This type of allergy causes cold-like signs and symptoms, such as a runny nose, itchy eyes, congestion, sneezing and sinus pressure. But unlike a cold, hay fever isn’t caused by a virus. Hay fever is caused by an allergic response to outdoor or indoor allergens, such as pollen, dust mites or pet dander.
Hay fever can make you miserable and affect your performance at work or school and interfere with leisure activities. But you don’t have to put up with annoying symptoms. Learning how to avoid triggers and finding the right treatment can make a big difference.
Symptoms of Hay Fever
Hay fever signs and symptoms usually start immediately after you’re exposed to a specific allergy-causing substance (allergen) and can include:
Runny nose and nasal congestion
Watery or itchy eyes
Itchy nose, roof of mouth or throat
Sinus pressure and facial pain
Swollen, blue-colored skin under the eyes (allergic shiners)
Decreased sense of smell or taste
Time of year can be a factor
Your hay fever symptoms may start or worsen at a particular time of year, triggered by tree pollen, grasses or weeds, which all bloom at different times. If you’re sensitive to indoor allergens, such as dust mites, cockroaches, mold or pet dander, you may have year-round symptoms. Many people have allergy symptoms all year long, but their symptoms get worse during certain times of the year.
The effects of age
Although hay fever can begin at any age, you’re most likely to develop it during childhood or early adulthood. It’s common for the severity of hay fever reactions to change over the years. For most people, hay fever symptoms tend to diminish slowly, often over decades.
Is it hay fever? Or is it a cold?
Signs and symptoms can be different. Here’s how to tell which one’s causing your symptoms:
Hay fever Signs and symptoms: Runny nose with thin, watery discharge; no fever
Colds: Runny nose with watery or thick yellow discharge; body aches; low-grade fever
Onset of Hay fever is Immediately after exposure to allergens while that of cold is 1-3 days after exposure to a cold virus
Duration for hay fever is as long as you’re exposed to allergens while that of colds is 3-7 days
When to see a doctor
See your doctor if:
You think you may have hay fever
Your symptoms are ongoing and bothersome
Allergy medications aren’t working for you
Allergy medications work, but side effects are a problem
You have another condition that can worsen hay fever symptoms, such as nasal polyps, asthma or frequent sinus infections
Many people — especially children — get used to hay fever symptoms. But getting the right treatment can reduce irritating symptoms. In some cases, treatment may help prevent more-serious allergic conditions, such as asthma or eczema.
You may want to see an allergy specialist (allergist) if:
Your symptoms are severe
Hay fever is a year-round nuisance
Allergy medications aren’t controlling your symptoms
Your allergy medications are causing troublesome side effects
You want to find out whether allergy shots (immunotherapy) might be an option for you
Causes of Hay Fever
During a process called sensitization, your immune system mistakenly identifies a harmless airborne substance as something harmful. Your immune system then starts producing antibodies to this harmless substance. The next time you come in contact with the substance, these antibodies recognize it and signal your immune system to release chemicals, such as histamine, into your bloodstream. These immune system chemicals cause a reaction that leads to the irritating signs and symptoms of hay fever.
Seasonal hay fever triggers include:
Tree pollen, common in the spring, Grass pollen, common in the late spring and summer, Ragweed pollen, common in the fall
Spores from fungi and molds, which can be worse during warm-weather months
Year-round hay fever triggers include:
Dust mites or cockroaches
Dander (dried skin flakes and saliva) from pets, such as cats, dogs or birds
Spores from indoor and outdoor fungi and molds
Hay fever doesn’t mean you’re allergic to hay. Despite its name, hay fever is almost never triggered by hay, and it doesn’t cause a fever.
Risk Factors of Hay Fever
The following factors may increase your risk of developing hay fever:
Having other allergies or asthma
Having a blood relative (such as a parent or sibling) with allergies or asthma
Living or working in an environment that constantly exposes you to allergens — such as animal dander
Problems that may be associated with hay fever include:
Reduced quality of life. Hay fever can interfere with your enjoyment of activities and cause you to be less productive. For many people, hay fever symptoms lead to absences from work or school.
Poor sleep. Hay fever symptoms can keep you awake or make it hard to stay asleep.
Worsening asthma. If you have asthma, hay fever can worsen signs and symptoms, such as coughing and wheezing.
Sinusitis. Prolonged sinus congestion due to hay fever may increase your susceptibility to sinusitis — an infection or inflammation of the membrane that lines the sinuses.
Ear infection. In children, hay fever often is a factor in middle ear infection (otitis media).
Tests and Diagnosis
Your doctor will ask detailed questions about your personal and family medical history, your signs and symptoms, and your usual way of treating them. Your doctor will also perform a physical examination to look for additional clues about the causes of your signs and symptoms. He or she may also recommend one or both of the following tests:
Skin prick test. During skin testing, small amounts of material that can trigger allergies are pricked into the skin of your arm or upper back and you’re observed for signs of an allergic reaction. If you’re allergic, you develop a raised bump (hive) at the test location on your skin. Allergy specialists usually are best equipped to perform allergy skin tests.
Allergy blood test. A blood test, sometimes called the radioallergosorbent test (RAST), can measure your immune system’s response to a specific allergen. The test measures the amount of allergy-causing antibodies in your bloodstream, known as immunoglobulin E (IgE) antibodies. A blood sample is sent to a medical laboratory, where it can be tested for evidence of sensitivity to possible allergens.
Treatment and Drugs
The best hay fever treatment is to avoid the substances that cause your reaction. However, this isn’t always possible, and you may need additional treatments along with strategies to prevent exposure.
If your hay fever isn’t too severe, over-the-counter medications may be enough to ease your symptoms. For more bothersome symptoms, you may need to take prescription medications. Many people get the best relief from a combination of allergy medications. It may take trying a few before you figure out what works best for you.
If your child has hay fever, talk with your doctor about the best treatment. Some medications are approved for use in children, while others are approved only for adults. If you want to try an over-the-counter medication for your child, be sure to read the labels carefully.
Medications for hay fever include:
Nasal corticosteroids. These prescription nasal sprays help prevent and treat the nasal inflammation, nasal itching and runny nose caused by hay fever. For many people they’re the most effective hay fever medications, and they’re often the first type of medication prescribed. Examples include fluticasone propionate (Flonase), triamcinolone (Nasacort AQ), mometasone (Nasonex) and budesonide (Rhinocort). Nasal corticosteroids are a safe long-term treatment for most people. Side effects can include an unpleasant smell or taste and nose irritation. Steroid side effects are rare.
Antihistamines. These preparations are usually given as pills. However, there are also antihistamine nasal sprays and eyedrops. Antihistamines can help with itching, sneezing and runny nose but have less effect on congestion. They work by blocking histamine, a symptom-causing chemical released by your immune system during an allergic reaction. Older over-the-counter antihistamines such as diphenhydramine (Benadryl) work as well as newer ones, but some types can make you drowsy. Newer oral antihistamines are less likely to make you drowsy. Over-the-counter examples include loratadine (Claritin, Alavert), cetirizine (Zyrtec Allergy) and fexofenadine (Allegra). The prescription antihistamine nasal sprays azelastine (Astelin, Astepro) and olopatadine (Patanase) can relieve nasal symptoms. Antihistamine eyedrops help relieve eye itchiness and eye irritation caused by hay fever.
Decongestants. These medications are available in over-the-counter and prescription liquids, tablets and nasal sprays. Over-the-counter oral decongestants include Sudafed and Drixoral. Nasal sprays include phenylephrine (Neo-Synephrine) and oxymetazoline (Afrin). Oral decongestants can cause a number of side effects, including increased blood pressure, insomnia, irritability and headache. Don’t use a decongestant nasal spray for more than two or three days at a time because it can actually worsen symptoms when used continuously (rebound congestion).
Cromolyn sodium. This medication is available as an over-the-counter nasal spray that must be used several times a day. It’s also available in eyedrop form with a prescription (Crolom). It helps relieve hay fever symptoms by preventing the release of histamine. Cromolyn sodium doesn’t have serious side effects, and it’s most effective when you begin using it before your symptoms start.
Leukotriene modifier. Montelukast (Singulair) is a prescription tablet taken to block the action of leukotrienes — immune system chemicals that cause allergy symptoms such as excess mucus production. It’s especially effective in treating allergy-induced asthma. It’s often used when nasal sprays can’t be tolerated, or when you have mild asthma. It can cause headaches. In rare cases, montelukast has been linked to psychological reactions such as agitation, aggression, hallucinations, depression and suicidal thinking. Seek medical advice right away for any unusual psychological reaction.
Nasal ipratropium. Available in a prescription nasal spray, ipratropium (Atrovent) helps relieve a severe runny nose by preventing the glands in your nose from producing excess fluid. It’s not effective for treating congestion, sneezing or postnasal drip. Mild side effects include nasal dryness, nosebleeds and sore throat. Rarely, it can cause more-severe side effects, such as blurred vision, dizziness and difficult urination. The drug is not recommended for people with glaucoma or men with an enlarged prostate.
Oral corticosteroids. Corticosteroid medications in pill form, such as prednisone, are sometimes used to relieve severe allergy symptoms. Because the long-term use of corticosteroids can cause serious side effects such as cataracts, osteoporosis and muscle weakness, they’re usually prescribed for only short periods of time.
Other treatments for hay fever include:
Allergy shots (immunotherapy). If medications don’t relieve your hay fever symptoms or cause too many side effects, your doctor may recommend allergy shots (immunotherapy or desensitization therapy). Over a period of three to five years, you’ll receive regular injections containing tiny amounts of allergens. The goal is to get your body used to the allergens that cause your symptoms, and decrease your need for medications. Immunotherapy may be especially effective if you’re allergic to cat dander, dust mites, or pollen produced by trees, grass or weeds. In children, immunotherapy may help prevent the development of asthma.
Rinsing your sinuses. Rinsing your nasal passages with distilled, sterile saline (nasal irrigation) is a quick, inexpensive and very effective way to relieve nasal congestion. Rinsing directly flushes out mucus and allergens from your nose. Look for a squeeze bottle or a neti pot — a small container with a spout designed for nose rinsing — at your pharmacy or health food store. Use water that’s distilled, sterile, previously boiled and cooled, or filtered using a filter with an absolute pore size of 1 micron or smaller to make up the saline irrigation solution.
Also be sure to rinse the irrigation device after each use with similarly distilled, sterile, previously boiled and cooled, or filtered water and leave open to air-dry