in every 5 people in the US, and it often starts as a child or teenager. It can run in families and you are more likely to have hay fever if you also suffer from asthma or eczema.

If you have hay fever, when you come into contact with pollen or the spores of molds or fungi that you’re allergic to, your body produces an antibody called immunoglobulin E (IgE). Antibodies are usually only released to fight infection, but in this instance, your body believes the substance you’re allergic to is harmful.

When there’s a lot of the substance you’re allergic to in the air, the IgE antibodies will trigger the release of chemicals from certain cells in your nose, throat and eyes. One of these chemicals is histamine, and as a result of histamine in your system, you’ll experience the symptoms of hay fever.

Pollen is seasonal. You may be allergic to just one type of pollen, which means you are only susceptible to symptoms at certain times of the year, and therefore treatment can be limited to this time.

Treatment can be targeted at relieving each symptom or with the aim of reducing inflammation throughout the body. With lots of hay fever products on the market, it can be tricky to know which is right for you, so let’s talk you through the options.

Doctor’s advice

What are the symptoms of hay fever?

Eyes

Your eyes can feel itchy, gritty and sensitive to light and you may get excessive streaming, making it difficult to see. You might also get puffy eyelids, dark circles under the eyes and redness on the whites of the eyes and its inner pockets (the conjunctivae).

Nose

Constant sneezing is a classic symptom of hay fever and the nasal passages can swell, making them feel blocked and congested. This can give your voice an odd tone and cause you to mouth-breathe.

Throat

Your throat can feel itchy and tingly and you may feel it constantly needs clearing, which may be in response to nasal congestion and the post-nasal drip, where secretions leak down from the back of the nose to the throat and irritate it.

Cough

The post-nasal drip can also cause an irritating tickly cough. You might get a dry cough if histamine release directly affects the lungs, and it can trigger asthma if you are susceptible.

Skin

Your skin can become itchy and blotchy, possibly with a rash. If you have eczema you’re more at risk of developing hay fever.

Complications

Without treatment, nasal congestion can lead to sinusitis, where deep nasal passages are inflamed, causing discomfort and pain. Those who suffer from hay fever also tend to get asthma and eczema, and untreated hay fever can cause a flare-up of either of these conditions.

If your child suffers from hay fever over a long period, they may develop a phenomenon called the allergic salute. This is where they get a runny or itchy nose and use their palm to repeatedly swipe upwards, causing a little horizontal crease on the bridge of their nose and swelling at the base. This will go away with time, once their symptoms are controlled.

Seasons of hay fever

The impact on people who are highly sensitive to hay fever can be immediate, but for others it can be more subtle. Symptoms can gather pace and get worse if you don’t recognize them early and start treatment.

The hay fever season is typically from the end of March to July but varies depending on where you are in the country and whether your allergy is to grass pollen or tree pollen. Tree pollen tends to be active in the spring. Some start as early as mid-February (alder, hazel and yew); most tree pollen is active in March or April (elm, willow, poplar, birch and ash), and some trees shed in May (plane, oak, pine and lime).

Grass pollen is most active for two months from the end of May, with yellow fields of oil seed rape pollen peaking in May and June, and others (nettle, dock and mugwort) from June to August.

How is hay fever diagnosed?

This is usually from the history and symptoms alone. Most people do not need to have special tests but occasionally your doctor may advise you to have a skin-prick allergy test to help determine if you're allergic to specific substances. It's also worthwhile keeping a diary of your symptoms and the time of year you get them – you may notice a pattern that can indicate which pollen you are allergic to, and start treatment a couple of weeks before this.

Treatment: home & drug-free

The first thing you can do is to keep an eye on the pollen count – the weather station pollen forecast is a reliable source of information.
If it's high in your area, you can take key steps to avoid it:

  • remain indoors if you can to avoid the pollen
  • keep doors and windows shut
  • if you need to go outdoors, avoid activities with excessive grass or pollen contact, such as mowing the lawn
  • particularly avoid dry or windy days, where dust carries more easily in the air
  • wear wraparound sunglasses to protect your eyes
  • when back indoors, shower and wash your hair and clothes, especially before bed
  • if you drive, avoid having the car windows open
  • you can get a pollen filter for your car vents

Other ways to help include avoiding cigarette smoke, cleaning your house regularly to keep dust and mold counts low – wear a mask, dust with a clean, damp cloth and vacuum instead of sweeping - removing items that easily trap dust, such as stuffed animals, dried flowers and curtains, and considering using low-allergy bedding products.

You may prefer to try drug-free options first, and these are a good choice for those who are pregnant or have suffered side effects from medicated hay fever products.

For nose symptoms, nasal lavage like Sterimar Allergy Relief or saline nasal sprays like NeilMed flush away allergens in the nose, preventing them from building up and provoking an immune response.

Topical nasal barriers aim to trap pollen before it enters the nasal passage and causes a reaction. Haymax Hay Fever Balm is one option, as is applying Vaseline inside the nostrils.

Desensitization is a technique designed to reduce the histamine over-reaction that causes hay fever symptoms. One type is allergy immunotherapy, where a series of injections aims to gently introduce your body to the allergen – pollen – before the hay fever season starts, so that you do not get the surge of histamine release. Some people swear by eating honey produced in the area where they live, as bees collect nectar which has captured local pollen. While this may work for some as a solution, and makes sense from the desensitization theory, again the evidence is deemed too weak to say if it definitely works for the majority of sufferers.

Pharmacist recommended products

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Treatment: products

People suffering from hay fever and allergies may suffer from the full spectrum of symptoms, or with just one. A stepwise approach is usually the best course.

Oral antihistamines in tablet or liquid form, will often be enough to bring down most of the symptoms such as sneezing, a runny nose, and watery eyes, and they are particularly useful if you suffer a combination of symptoms. They are available in tablet or liquid form, they can get to work fast, and can be used throughout the hay fever season. If you know your pollen season, it’s a good idea to start antihistamines a couple of weeks beforehand, to reduce or avoid symptoms when the pollen starts shedding.

Some antihistamines are classed as non-drowsy, such as cetirizine or loratadine, and some of the older ones can cause drowsiness, like chlorpheniramine or diphenhydramine. This may be an advantage if symptoms keep you awake, and some people find one works better for them than another.

Fexofenadine is a stronger antihistamine that you can try if others have failed.

You should change the class of antihistamine if using one continuously for more than 3 months, as you can build up a tolerance to its effects and it may have stopped working as well.

Add-on treatments can help resolve any remaining symptoms such as sinus congestion or red itchy eyes, or they can be used alone if symptoms are mild or you wish to avoid antihistamine tablets.

Eye medications: Antihistamines are available over-the counter for those aged 2-3 years.

Ketotifen (Alaway, Zaditor) is dosed two to three times a day. Olopatadine (Pataday) is available in a once a day and a twice a day formulation.

Nose medications: A steroid nasal spray reduces inflammation in the nose, suppressing histamine release and reducing the sensitivity to pollen or allergens. It's a good long-term option to help relieve congestion, sneezing, itching, and a runny nose, and you can start it a few weeks before you expect your hay fever to start. Allow five to seven days of daily application for it to get to work, and continue throughout the allergy season.

Nasal decongestants provide short-term relief from a blocked nose, but they shouldn’t be used in the long term, as they don’t reduce the immune overdrive and can cause side effects.

A saline nasal spray or nasal lavage can also be good drug-free options.

Throat or cough medications such as a steroid nasal spray or drug-free nasal spray, may be best to address coughs and throat symptoms. If you suspect pollen has caused a flare of your asthma symptoms, it’s worth addressing this directly with inhalers and advice from your doctor.

For some people, there may be a few restrictions over the counter on what can be used such as those who might be pregnant or who wear contact lenses. If you’re pregnant, try the drug-free options first, such as sea salt-based nasal sprays, and avoid taking any medication without speaking to a doctor or midwife first.

Not all eye drops are suitable for those wearing contact lenses, so it’s worth checking the product information carefully when deciding what to use.

Treatment for children

Drug-free options are safe and effective – this may be enough, but they are also useful to use alongside medicated products, if needed. Preventative measures include balms to trap pollen in the nostrils, such as Haymax Balm, or nasal barrier sprays to prevent pollen travelling higher up the nose, like AllerBlock Nasal Spray.

Saline washes are also a safe option to flush out pollen from the nose, such as Sterimar Baby Nasal Spray (suitable from 3 months old). For the eyes, it’s good practice to keep eyes clear of pollen with regular washing and some handy eye wipes, like Kleenex Water Fresh Wipes Allergy Comfort.

This may not be enough, and as hay fever can have an impact on your child’s sleep and concentration at school, you may wish to progress to something medicated. Certain antihistamine formulations are known to be safe for children and babies, such as Zyrtec Allergy Syrup, containing active ingredient cetirizine and suitable for children aged 2 years and over. Some oral solutions contain loratadine (Claritin), a non-sedating antihistamine like cetirizine, as a safe alternative for children aged 2 years and over. Other options are levocetirizine (Xyzal) and fexofenadine (Allegra).

When should I see my doctor?

You should consult your doctor if you have used pharmacy medications for 2 weeks with no relief or worsening symptoms, or if symptoms are having a significant impact. It’s also worth a trip if you’ve been reliant on antihistamines for 3 months or more without your doctor's input.

The doctor will ask you about your medical history and current symptoms. They may examine and listen to your chest or look in your throat, depending on your symptoms.

The doctor can prescribe different medications not available in the pharmacy, and in certain cases, they may refer you to an allergy clinic. The clinic may decide to do skin prick testing to find out specific allergies. If you think your hay fever is making asthma or eczema symptoms worse, this is worth discussing with your doctor.

If over-the-counter remedies aren't really helping your child or you're not sure of their diagnosis, do book an appointment with their doctor.

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Dr Karen Martin
Reviewed by Dr Karen Martin
Reviewed on 19.10.2023
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