Hay fever

What is hay fever?

Hay fever is the common name for allergic rhinitis. Hay fever describes a reaction that occurs when your nose or eyes come in contact with allergens, which are substances to which you are sensitive. Allergens can include pollens, dust mites, moulds, animal dander, or other substances. For some people, exposure to these allergens can trigger an immune response (your body’s natural defence system), which leads to swelling and inflammation in the inner lining of the nose (known as rhinitis).

Hay fever is common — it affects 1 in 5 people in Australia. Despite its name, it’s not caused by hay and doesn’t cause a fever.

What are the symptoms of hay fever?

Common symptoms of hay fever include:

• an itchy, runny or blocked nose
• itchy or watery eyes
• frequent sneezing
• needing to breathe from your mouth
• frequently needing to clear your throat
• feeling like you have a cold that won’t go away
• snoring during sleep

Less common symptoms of hay fever may include:

• interrupted sleep, that may lead to feeling tired during the day
• difficulty concentrating
• frequent headaches and/or facial pain
• recurring sore throats
• a reduced sense of smell
• frequent sinus infections in adults
• recurring ear infections (otitis) in children

You might only experience some of these symptoms, and still have hay fever or allergic rhinitis. Some of these symptoms can be caused by other diseases too.

What causes hay fever?

Common allergens that may trigger hay fever symptoms include:

• grass, weeds and tree pollens
• dust mites and dust
• animal fur or skin flakes
• moulds and fungal spores
• air pollutants
• latex

You may experience hay fever symptoms only at certain times of the year (such as in spring or summer), depending on the allergens to which you are sensitive. Hay fever and other allergies can also be affected by your genes. You may have the same or different triggers to your family members.

When should I see my doctor?

Most people are able to manage or relieve hay fever on their own. However, you should speak with your doctor about treatment options if your symptoms are:

• persistent — meaning that you experience symptoms at least 4 days in a week, for at least 4 weeks or more
• moderate to severe — meaning that your symptoms affect your sleep and daily activities such as work, school, sport and leisure

Your doctor can help you by asking you in detail about your symptoms. They will review your home and work environment for possible triggers, assess how intense your hay fever symptoms are and how much hay fever affects your day-to-day life. They can then organise further tests to investigate possible causes and help you find ways to manage or avoid hay fever in the future.

How is hay fever diagnosed?

History

Your doctor can diagnose hay fever from a description of your symptoms and when they occur. They may also ask what over-the-counter or prescribed medicines you already take for hay fever. It’s also a good idea to record and tell your doctor about any triggers you have noticed in your work or home environment, and how hay fever affects your quality of life.

Physical examination

To rule out other causes of your symptoms, your doctor may:

• examine your face (especially your nose and eyes) for signs of hay fever
• ask you to breathe through your nose
• examine your nostrils with a special scope (a tiny camera attached to a long, thin tube)
• examine your throat

Allergy testing

Allergy testing (for example, using a blood test or skin prick test) is the main way to learn whether your hay fever symptoms are caused by a particular allergen. You may be referred to a clinical immunologist or allergy clinic for this test.

If you have skin prick testing, a tiny amount of a suspected allergen will be dropped onto your skin (usually on the forearm, upper arm or back). The doctor or nurse doing the test will then prick your skin where the allergen was placed. If you are allergic to this specific allergen, the place where you were pricked will become swollen and itchy. This generally goes away within 2 hours. Although skin prick testing can be uncomfortable, most people find it tolerable. The results are available within 20 minutes.

Any allergy testing needs to be considered alongside your history and symptoms of hay fever. A positive test result doesn’t actually prove that the allergen is causing your symptoms, only that your body is sensitive to the allergen.

Taking too many allergy tests may sometimes cause confusion, and cause you unnecessary lifestyle changes to avoid many types of allergens that may not actually be causing your symptoms. Speak with your doctor about what the results of your allergy test mean, and whether you need to make changes to your lifestyle.

How is hay fever treated?

Hay fever can be treated in 4 main ways, depending on what you are allergic to and how severe your symptoms are:

• Minimise exposure to allergens
• Nasal irrigation
• Medicines
• Immunotherapy

Minimise exposure to allergens

If you know which allergens trigger your hay fever, reducing your exposure to them may reduce symptoms.

If pollens are causing your hay fever, these tips may help:

• Stay indoors until after midday, especially when the pollen count is high, it’s windy or after thunderstorms (you can check today’s pollen count at the Pollen Forecast Network website).
• Wear sunglasses, carry tissues, shower when you arrive home and rinse your eyes with water.
• If your trigger is grass, avoid mowing, playing or walking in grassy areas and don’t go camping on grass.
• Keep your windows closed at home and in the car, and use recirculating air conditioning in the car.
• Avoid outdoor picnics during pollen season.
• Try to plan holidays out of the pollen season, or holiday at the seaside.
• If you’re gardening at home, research which plants are less likely to trigger hay fever. Remove any weeds or vegetation outside your bedroom window that might trigger symptoms.

Nasal irrigation

For some people, saltwater nasal sprays or douches (a stream of water sprayed into the nose) will provide substantial relief from hay fever. These non-medicated approaches are safe and can often help relieve symptoms.

Medicines

While medicines can’t cure hay fever, they can reduce your symptoms effectively.

Their side effects are generally well tolerated. Ask your doctor or pharmacist about the following medicines:

• Intranasal corticosteroids: These are nasal sprays that effectively reduce inflammation in the lining of the nose caused by hay fever or other conditions. Corticosteroid nasal sprays must be used regularly and correctly to be effective. Different brands are available, so ask your doctor which one is right for you. Ask you pharmacist on how to use your nasal spray, to be sure you are using it correctly.
• Antihistamines: These medicines manage symptoms of hay fever by blocking the action of histamine, which the body releases in response to exposure to an allergen. In this way, antihistamines reduce the symptoms of the allergic reaction. They are available as tablets, syrups, nasal sprays and eye drops to offer localised relief where you are experiencing hay fever symptoms. For example, use eye drops for itchy or watery eyes.
• Combination medicines: These contain an antihistamine and an intranasal corticosteroid. They offer the advantages of both medicines.
• Decongestant sprays: These unblock and dry the nose, but they should not be used for more than a few days at a time. This is because they can cause problems such as ‘rebound congestion’. This is when your symptoms become worse after you stop using the decongestant.
• Decongestant tablets: These also unblock and dry the nose, but they can have stimulant side effects such as tremors, difficulty sleeping, anxiety or increased blood pressure. Speak with your pharmacist to check if decongestant tablets are suitable for you, especially if you have high blood pressure.

Immunotherapy

Allergen-specific immunotherapy, also known as ‘desensitisation’, is a therapy designed to reduce the intensity of the body’s reaction to an allergen. Immunotherapy works by gradually exposing someone to increasing doses of allergen extracts, either by injection or orally. This is a long-term treatment option and should only be started by a medical specialist such as a clinical immunologist.

What are the complications of hay fever?

Complications of hay fever may include:

• disturbed sleep
• tiredness during the day
• headaches
• poor concentration

Hay fever may also trigger frequent ear infections, such as otitis media in children, and sinus infections (sinusitis) in adults.

Untreated hay fever may also increase the risk of developing asthma or make asthma harder to control, so it’s especially important to treat your nasal symptoms if you have asthma. This is because asthma and hay fever are both associated with airway inflammation. About 4 in every 5 people with asthma also have hay fever.