Hay Fever and Allergic Rhinitis

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What is hay fever?

Hay fever is a common allergic reaction which occurs at particular times of the year. It is known as seasonal rhinitis, sharing symptoms with perennial (year round) allergic rhinitis, but occurring as a reaction to pollen from grass, trees and weeds during the early spring and summer months. It can affect both adults and children.

Hay fever is usually worse between late March and September, especially when it’s warm, humid and windy. This is when the pollen count is at its highest.

What causes hay fever?

Hay fever is caused when the body makes allergic antibodies (IgE) to certain substances, such as pollen, house dust mites or mould, which are known as allergens.

Grass pollen is the most common allergen (May to July), but tree (February to June) and weed (June to September) pollens can also cause the allergic reaction we know as hay fever. In perennial allergic rhinitis the symptoms continue all year round and usually relate to indoor allergens, such as house dust mites, pets, including birds, or moulds.

What are the symptoms of hay fever?

  • Itchy eyes/ throat
  • Sneezing, blocked/runny nose
  • Watering, red eyes (allergic conjunctivitis)
  • Headaches, blocked sinuses
  • Shortness of breath
  • Tiredness
  • The sensation of mucus running down the back of the throat, which can also be a symptom, is called ‘post-nasal drip’.

These symptoms may become more severe when the pollen count is high.

Antihistamines

Antihistamines are medicines often used to relieve symptoms of allergies, such as hay fever, urticaria, conjunctivitis and reactions to insect bites or stings.

Hay fever tablets are also sometimes used to prevent motion sickness and as a short-term treatment for insomnia. Most antihistamines can be bought from pharmacies and shops, but some are only available on prescription.

Types of antihistamines for hay fever

There are many types of antihistamine. They’re usually divided into 2 main groups:

  • Antihistamines, hay fever tablets, that make you feel sleepy, such as chlorphenamine (Piriton), cinnarizine, diphenhydramine, hydroxyzine and promethazine.
  • Non-drowsy antihistamines that are less likely to make you feel sleepy, such as acrivastine, cetirizine, fexofenadine and loratadine.

They also come in several different forms – including tablets, capsules, liquids, syrups, creams, lotions, gels, eyedrops and nasal sprays. Non-drowsy antihistamines are generally the best option, as they’re less likely to make you feel sleepy. But types that make you feel sleepy may be better if your symptoms stop you sleeping.

Ask a pharmacist for advice if you’re unsure which medicine to try as not all antihistamines are suitable for everyone.

What hay fever medications could I use?

The treatments prescribed for allergy control the symptoms and reactions; they do not cure the condition. Find out more about treatments from our factsheet.

Antihistamines are probably the best known type of allergy medication, and most are readily available from a pharmacy without prescription. However, there are a number of different types of antihistamines; some have been used for many years, some are improvements on old drugs, and new antihistamines are being developed all the time.

While antihistamines used to have a reputation for making people drowsy, more modern antihistamines only occasionally have those side effects. These can be used on their own for mild hay fever or in combination with an intranasal steroid spray for moderate to severe symptoms You can find out more about how antihistamines work on our ‘Allergy Medications‘ factsheet.

How to use your nasal spray

When allergies strike, nasal sprays can help. There are many different types, and most work faster than pills. You can buy them over the counter at most supermarkets and pharmacies, or your doctor can prescribe one to relieve a stuffy or runny nose.

Many people don’t realise that using your nasal spray incorrectly can reduce its effectiveness. You can download our handy how to guide to help promote correct use.

Hay fever treatment

Immunotherapy, often referred to as desensitisation, is a unique treatment for allergic diseases. It is a well-established treatment reserved for certain severe allergies such as when someone has had a serious allergic reaction to wasp or bee venom or severe allergic rhinitis that has not been previously controlled by any of the anti-allergy medication tried.

Immunotherapy usually involves the administration of increasing doses of allergen extracts over a period of time, given to patients by injection or drops/ tablets under the tongue (sublingual). Food allergen desensitisation aims to reduce reactivity to the allergen and is done under very controlled medical conditions, (currently only available privately) but newer approaches to administration (such as by a skin patch that is worn and replaced) may become available in the future. These types of approaches to food desensitisation are very new and not widely available yet, but it something to provide hope for in those at risk of severe food allergic reactions.

Did you know...

A 2020 study by Allergy UK and Kleenex® suggests a surge in UK hay fever sufferers over the last few years

  • up to 56%

    of people

    are anxious that others may mistake their symptoms for signs of Covid-19

  • up to 49%

    of UK population

    report suffering from hay fever symptoms

  • up to 37%

    of people

    have developed symptoms for the first time in the last five years

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Greg's Story

Click here to view Greg’s story, an inspirational video from one of our amazing supporters on hay fever and the effects it can have on an individual’s daily routine and social life.

How do I manage hay fever symptoms?

These unpleasant and sometimes debilitating symptoms can be relieved by avoidance of the allergic triggers and the use of antihistamines. Find our 4 top tips below:

  1. Monitor pollen forecasts daily and stay indoors wherever possible when the count is high (generally on warmer, dry days). Rain washes pollen from the air so counts should be lower on cooler, wet days
  2. On high pollen days, shower and wash your hair after arriving home and change your clothing
  3. Avoid drying washing on a clothes-line outside when pollen counts are high
  4. Apply an effective allergen barrier balm around the edge of each nostril to trap or block pollens and other allergens and help prevent a reaction.

Find out more about managing your hay fever symptoms during a high pollen count.

What not to do

  • do not cut grass or walk on grass
  • do not spend too much time outside
  • do not keep fresh flowers in the house
  • do not smoke or be around smoke – it makes your symptoms worse
  • do not dry clothes outside – they can catch pollen
  • do not let pets into the house if possible – they can carry pollen indoors

For more detailed information about hay fever and for more useful tips on management and treatment, please find further useful resources above.

Allergic eye disease 

Allergic conjunctivitis can be seasonal or all year round (perennial). For most of those affected seasonally, sometimes known as hay fever eyes, the symptoms are part of their hay fever and the cause is the same – grass, tree, and weed or shrub pollen.

What are the symptoms of allergic eye disease

  • Itching eyes
  • Burning, watering and redness of the eyes
  • Puffiness of the eyelids

Perennial allergic conjunctivitis is usually a reaction to house dust mite or pets in the indoor environment. For more information on diagnosis and management of allergic eye disease please see our Factsheet.

Play video

Sam's Story

Sam is nine years old and has been living with Vernal Keratoconjunctivitis (a rare type of allergic eye disease). Sam also has asthma, and between the ages of one and four was admitted several times to hospital via the emergency department.

Allergy to pollens and moulds

Of all airborne allergens that we breathe in outdoors, pollens and mould spores are the most common and problematic. Typical hay fever symptoms are a runny nose, itchy and watery eyes, sneezing, and a feeling of nasal congestion.

Gardens can be designed to reduce exposure to allergens like pollen and moulds. The first principle of treating allergy is avoidance. Total avoidance by staying indoors is not a realistic option, but reducing contact with allergens is possible, particularly where gardens are enclosed.

Pollen levels are at their highest at the beginning of the day, when they rise with the warming air, and at the end of the day when it’s cooling down.

What is pollen food syndrome

Pollen food syndrome, commonly referred to as oral allergy syndrome, is a hypersensitivity reaction to fruits, vegetables and nuts (often referred to as plant based foods) usually causing mild irritant symptoms such as itching of the mouth, lips and throat itching when eaten in their raw form. The most common presentation of pollen food syndrome is to foods that cross react with birch pollen. This is because a variety of plant food allergens have a similar protein structure to birch pollen.

In Europe, the prevalence of birch pollen sensitisation is estimated to be around 8-16%, and of those, approximately 70% cross react with food sources (pollen food syndrome). Foods include: almond, apple, apricot, carrot, celery, cherry, hazelnut, kiwi, nectarine, peanut, peach, pear, plum, potato, soya and walnut.

The most common reactions in Northern Europe are to apples, hazelnut, and carrots. However, this will vary depending on each individual and their pollen allergies. Avoidance of the food that cause reactions is important, however, there is no need to avoid food that do not cause symptoms. Most of the time, the food only needs to be avoided in raw form as cooking denatures (breaks down) the allergen. For many with pollen food syndrome they can tolerate fruit and vegetables that are well cooked. If you are unsure how to manage symptoms or have symptoms suggestive of pollen food syndrome, speak with a health professional.

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