Hay Fever: Symptoms, Diagnosis and Treatments

160665-hayfever-lady
Hay fever, also known as allergic rhinitis, is a common condition that shows signs and symptoms similar to a cold with sneezing, congestion, runny nose and sinus pressures.
This article is about allergic rhinitis. You can read about non-allergic rhinitis here.
 
Hay fever is caused by an allergic response to airborne substances, such as pollen – unlike a cold which is caused by a virus. The time of year in which you get hay fever depends on what airborne substance you are allergic to.
 
The substance that causes an allergic reaction in hay fever is called an “allergen”. For the majority of people, those who do not get hay fever, these substances are not allergens, because their immune system does not react to them.
 
Despite its name, hay fever does not mean that the person is allergic to hay and has a fever. Hay is hardly ever an allergen, and hay fever does not cause fever.
 
Although hay fever and allergic rhinitis have the same meaning, most lay people refer to hay fever only when talking about an allergic reaction to pollen or airborne allergens from plants or fungi, and understand allergic rhinitis as an allergy to airborne particles, such as pollen, dust mites or pet dander which affect the nose, and maybe the eyes and sinuses as well.
 
The rest of this article focuses on hay fever caused by pollen and other airborne allergens that come from plants or fungi. Hay fever caused by pollen is also known as pollinosis.
 
Diagram of hay fever
Some people are only mildly affected by hay fever and rarely reach a point where they decide to seek medical advice. However, for many, symptoms may be so severe and persistent that they are unable to carry out their daily tasks at home, work or at school properly – these people will require treatment. Treatments may not get rid of the symptoms altogether, but they usually help to lessen their impact, making them easier to live with.
 
As with other allergies, hay fever symptoms are a result of your immune system mistaking a harmless substance as a harmful one, and releasing chemicals that cause the symptoms.
 
It is estimated that about 20% of people in Western Europe and North America suffer from some degree of hay fever. Although hay fever can start affecting people at any age, it generally develops during childhood or early adulthood. It is said that the majority of hay fever sufferers find their symptoms become less severe as they get older.
 
Contents of this article:
 
Symptoms of hay fever
What causes hay fever?
Risk factors for hay fever
Diagnosis of hay fever
Treatment options for hay fever
How to minimise the impact of hay fever
Fast facts on hay fever
Here are some key points about hay fever. More detail and supporting information is in the main article.
Allergic rhinitis, often called hay fever, is a common condition that causes symptoms such as sneezing, stuffy nose, runny nose, watery eyes and itching of the nose, eyes or the roof of the mouth.
Roughly 7.8% of people 18 and over in the US suffer from hay fever.
Around 17.6 million (7.5%) adults in the US are diagnosed with hay fever per year.
There are 6.6 million (9%) children diagnosed with hay fever each year in the US.
A 2010 study suggests that white children are more likely to have hay fever (10%) than black children (7%).
Allergic rhinitis can be seasonal or perennial. Symptoms of seasonal allergic rhinitis occur in spring, summer and early fall.
The symptoms of hay fever are usually caused by allergic sensitivity to pollens from trees, grasses or weeds, or to airborne mold spores.
Allergic rhinitis treatment options are: avoidance, eliminating or decreasing your exposure to the irritants or allergens that trigger your symptoms, medication and immunotherapy.
Immunotherapy (allergy shots) helps reduce hay fever symptoms in about 85 percent of people with allergic rhinitis.
Allergic diseases, which include asthma, are the fifth most prevalent chronic diseases in all ages, and the third most common in children.
Symptoms of hay feverLady suffering from hay fever
Symptoms of hay fever may start at different times of year, it depends on what substance the patient is allergic to. If a person is allergic to a common pollen, then when the pollen count is higher his symptoms will be more severe.
 
Common hay fever symptoms include:
 
Sneezing
Watery eyes
Itchy throat
Itchy nose
Blocked/runny nose
Severe hay fever symptoms may include:
 
Sweats
Headaches
Loss of smell and taste
Facial pain caused by blocked sinuses
Itchiness spreads from the throat, to the nose and ears
Sometimes hay fever symptoms can lead to:
 
Tiredness (fatigue)
Irritability
Insomnia
People with asthma may find that when hay fever symptoms emerge their wheezing and episodes of breathlessness become more severe. A significant number of people only have asthma symptoms when they have hay fever.
 
What causes hay fever?Grass pollen
Grass pollen tends to affect people in late spring and summer.
Hay fever occurs when the immune system mistakes a harmless airborne substance as a threat. As your body thinks the substance is harmful it produces an antibody called immunoglobulin E to attack it. It then releases the chemical histamine which causes the symptoms.
 
There are seasonal hay fever triggers which include pollen and spores that will only cause symptoms during certain months of the year.
 
The following are some examples of hay fever triggers:
 
Tree pollen – these tend to affect people in the spring.
Grass pollen – these tend to affect people later on in the spring and also in the summer.
Weed pollen – these are more common during autumn (fall).
Fungi and mold spores – these are more common when the weather is warm.
What are the risk factors for hay fever?
A risk factor is something that increases a person’s chances of developing a disease or condition. Below are some risk factors for hay fever:
 
Family history (inheritance, genetics) – if you have a close family member who has/had hay fever, your risk of developing it yourself is higher. There is also a slightly higher risk if a close family member has any type of allergy.
Other allergies – people with other allergies are more likely to suffer from hay fever as well.
Asthma – a significant number of people with asthma also have hay fever.
Gender and age – hay fever affects more young males than young females. Before adolescence, twice as many boys as girls have hay fever. However, after adolescence many boys outgrow it and slightly more girls than boys are affected.
Birth date – people born during the high pollen season have a slightly higher risk of developing hay fever than other people.
Second-hand smoke – infants and babies who are regularly exposed to cigarette smoke during their first years of life are more likely to develop hay fever than babies who aren’t.
Being the first child – a higher percentage of firstborn children eventually develop hay fever, compared to other people.
Babies from smaller families – a higher proportion of babies with no siblings, or just one sibling develop hay fever later on compared to babies born to larger families.
Babies born to high income families – babies born to families with a high standard of living have a higher risk of developing hay fever later on, compared to other babies.
Many experts believe that the last three risk factors are linked to childhood infections. If a baby and/or small child has had fewer infections, there is a greater risk of autoimmune problems.
 
On the next page we look at how hay fever is diagnosed, tips for minimising the impact of hay fever and the available treatments to help with the condition.
Diagnosis of hay fever
Generally, doctors can make a diagnosis based on the symptoms, which are usually fairly obvious. The doctor will also ask questions about the patient’s personal and family medical history, and how signs and symptoms have been dealt with so far.
 
A blood or skin test can be followed up to identify which substance(s) the patient is allergic to.
 
Skin test – the skin is pricked with a minute amount of a known allergen (substance that some people are allergic to). The amount of IgE antibodies (immunoglobulin E) is measured. IgE antibodies are produced in high amounts if a person has an allergy to something.
Blood test – the test simply measures the level of IgE antibody in the blood. If it is zero there is no sensitivity, whereas 6 indicates very high sensitivity.
Treatment options for hay fever
There is a vast array of OTC (over-the-counter) and prescription medications for treating hay fever symptoms. Some patients may find that a combination of two or three medications works much better than just one.
 
It is important for parents to remember that some hay fever medications are just for adults. If you are not sure, talk to a qualified pharmacist, or ask your doctor.
 
Medications include:Nasal spray diagram
Nasal sprays can offer effective relief for hay fever
Antihistamine sprays or tablets
 
These are commonly available over the counter. The medication stops the release of the chemical histamine. They usually effectively relieve symptoms of runny nose, itching and sneezing. However, if your nose is blocked they don’t work.
 
Newer antihistamines are less likely to cause drowsiness than older ones – but older ones are just as effective. Examples of OTC antihistamines include loratadine (Claritin, Alavert) and cetirizine (Zyrtec). Examples of prescription antihistamines include Fexofenadine (Allegra) and the nasal spray azelastine (Astelin). Azelastine starts working very rapidly and can be used up to 8 times a day – however, it can cause drowsiness and leave a bad taste in the mouth after use.
 
Eye Drops
 
These reduce itching and swelling in the eyes and are usually used alongside other medications. Eye drops containing cromoglycate are commonly used.
 
Nasal Corticosteroids
 
These sprays treat the inflammation caused by hay fever, and are a safe and very effective long-term treatment. Examples include fluticasone (Flonase), fluticasone (Veramyst), mometasone (Nasonex) and beclomethasone (Beconase). Most patients may have to wait about a week before experiencing any significant benefits. Some patients may notice an unpleasant smell or taste, and have nose irritation.
 
Oral corticosteroids
 
For very severe hay fever symptoms the doctor may prescribe prednisone in pill form. They should be prescribed only for short-term use, because of their long-term link to cataracts, muscle weakness and osteoporosis.
 
Immunotherapy
 
Immunotherapy (allergy shots) is a proven treatment approach providing long-term relief for many people suffering from allergic rhinitis. It works by gradually desensitizing the patient’s immune system to the allergens that trigger their symptoms.
 
Immunotherapy can potentially lead to lasting remission of allergy symptoms, and it may play a preventive role in the development of asthma and new allergies.
 
The Food and Drug Administration (FDA) approved another form of allergy immunotherapy in April 2014 called sublingual immunotherapy.
 
According to Johns Hopkins Medicine, sublingual immunotherapy is one of several state-of-the-science treatments for allergic rhinitis and is recommended by a panel of experts in a guideline published February 2, 2015, by the American Academy of Otolaryngology – Head and Neck Surgery Foundation.
 
Immunotherapy used to require visits to a doctor’s office for injections, but in sublingual immunotherapy, patients can take tablets or drops at home.
 
The guideline recommends that immunotherapy be used for patients who test positive for a specific allergen, but have not responded well to other treatments. It can take up to five years to complete the treatment.
 
Patients have had allergic reactions to immunotherapy in rare cases.
 
Alternative therapies
 
Some alternative therapies claim to treat hay fever effectively.
 
A study published in The Medical Journal of Australia suggested that acupuncture is effective in the symptomatic treatment of persistent allergic rhinitis. (MJA 2007; 187 (6): 337-341). Another piece of research reported in the Annals of Internal Medicine in February 2013 has suggested that acupuncture may help relieve hay fever symptoms.
It is important to remember that although some patients do report benefits from alternative therapies, a lot of information one reads in books and on the internet is anecdotal. For therapy to be convincing, it should undergo proper clinical tests which are either compared to a placebo (dummy treatment) or some treatment known to be effective. Before undergoing any complementary/alternative therapy, check it out carefully.
 
A note of caution
 
Pregnancy – decongestants and birth defects – researchers at Boston University reported in the American Journal of Epidemiology that pregnant mothers who take over-the-counter decongestants during their first trimester may have a higher risk of giving birth to babies with rare defects in their digestive tract, ear and heart.
 
How to minimise the impact of hay fever
There is not much you can do to prevent yourself from becoming allergic to pollen or allergens from plants or fungi. However, avoiding situations where your exposure might be high will help reduce the likelihood of an allergic reaction, or perhaps its severity. The following measures may be helpful:
 
Be aware of the pollen count during your susceptible months. You can get information from the TV, radio, internet or daily newspapers. On humid and windy non-rainy days pollen counts tend to be higher. Pollen counts tend to be higher during the early evening.
Keep windows and doors shut when pollen is high.
Avoid mowing the lawn altogether during your susceptible months.
Choose low pollen days for gardening.
Keep away from grassy areas when pollen counts are high.
Regularly splash your eyes with cool water. It will sooth them and clear them of pollen.
If pollen counts are high and you come indoors, have a shower and change your clothes.
Remember that wrap-around glasses protect your eyes from pollen getting through.
A hat helps prevent pollen from collecting in your hair and then sprinkling down onto your eyes and face.
When driving on a high count day or time of day keep windows closed. There are pollen filters for cars.
Do not have flowers inside your home.
Keep your surfaces, floors, carpets as dust free as possible.
If you use a vacuum cleaner make sure it has a good filter.
Ask smokers not to let their smoke get near you.
If you are a smoker, giving up will help reduce your symptoms.
Pets can bring in pollen from outside. Whenever a pet comes indoors on a high pollen count day, either wash it or smooth its fur down with a damp cloth. Sometimes pets can be a source of allergic rhinitis which makes your pollen allergy worse.
Smear Vaseline around the inside edges of your nostrils – it helps stop pollen from getting through.
If you know when your hay fever season starts, prepare yourself in advance. See your GP and ask him/her to develop a plan for you.

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