Hay Fever and Allergic Rhinitis
Rhinitis is inflammation of the nose, which is recognised by symptoms such as sneezing, runny nose, blocked/stuffy nose, itching and 'post-nasal drip' (the sensation of mucus running down the back of the throat). It can occur in association with inflammation of the eyes or sinuses. Rhinitis can have several causes, such as infection, a reaction to medication, irritation by dusts, or allergy.
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Allergic rhinitis is caused when the body makes allergic antibody (IgE) to a substance such as pollen, house dust mites, cat, dog or moulds (called an allergen). In people sensitive to these allergens, exposure causes the release of chemicals from cells in the nasal passages, eyes or airways. This results in inflammation and irritation to the lining of the eyes, nose and throat.
Grass pollen is the most common allergen, which affects sufferers at the specific times of the year when grass pollen is released (May-July). However, some people become allergic to tree or weed and shrub pollens, and will therefore be affected at different times of the year (February-June for trees; September and October for weeds). The patient who is allergic to tree, grass and weed pollens may suffer a very prolonged 'hayfever' season. Rhinitis which occurs for only part of the year in this way is called seasonal allergic rhinitis.
Symptoms that continue all year are called perennial allergic rhinitis and commonly relate to indoor allergens, such as house dust mites, pets and indoor moulds.
Symptoms
In an attempt to rid the body of allergens, the immune system overreacts and releases chemicals (mediators) which cause inflammation. Some of these mediators (e.g. histamine) work quickly, causing sneezing, itching and runny nose. The eyes may also be affected, with itching, redness and watering (allergic conjunctivitis). Other mediators work more slowly, causing a blocked or stuffy nose, which may lead to headache and difficulty sleeping.
Rhinitis is often regarded as a trivial problem but studies have shown that it severely affects people's quality of life. It disturbs sleep, impairs daytime concentration and the ability to carry out tasks, causes people to miss work or school, and has been shown to affect children’s school exam results.
People who suffer rhinitis are at increased risk of developing asthma. Inflammation at one end of the airway (the nose) often spreads to the other end (the lungs), and this has led to the 'one airway' approach to treatment. Asthmatics who also suffer rhinitis have less severe asthma and less A&E and hospital admissions if their rhinitis is treated effectively.
Pollen-food allergy
Some people with pollen allergy (especially allergy to tree pollens) may be affected by cross-reactions between their pollen allergy and certain foods. For example, they may find that when eating certain fruits and vegetables, especially raw, they get an itchy mouth or throat. See our factsheet Oral Allergy Syndrome for more details.
Management
Rhinitis can be managed by:
1. Avoidance of the allergic trigger (pollens, moulds, house dust mite etc.)
Allergen avoidance is difficult for people with allergy to substances in the air, such as pollen. For example, tiny pollen spores are windborne and travel for miles on air currents. However, many people do benefit from allergen avoidance to house dust mite and pets, while some simple measures can be used to help people with hay fever.
See Avoiding Respiratory Allergens for more information.
2. Treatments that suppress the symptoms of rhinitis
Anti-histamines work against histamine, an important mediator in rhinitis. They are available as tablets (liquids are available for children) although anti-histamine nasal sprays are also available. There are a large range of anti-histamines; the newer ones are mostly taken once daily and do not cause drowsiness in most people. This form of treatment can be all that is needed in some people and is most effective for sneezing, an itching and runny nose, but less so for a blocked nose. Different anti-histamines suit different people so if the first one you try is not helping, switch to another.
If your symptoms persist or are more severe, the regular use of a steroid nasal-spray is often effective in relieving symptoms, especially if a blocked nose is a problem. These are available from pharmacists or on prescription from your GP. As with anti-histamines, there are different types of steroid nasal spray and you may need to try more than one to find the best solution.
Cromoglycate nasal sprays are useful alternatives to anti-histamines in some people. Additional drugs are available on prescription for people who suffer seasonal asthma as well as hay fever symptoms.
Nasal sprays that contain decongestants may be useful on the worst days but should not be used regularly, as they can make symptoms worse if used frequently.
Anti-histamines and steroid nasal sprays often control eye symptoms as well, but eye drops are available over-the-counter or on prescription if needed. Cromoglycate drops are often effective.
All rhinitis treatments should be taken regularly, starting shortly before your symptoms normally begin. It is more difficult to control symptoms that are already well established. Only taking medications occasionally on the worst days is much less effective.
3. Treatments that alter the immune system response to the allergen
Desensitisation (also called immunotherapy) is a treatment where an allergic person is exposed to very small doses of allergen on a regular basis. It can be a very successful treatment for severe allergic rhinitis, as it causes the body to develop ‘regulatory’ immune cells which control the allergic reaction and results in tolerance to the allergen.
Desensitisation is available in two main forms, either as injections or as a tablet which dissolves under the tongue (sublingual therapy). To date, the most effective treatment is a course of injection immunotherapy, which can have long lasting benefits. Injection therapy is available for allergy to grass pollens, tree pollens, housedust mite allergy and allergy to pets. The tablet form of immunotherapy is currently only available for grass pollen allergy.
As immunotherapy is so intensive and time-consuming, it is only those with extreme symptoms uncontrolled by normal medications who receive this therapy. In order to be considered for desensitisation you will need to be referred to a specialist allergy clinic by your GP.
For more information, see our factsheet Immunotherapy.
Allergy testing
Allergy testing is not usually required in simple hayfever because the trigger substances can be easily identified from the history of when and where symptoms occur. However, in certain cases a skin prick test or blood test might be of some value.
If anything in these instructions is unclear, ask your physician for help or advice, or call the Allergy UK Helpline on 01322 619 898 (9am to 5pm Monday to Friday).
Last updated: March 2012
