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Hay fever (seasonal allergic rhinitis)

About hay fever

Hay fever is an allergic reaction to pollen from grasses, weeds or trees, and also possibly to moulds that are carried in the air, usually during the spring and summer. These plants and moulds produce allergens – substances that can cause an allergic reaction.

An allergic reaction happens when your body's immune system reacts to an allergen because it mistakes it for a harmful invader, such as a virus. Hay fever is the result of your immune system overreacting to pollen allergens, which are harmless to most people.

Hay fever, asthma, food allergy and eczema are related allergic conditions and you’re more likely to develop them if they run in your family. This is called atopy. It means that your body produces a certain type of antibody called immunoglobulin E (Ig E) in response to harmless allergens, such as pollen and dust mites.

Symptoms of hay fever

If you have hay fever, you may have symptoms including:

  • sneezing
  • a blocked or runny nose (rhinitis)
  • itchy eyes, nose, throat and roof of your mouth (palate)
  • headaches

These symptoms can make it difficult for you to concentrate or sleep properly. In some people, pollen may also trigger asthma.

If you have hay fever symptoms all year round, you may also be allergic to house dust mites, pet hair and moulds. This is called perennial or persistent allergic rhinitis.

Causes of hay fever

If you have hay fever, your body produces immunoglobulin when you come into contact with pollen or the spores of moulds or fungi. Antibodies are usually only released to fight infection, but with hay fever your body believes the pollen is harmful. This antibody triggers the release of chemicals from certain cells in your nose, throat and eyes. One of these chemicals is histamine, which sets off the symptoms of hay fever.

You may be allergic to one or more types of pollen – this will determine when your symptoms are most severe. Some possible causes are listed below.

  • Grass pollen – up to nine out of 10 people in the UK who have hay fever are allergic to grass pollen.
  • Tree pollen – different trees produce pollen at different times of the year and one in four people in the UK with hay fever is allergic to birch tree pollen.
  • Weeds, such as ragwort and other plants, as well as spores from fungi and moulds.
Allergen

Time of year when symptoms
are worst
Grass pollen May to July/August
Birch pollen April/May
Weeds, spores June/July to November

The pollen season can vary depending on where you live. In the UK, the pollen season usually starts earlier in the year in the south and lasts until later in the north.

Diagnosis of hay fever

Your GP will usually be able to tell if you have hay fever by asking about your symptoms and when you get them. He or she may look inside your nose and down your throat to make sure you don't have any other conditions that could be causing your symptoms.

Your GP may advise you to have a skin-prick allergy test to find out if you're allergic to specific pollens. If you have very severe symptoms that are difficult to control, he or she may also do a radioallergosorbent test (RAST) blood test to measure the level of immunoglobulin antibodies for a specific allergen in your blood.

Treatment of hay fever

Self-help

You can reduce your symptoms by trying to stay indoors and keeping the windows closed on days when the pollen count is high.

Medicines

There are a range of treatments available. You can buy some of these in shops and supermarkets. Others are only available in pharmacies, and some need a prescription from your GP. Get advice from your pharmacist or GP before starting any medication, even if you don't need a prescription for it.

Always read the patient information leaflet that comes with your medicine and if you have any questions, ask your pharmacist or GP for advice. Some hay fever treatments aren’t suitable for women who are pregnant or breastfeeding.

Nasal sprays

If you only get hay fever symptoms now and again and they only affect your nose, you could try an antihistamine nasal spray such as azelastine.

A decongestant nasal spray such as xylometazoline can improve a runny or blocked nose, but it's only suitable for occasional use. Using it for more than a week can lead to 'rebound congestion' where the spray actually causes a blocked nose.

A steroid nasal spray can help prevent symptoms, especially a blocked nose, but isn't very good at treating symptoms swiftly once they have started. A nasal steroid works best if you take it before your symptoms start and then every day during the hay fever season. Take it even if you have no symptoms while the pollen count is high. You shouldn’t take more than the recommended dose, even if you don't feel it's controlling your symptoms. Ask your GP for advice.

You can buy the nasal steroids beclomethasone, budesonide and fluticasone from a pharmacy. Your GP can prescribe all of these and other, more powerful, nasal steroids.

Tablets

Antihistamine tablets usually reduce sneezing and a runny nose, but will probably not improve a blocked nose. Some antihistamines can cause drowsiness, but there are others that don’t and it’s best to try these first. Always ask your GP or pharmacist for advice and read the patient information leaflet that comes with your medicine.

Eye drops

If you have itchy or sore eyes, antihistamine or sodium cromoglicate eye drops can help.

Steroid tablets

If your hay fever is seriously interfering with your life, your GP may prescribe you a short course of steroid tablets. You can use other treatments such as nasal sprays while taking the steroids.

Immunotherapy

If all other treatments haven’t improved your hay fever symptoms, you will need to see an allergy specialist. He or she may offer you immunotherapy. This usually involves having injections of the pollen you're allergic to over a period of three years.

If you have hay fever that is caused by grass pollen, you can take a grass pollen extract as a tablet that you put under your tongue. Your allergy specialist will give you the first dose but after that you can take the tablets at home. You need to take the tablet every day for at least four months before the start of the summer pollen season. You may have an itching, tingling or slight swelling in your mouth for a week or two, but there are rarely any serious or long-lasting side-effects. Studies are currently being carried out to see if the tablet helps to reduce your symptoms in the long term.

Light therapy (phototherapy)

Research has shown that light therapy can improve hay fever symptoms. This involves shining specific wavelengths of ultraviolet light inside your nose. This is a fairly new treatment and it’s not known if it helps to reduce symptoms in the long term.

The pollen count

This is the average number of pollen grains in one cubic metre of air over 24 hours. Pollen counts are done daily for grass, tree and weed pollen. Pollen forecasts predict how high the pollen count will be. This can be useful in helping you decide when will be the best times to start and stop treatment. The weather can affect the pollen count and it's generally higher on sunny days and lower on rainy days.

Prevention of hay fever

There are things you can do to help reduce your symptoms when the pollen count is high. Some of these include:

  • keeping doors and windows closed
  • staying away from areas where there is more pollen such as grassy parks, especially in the early morning and evening when the pollen count is highest
  • wearing wrap-around sunglasses to keep pollen out of your eyes
  • taking a shower and washing your hair after going outside
  • not drying washing outside – pollen may get trapped in the fibres of clothes and bed linen
  • putting Vaseline on the inside of your nostrils to reduce the amount of pollen that gets into your nose

Will I have hay fever abroad?

Answer

It depends on which country you visit and at what time of year.

Explanation

The hay fever season falls at different times in different countries, depending on the climate and the type of vegetation growing there. If you get severe hay fever, it's best to go on holiday somewhere where the pollen count is low all year round, or to visit places that aren't in their peak pollen season.

The grass pollen season in Mediterranean countries such as Greece, southern France and Spain finishes about five weeks before it does in the UK. So a good time to visit these countries is after the middle of July because the pollen count will have already passed its peak. Some local plants may cause problems at other times of the year.

There is generally less pollen in coastal areas, so if you visit the seaside, your hay fever symptoms should lessen. This is because the sea breeze blows pollen inland and brings in fresh air. Mountainous areas may also be good places to visit as they contain fewer pollen-producing plants.

The World Allergy Association has a list of pollen counts by country, so you may be able to check pollen counts before you travel.

Do supermarket own-brand antihistamines work?

Answer

The own-brand products of big supermarkets contain the same active ingredients as the branded antihistamines, so work in exactly the same way.

Explanation

Most antihistamines are available as branded products. Exactly the same ingredients are available, in the same dose, in unbranded or pharmacy or supermarket own-brands for often less than half the price of the branded version. These unbranded equivalents are known as 'generics'. The manufacturers of generic medicines sold in the UK have to follow the same stringent government rules as the manufacturers of the branded equivalent. Therefore, the active ingredient of the generic product will be chemically identical and have the same effect in the body as the branded one.

There is no reason to pay more for the advertised and possibly more smartly packaged product. Always read the patient information leaflet that comes with your medicine and if you have questions, ask your pharmacist for advice.

Do any complementary therapies work for treating hay fever?

Answer

No, there isn't much scientific evidence to show that complementary therapies are useful for treating hay fever.

Explanation

Complementary therapies can be used alongside the medication prescribed by your GP. They include acupuncture, homeopathy and herbal medicines. Some practitioners claim that these complementary therapies can relieve your hay fever symptoms or even prevent them. But there isn't much scientific evidence to prove that these therapies actually work.

If you would like to try using a complementary therapy, let your GP know first. Always continue taking your usual medication, as complementary therapies can't be used to replace this.