Find out more about how to diagnose and get relief from this common condition that can make you feel awful, seasonally and year-round.
Hay fever, also called allergic rhinitis, 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 tiny flecks of skin and saliva shed by cats, dogs, and other animals with fur or feathers (pet dander).
Besides making you miserable, hay fever can affect your performance at work or school and 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.
Hay fever signs and symptoms can include:
Your hay fever signs and symptoms may start or worsen at a particular time of year. Triggers include:
Signs and symptoms can be similar, so it can be difficult to tell which one you have.
| Condition | Signs and 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 | One to three days after exposure to a cold virus | Three to seven days |
See your doctor if:
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.
When you have hay fever, your immune system identifies a harmless airborne substance as harmful. Your immune system then produces antibodies to this harmless substance. The next time you come in contact with the substance, these antibodies signal your immune system to release chemicals such as histamine into your bloodstream, which cause a reaction that leads to the signs and symptoms of hay fever.
The following can increase your risk of developing hay fever:
Problems that may be associated with hay fever include:
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 doctor.
Your doctor will perform a physical examination, take a medical history, and possibly recommend one or both of the following tests:
It's best to limit your exposure to substances that cause your hay fever as much as possible. If your hay fever isn't too severe, over-the-counter medications 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 before you find what works best.
If your child has hay fever, talk with your doctor about treatment. Not all medications are approved for use in children. Read labels carefully.
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 mometasone (Nasonex) and budesonide (Rhinocort), both available by prescription, and Fluticasone (Flonase Allergy Relief), budesonide (Rhinocort Allergy) and triamcinolone (Nasacort Allergy 24 Hour), available over the counter. The prescription nasal spray azelastine and fluticasone (Dymista) combines an antihistamine with a steroid.
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 a runny nose but have less effect on congestion. They work by blocking a symptom-causing chemical released by your immune system during an allergic reaction (histamine).
Over-the-counter pills include loratadine (Claritin, Alavert), cetirizine (Zyrtec Allergy) and fexofenadine (Allegra Allergy). The prescription antihistamine nasal sprays azelastine (Astelin, Astepro) and olopatadine (Patanase) can relieve nasal symptoms. Antihistamine eyedrops such as ketotifen fumarate (Alaway) 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 pseudoephedrine (Sudafed, Afrinol, others). Nasal 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. 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).
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 for mild asthma.
Montelukast can cause headaches. In rare cases, it 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 helps relieve 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.
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 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 might 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 effective way to relieve nasal congestion. Rinsing 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. To make up the saline irrigation solution, 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. 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.
It's not possible to avoid allergens completely, but you can reduce your symptoms by limiting your exposure to them. If you know what you're allergic to, you can avoid your triggers.
While there isn't much evidence about how well alternative treatments work, a number of people try them for hay fever. These 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.
You're likely to start by seeing your family doctor or a 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.
Here's some information to help you prepare for your appointment:
For hay fever, some questions to ask include:
Don't hesitate to ask other questions you have.
Your doctor is likely to ask you a number of questions, including:
If you don't see your doctor right away, over-the-counter remedies may help ease symptoms. A number of medications are available that may help relieve your hay fever symptoms. They include pills, liquids, nasal sprays and eye-drops.
June 21st, 2021
