Hay fever

Hay fever, also called allergic rhinitis, causes cold-like symptoms. These may include 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 a harmless outdoor or indoor substance the body identifies as harmful (allergen).

Common allergens that can trigger hay fever symptoms include pollen and dust mites. Tiny flecks of skin shed by cats, dogs, and other animals with fur or feathers (pet dander) also can be allergens.

Besides making you miserable, hay fever can affect how well you perform at work or school and can generally interfere with your life. But you don't have to put up with annoying symptoms. You can learn to avoid triggers and find the right treatment.

Symptoms

Hay fever symptoms can include:

• Runny nose and nasal stuffiness (congestion)
• Watery, itchy, red eyes (allergic conjunctivitis)
• Sneezing
• Cough
• Itchy nose, roof of mouth or throat
• Mucus that runs down the back of your throat (postnasal drip)
• Swollen, bruised-appearing skin under the eyes (allergic shiners)
• Extreme tiredness (fatigue), often due to poor sleep

Hay fever triggers

Your hay fever signs and symptoms may occur year-round or may start or worsen at a particular time of year (seasonal).

Hay fever triggers include:

• Tree pollen, which is common in early spring
• Grass pollen, which is common in late spring and summer
• Ragweed pollen, which is common in fall
• Dust mites and cockroach droppings, which are present year-round
• Dander from pets, which can be bothersome year-round but might cause worse symptoms in winter, when houses are closed up
• Spores from indoor and outdoor fungi and molds, which can be both seasonal and year-round

Hay fever or common cold?

Symptoms can be similar, so it can be difficult to tell which one you have.

Condition	Symptoms	Onset	Duration
Hay fever	Runny nose with thin, watery discharge; no fever	Immediately after exposure to allergens	As long as you're exposed to allergens
Common cold	Runny nose with watery or thick yellow discharge; body aches; low-grade fever	1 to 3 days after exposure to a cold virus	3 to 7 days

When to see a doctor

See your health care provider if:

• You can't find relief from your hay fever symptoms
• Allergy medications don't provide relief or cause annoying side effects
• 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, so they might not seek treatment until the symptoms become severe. But getting the right treatment might offer relief.

Causes

When you have hay fever, your immune system identifies a harmless airborne substance as being harmful. This substance is called an allergen. Your immune system is how your body protects itself, so it produces immunoglobulin E (IgE) antibodies to protect against this allergen. The next time you come in contact with the allergen, these antibodies signal your immune system to release chemicals such as histamine into your bloodstream. This causes a reaction that leads to the symptoms of hay fever.

Risk factors

The following can increase your risk of developing hay fever:

• Having other allergies or asthma
• Having a condition called atopic dermatitis or eczema, which makes your skin irritated and itchy
• 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 or dust mites
• Being exposed to smoke and strong odors that irritate the lining of the nose
• Having a mother who smoked during your first year of life

Complications

Problems that may go along 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 missing work or school.
• Poor sleep. Hay fever symptoms can keep you awake or make it hard to stay asleep. This can lead to fatigue and a general feeling of being unwell (malaise).
• Worsening asthma. Hay fever can worsen symptoms of asthma, such as coughing and wheezing.
• Sinusitis. Prolonged sinus congestion due to hay fever may increase your risk of getting 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).

Prevention

There's no way to avoid getting hay fever. If you have hay fever, the best thing to do is to lessen your exposure to the allergens that cause your symptoms. Take allergy medications before you're exposed to allergens, as directed by your health care provider.

Diagnosis

To diagnose hay fever, your health care provider typically does a physical exam and talks about your health, symptoms and possible triggers. Your provider may recommend one or both of these tests:

• Skin prick test. Small amounts of material that can trigger allergies are pricked into patches of skin on your arm or upper back. You're then watched for an allergic reaction. If you're allergic, you develop a raised bump (hive) at the site of that allergen. This typically takes about 15 to 20 minutes. Allergy specialists usually are best equipped to perform allergy skin tests.
• Allergy blood test. A blood sample is sent to a lab to measure your immune system's response to a specific allergen. This test measures the amount of allergy-causing antibodies in your bloodstream, known as immunoglobulin E (IgE) antibodies.

Treatment

Once you know what you're allergic to, you and your health care provider can develop a treatment plan to reduce or get rid of your hay fever symptoms.

It's best to limit your exposure to substances that cause your hay fever. If your hay fever isn't too severe, medications you can buy without a prescription may be enough to relieve symptoms. For worse symptoms, you may need prescription medications.

Many people get the best relief from a combination of allergy medications. You might need to try a few different options before you find what works best.

If your child has hay fever, talk with your child's health care provider about treatment. Not all medications are approved for use in children. Read labels carefully.

Treatments for hay fever may include medications, immunotherapy and nasal saline rinses.

Medications for hay fever

Nasal corticosteroids

These nasal sprays help prevent and treat the nasal stuffiness (congestion) and the itchy, runny nose caused by hay fever. For many people, nasal sprays are the most effective hay fever medications, and they're often the first type of medication recommended.

• Nonprescription nasal sprays include fluticasone (Flonase Allergy Relief), budesonide (Rhinocort Allergy), triamcinolone (Nasacort Allergy 24 Hour) and mometasone (Nasonex 24HR Allergy).
• Prescription nasal sprays that combine an antihistamine with a steroid include azelastine and fluticasone (Dymista) and mometasone and olopatadine (Ryaltris).

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 from a nasal spray are rare.

Antihistamines

Antihistamines work by blocking a symptom-causing chemical (histamine) released by your immune system during an allergic reaction. Antihistamines can help with itching, sneezing and a runny nose but have less of an effect on congestion. These preparations are usually given as pills (orally). However, there are also antihistamine nasal sprays that can relieve nasal symptoms. Antihistamine eye drops can help relieve eye itchiness and irritation.

• Oral antihistamines available without a prescription include loratadine (Claritin, Alavert), cetirizine (Zyrtec Allergy) and fexofenadine (Allegra Allergy).
• Nonprescription eye drops include olopatadine (Pataday) and ketotifen fumarate (Alaway, Zaditor).
• Nonprescription nasal sprays include azelastine (Astepro Allergy).
• Prescription nasal sprays include olopatadine (Patanase).

Common side effects of antihistamines are dry mouth, nose and eyes. Some oral antihistamines may make you sleepy. Other side effects of oral antihistamines can include restlessness, headaches, changes in appetite, trouble sleeping, and problems with blood pressure and urinating. Talk to your health care provider before taking antihistamines, especially if you're pregnant or breastfeeding, or have glaucoma or an enlarged prostate.

Decongestants

Decongestants reduce nasal stuffiness and pressure from swelling. Because they do not relieve other symptoms of hay fever, they're sometimes combined with other medications such as antihistamines.

Decongestants are available as liquids, tablets and nasal sprays. They are also available with and without a prescription.

• Oral decongestants include pseudoephedrine (Sudafed).
• Nasal decongestant sprays include phenylephrine hydrochloride (Neo-Synephrine) and oxymetazoline (Afrin).

Oral decongestants can cause a number of side effects, including increased blood pressure, insomnia, irritability and headache. Decongestants may cause problems urinating if you have an enlarged prostate. Check with your health care provider before taking decongestants if you have high blood pressure or heart disease or if you're pregnant.

Don't use a decongestant nasal spray for more than 2 to 3 days at a time because it can worsen symptoms when used continuously (rebound swelling).

Cromolyn sodium

Cromolyn sodium can help relieve hay fever symptoms by preventing the release of histamine. This medication is most effective if you start using it before you have symptoms. Cromolyn sodium is available as a nonprescription nasal spray that must be used several times a day. It's also available in eye drop form with a prescription. Cromolyn sodium doesn't have serious side effects.

Leukotriene modifier

Montelukast (Singulair) is a prescription tablet taken to block the action of leukotrienes. Leukotrienes are immune system chemicals that cause allergy symptoms, such as irritation in the nose and making too much mucus. It's especially effective in treating allergy-induced asthma. It's often used when nasal sprays can't be tolerated or for mild asthma.

Montelukast can cause headaches. In rare cases, it has been linked to psychological reactions such as insomnia, anxiety, depression and suicidal thinking. Get medical advice right away for any unusual psychological reaction.

Nasal ipratropium

Available in a prescription nasal spray, ipratropium helps relieve severe runny nose by preventing the glands in the nose from making too much mucus. It's not effective for treating congestion, itching or sneezing.

Mild side effects include dry nose, nosebleeds, dry and irritated eyes, and sore throat. Rarely, the medication can cause more-severe side effects, such as blurred vision, dizziness and trouble urinating. This drug is not recommended if you have glaucoma or an enlarged prostate.

Oral corticosteroids

Corticosteroid pills such as prednisone sometimes are 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.

Immunotherapy for hay fever

Allergy shots

Also called immunotherapy or desensitization therapy, allergy shots change the way the immune system reacts to allergens. If medications don't relieve your hay fever symptoms or cause too many side effects, your health care provider may recommend allergy shots. Over 3 to 5 years, you'll get regular shots (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 might be especially effective if you're allergic to animal dander, dust mites or pollen produced by trees, grass or weeds. In children, immunotherapy may help prevent asthma.

Under-the-tongue (sublingual) allergy tablets

Rather than getting shots, you take tiny amounts of allergen in pill form that dissolves in your mouth. Pills are usually taken daily. Sublingual allergy tablets don't work for all allergens but can be helpful for grass and ragweed pollens and dust mites.

Nasal saline rinses for hay fever

Saline nasal spray

Saline nasal sprays can moisten dry nasal passages and thin nasal mucus. You don't need a prescription and you can use them as often as needed.

Nasal irrigation

Rinsing your nasal passages with saline (nasal irrigation) is a quick and effective way to relieve nasal congestion. Rinsing flushes out mucus and allergens from your nose. Saline irrigation is a water-based solution that contains a tiny amount of salt (sodium) and other ingredients.

Saline irrigation solutions can be purchased ready-made or as kits to add to water. You can also use a homemade solution. 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.

To make up the saline irrigation solution, do not use tap water, as it can contain organisms that could cause infection. Use water that's distilled or sterile. You can also use water that was boiled and cooled. Another option is using water that has been filtered using a filter with an absolute pore size of 1 micron or smaller.

To prevent infections, wash the bottle or pot with hot soapy water and rinse it after every use and leave it open to air-dry. Do not share a container with other people.

Lifestyle and home remedies

It's not possible to avoid allergens completely, but you can reduce your symptoms by limiting your exposure to these substances. If you know what you're allergic to, you can avoid your triggers. Consider some of these tips.

Pollen or molds

Pollen and mold spores are fine dustlike particles that plants use in fertilization. They float in the wind and can get into your nose and eyes.

• Close doors and windows during pollen season.
• Don't hang laundry outside — pollen can stick to sheets and towels.
• Use air conditioning in your house and car.
• Use an allergy-grade filter in your home ventilation system and change it regularly.
• Avoid outdoor activity in the early morning, when pollen counts are highest, and also on high pollen-count days.
• Stay indoors on dry, windy days.
• Use a dehumidifier to reduce indoor humidity.
• Use a high-efficiency particulate air (HEPA) filter in your bedroom and other rooms where you spend a lot of time.
• Avoid mowing the lawn or raking leaves.
• Wear a dust mask when cleaning house or gardening.
• Wear glasses or sunglasses when outside to limit pollen getting in your eyes.

Dust mites

Dust mites are tiny, insect-like pests that are common in dust. They live in bedding, carpets, upholstery and stuffed animals. Dust mites prefer warm, humid spaces.

• Use allergy-proof covers on mattresses, box springs and pillows.
• Wash sheets, blankets and stuffed animals at least weekly in water heated to at least 130 F (54 C).
• Use a dehumidifier or air conditioner to reduce indoor humidity.
• Vacuum carpets weekly with a vacuum cleaner equipped with a small-particle or HEPA filter.
• Consider removing carpeting, especially where you sleep, if you're highly sensitive to dust mites.
• Use a damp mop and dust cloth to avoid stirring up dust.

Cockroaches

Cockroaches leave tiny droppings that can become airborne. Getting rid of the insects gets rid of their droppings.

• Block cracks and crevices where cockroaches can enter.
• Seal around and fix leaky faucets and pipes.
• Wash dishes and empty garbage and recyclables daily.
• Sweep food crumbs from counters and floors.
• Store food, including pet food, in sealed containers.
• Consider professional pest extermination.

Pet dander

Pet dander is tiny flecks of skin shed by cats, dogs, and other animals with fur or feathers. Pet urine and saliva may also contain allergens.

• Keep pets out of your home, if possible.
• Bathe dogs twice a week, if possible. The benefit of bathing cats hasn't been proved.
• Keep pets out of your bedroom and off furniture.
• Vacuum carpets often with a vacuum cleaner equipped with a small-particle or HEPA filter.
• Wash your hands after petting an animal.
• Wash clothes after contact with an animal.
• Ask a person without allergies to provide grooming and cleaning of pet areas.
• Consider removing carpeting, especially where you sleep, if you're highly sensitive to pet dander.
• Use a damp mop and dust cloth to avoid stirring up pet dander.

Alternative medicine

While there isn't much evidence about how well alternative treatments work, people sometimes try them for hay fever. Examples include:

• Herbal remedies and supplements. Extracts of the shrub butterbur may help prevent seasonal allergy symptoms. If you try butterbur, be sure to use a product that's labeled PA-free, which indicates that it's had potentially toxic substances removed.

  There's some limited evidence that spirulina and Tinospora cordifolia also may be effective. Though their benefits are unclear, other herbal remedies for seasonal allergies include capsicum, honey, vitamin C and fish oil.

  Herbal remedies and supplements are not evaluated by the U.S. Food and Drug Administration the way medications are. Discuss these products with your health care provider before using them.

• Acupuncture. Some people claim that acupuncture can help with seasonal allergy symptoms. There's limited evidence that these treatments work, but there's also little evidence of harm.

Preparing for an appointment

You're likely to start by seeing your primary care provider. However, in some cases when you call to set up an appointment, you may be referred to an allergist or other specialist.

Take a family member or friend along, if possible. Someone who accompanies you can help you remember information.

Here's some information to help you prepare for your appointment. Before your appointment, make a list of:

• Your symptoms, when they occur and what seems to trigger them. Include symptoms that might seem unrelated to hay fever.
• Recent life changes, such as a move to a new home or new part of the country.
• All medications you take, including vitamins, herbs and supplements, and their dosages.
• Questions for your health care provider.

For hay fever, questions to ask include:

• What is likely causing my symptoms?
• What tests do I need?
• Is my condition likely to go away on its own?
• What is the best course of action?
• What other treatments or ways to avoid triggers can you suggest?
• I have other health conditions. How can I best manage them together?
• Are there restrictions I should follow?
• Should I see a specialist?
• Are there brochures or other printed material that I can have? What websites do you recommend?

Don't hesitate to ask other questions during your appointment.

What to expect from your doctor

Your health care provider is likely to ask you a number of questions, including:

• When did your symptoms begin?
• Have your symptoms been continuous or occasional?
• How severe are your symptoms?
• What seems to trigger your symptoms?
• What, if anything, seems to improve your symptoms?
• Do any of your blood relatives, such as a parent or sibling, have hay fever or other allergies?
• Do your symptoms interfere with work, school or sleep?

What you can do in the meantime

While waiting for your appointment, remedies available without a prescription may help ease hay fever symptoms. They include pills, liquids, nasal sprays and eye drops. Also, try to reduce your exposure to possible triggers, if possible.

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