Hay fever

Also known as allergic rhinitis

Hay fever is the inflammation of the lining of the nose and eyes due to allergy. Many people experience it as seasonal allergy to grass pollens.

Key points

  1. Hay fever causes blocked, runny and itchy nose, sneezing and itchy watery eyes. Avoiding the allergen, if possible, is the best way to prevent allergic rhinitis.
  2. Treatment includes antihistamines, corticosteroid and/ or decongestant medications may provide symptom relief.
  3. Immunotherapy may help desensitise you to certain allergens.
  4. For some people bad rhinitis can be associated with worsening asthma so it can be hard to breathe.

Causes

Substances that cause hayfever are present in the air and are breathed into the nose. They include:

  • grass, weed and tree pollens
  • house dust mites
  • mould spores
  • hair and skin flakes from animals (known as 'dander')
  • cockroach droppings.

Allergic rhinitis can be categorised into two groups:

  1. Seasonal rhinitis (hay fever) is when symptoms occur at certain times of the year (eg, spring). Wind-borne pollens are the cause of seasonal hay fever, which usually occurs in spring and summer. The length of the pollen season depends on where you live and the plant species you are allergic to.
  2. Perennial rhinitis is when symptoms occur at any time of the year. Dust mites and domestic pets are the most common causes of perennial rhinitis.

Symptoms

undefinedSymptoms of allergic rhinitis within minutes of contact with allergen:

  • sneezing – usually within minutes of exposure to allergen
  • running nose – worst about 20 minutes after contact with allergen

Symptoms of allergic rhinitis 6-12 hours after contact with allergen:

  • watery, itchy, puffy eyes
  • blocked nose, and sometimes blocked ears as well.

If allergic rhinitis is severe and untreated:

  • you may sleep poorly, which can leave you feeling tired during the day
  • you may be more prone to sinus infections and eye infections
  • if you have asthma, allergic rhinitis can make your asthma symptoms more difficult to control.

Diagnosis

The symptoms of allergic rhinitis can be similar to other conditions that might affect your nose, such as colds or nasal polyps. See your doctor to confirm whether your symptoms are due to allergic rhinitis or some other condition.

  • your doctor will examine your eyes, nose and throat for signs of irritation and congestion
  • they will ask you questions about your history of allergic rhinitis, which may provide clues as to which substance (allergen) is causing your symptoms
  • your doctor may need to order blood tests or skin-prick tests to find out what you are allergic to.

Skin prick tests

  • This involves placing a drop of the allergen on your skin and then scratching your skin through the drop.
  • If you are allergic, your skin will become red and swollen at the site within 15 minutes.
  • Skin tests are not a diagnosis by themselves and these results need to be considered with your history and symptoms.

Once you know which allergen is triggering your symptoms, the major treatment aim is to avoid it.

Treatment

Medications

Medications to treat and help prevent allergic rhinitis are available from your doctor or over-the-counter at your pharmacy. These can be very effective in reducing your symptoms. Always continue to avoid your allergen whenever possible, even when taking medications.

These medications are taken as a tablet or as a nasal spray and include:

Other medicines are available on prescription. Some medications are started before the pollen season, and taken every day to help prevent your symptoms occurring. Others can be used 'as needed' for quick relief when symptoms occur. Your doctor can advise you on which option is best for you.

Immunotherapy

If allergic rhinitis symptoms continue to be troublesome despite the use of allergen avoidance and appropriate medications, immunotherapy may be helpful. The aim is to desensitise you to the allergen, and reduce or even eliminate your symptoms.

During immunotherapy you receive a very small amount of the allergen –  either by injection or sub-linqually (under-the-tongue). The amount is increased gradually over several years.

Prevention

The best way to avoid an allergic reaction is to avoid the allergens that trigger it – something that is easier said than done.

Avoiding allergens

While allergens can be difficult to avoid, here are some suggestions that may help.

If you have seasonal hay fever:

  • consider staying inside when the pollen count forecast is high, on windy days or after thunderstorms
  • select plants for your garden that are pollinated by birds or insects, rather than plants that release their seeds into the air
  • avoid mowing the lawn, raking leaves or having an open compost heap
  • splash your eyes with cold water or shower after any activities that have exposed you to a lot of pollen
  • rub petroleum jelly (like Vaseline) inside your nose to stop the pollen from coming into contact with the lining of your nose.

If you are allergic to pet dander: keep your pet outdoors and out of bedrooms!

If you are allergic to house dust mites, the following tips for reducing dust mite levels are often recommended and help some people. However, a recent high quality study concluded that dust mite and bedroom measures might reduce symptoms of allergic rhinitis for some people, but the evidence is not strong. More research is needed. 

  • keep your house well ventilated, to avoid a build up of moist air inside the house (house dust mites thrive in damp conditions)
  • select vinyl or leather furnishings rather than soft covers
  • cover mattresses and pillows with dust mite covers
  • use a vacuum cleaner with a HEPA air filter or, if possible, get someone else to do the vacuuming
  • dust with a damp cloth damp
  • wash soft toys regularly in hot water or put in the freezer for 1 to 2 days.

Learn more

What is allergic rhinitis? Allergy NZ
Allergic rhinitis Patient Info, UK
Hay fever Better Health Channel, Australia
Allergies section  Auckland District Health Board Immunology Department - HealthPoint

Credits: Health Navigator August 2014.