Hay Fever

What is hay fever?

Hay fever is a kind of allergic rhinitis. Allergic rhinitis is one of the atopic diseases (a set of genetically inherited conditions including asthma, atopic eczema and atopic dermatitis). People affected by hay fever experience an allergic rhinitis reaction to pollen from plants. Plants produce more during the early spring and summer months. For this reason, the “hay fever” kind of allergic rhinitis can also be described as seasonal rhinitis. Both adults and children can suffer from hay fever and it is estimated to affect between 40 and 60 million people in the United States.[1]

Symptoms

Allergic rhinitis is triggered when certain allergens such as pollen, mold or house dust come into contact with the lining of the eyes, nose and throat. This causes an allergic reaction in these areas, with symptoms such as:

  • Coughing (as a result of the post nasal drip)
  • Hives (a rash on the skin)
  • Red, itchy, and watery eyes
  • Runny or stuffy nose
  • Sneezing
  • Swelling around the eyes

The symptoms of allergic rhinitis can be uncomfortable for the sufferer and may interfere with daily life. As a result of their symptoms, people with hay fever can experience trouble sleeping, problems remembering things, irritability, decreased concentration, and increased risk of work-related injuries and vehicle accidents.

In addition to the symptoms listed above, people who suffer from both asthma and allergic rhinitis are likely to experience asthmatic symptoms during an attack of hay fever. Most commonly these include a tight feeling in the chest, wheezing and shortness of breath.

Triggers

To reduce the negative impact of hay fever, it is necessary to identify the specific allergens which trigger the symptoms. Sufferers of seasonal rhinitis commonly experience symptoms during the summer months when the pollen count is at its highest. Particular plants which are known to provoke hay fever symptoms on a widespread scale include:

  • Airborne mold (summer and autumn)[2]
  • Grass pollen (spring and summer)
  • Pollen from trees (spring and summer)
  • Weed pollen (spring, summer and autumn)

Diagnosis

To diagnose hay fever, a doctor will assess the symptoms and in some cases carry out additional tests: an intradermal test and/or a prick and scratch test. These tests involve giving the affected person small amounts of specific allergens to see if an allergic reaction takes place.

Intradermal test

An intradermal test is the most accurate way to determine whether an individual is suffering from hay fever. Possible allergens (such as grass and weed pollen) are injected under the skin. After 20 minutes, the site is monitored for an allergic reaction, which usually involves the reddening of the skin and an itching sensation.

Prick or scratch test

The prick or scratch test the most common type of skin test. It involves pricking or scratching the skin before exposure to an allergen-containing solution. The results are known within 10 to 20 minutes.

Prevention

Whilst it is not always possible to avoid pollen and other allergens completely, it is possible to take precautions against hay fever. Making changes to your daily routine and environment can reduce your exposure to airborne pollen.

It is advisable to stay indoors as much as possible. Drinking plenty of fluids throughout the day can help to prevent allergic reactions. It is also advisable to avoid smoking which can aggravate the symptoms of hay fever by irritating the airways. Breathing moist air (from hot water) can also help to alleviate the congestion associated with hay fever.

To exclude pollen from your home environment, changing into freshly washed clothes when you reenter the house and keeping the windows and doors shut are reccomended. Cleaning any domestic air vents and installing a pollen filter in your car can also help reduce contact with allergens. When one is outside, it is helpful to avoid cut grass and fresh flowers.

Medications for temporary relief

For many people affected by hay fever, short-term medications effectively treat the symptoms of hay fever on a temporary basis. Alleviating the symptoms when they flare up is usually sufficient for someone with hay fever to maintain a normal quality of life.

Antihistamines relieve the symptoms of an allergic reaction such as itching, skin irritation and watery eyes. They can be administered as needed as nasal spray, tablets or eye drops. Nasal corticosteroid medications are very effective at reducing the symptoms caused by allergies. Used over time, they can help to desensitise the nasal passageway to the allergens which cause hay fever.[3]

Immunotherapy (hyposensitization therapy)

If antihistamines and nasal corticosteroid medications do not enable you to manage your hay fever symptoms effectively, the doctor will prescribe a course of immunotherapy. This long-term treatment option serves to alter the body’s autoimmune response to allergens which trigger hay fever. A course of immunotherapy typically begins about three months before exposure to hay fever triggers is likely to occur and involves either a series of injections or the administration of sublingual allergy tablets.

Treatment with sublingual immunotherapy involves daily administration of the allergens, in a liquid or tablet which is placed under the tongue. Treatment with injections is divided into two stages. In the first stage, you will be injected over a period of several weeks with increasingly concentrated doses of the allergen. During the second phase, you will receive monthly top-up injections of the the allergen at a uniform dose.

Treatment

A treatment plan for hay fever typically involves following precautions to avoid hay fever triggers and taking medication as needed to manage the symptoms. For many people, one or more short-term medications can be sufficient to manage the symptoms of hay fever. For others, immunotherapy is a possible treatment option that can provide long-term relief.

Hay fever FAQs

Q: Does antihistamine cause tiredness?
A: Many systemic antihistamines cause drowsiness as a side-effect. Doctors often advise taking varieties of antihistamine which cause tiredness at night time. When sourcing medication for hay fever, it is important to find out whether tiredness is one of its side effects, as this will make it unsafe to drive or operate heavy machinery.

Q: Is there a cure for hay fever?
A: There is no absolute cure for allergic rhinitis, but the right treatment plan can reduce symptoms significantly and enable a normal quality of life. Immunotherapy/hyposensitization therapy can achieve long-term pollen desensitization to specific triggers.

Q: Can hay fever be mistaken for other conditions?
A: Hay fever shares many symptoms with the common cold. If you have been suffering from cold-like symptoms including nasal congestion and sneezing for over two weeks, it is advisable to seek a medical opinion as you may be suffering from hay fever.


  1. American College of Allergy, Asthma and Immunology. “Types of Allergies: Allergic Rhinitis.” 2014. Accessed: 27 June 2017.

  2. Asthma and Allergy Foundation of America. “Mold Allergy.” October 2015. Accessed: 27 June 2017.

  3. Drugs.com. “Nasal Steroids.” June 2017. Accessed: 27 June 2017.