Hay Fever: How to Recognize and Treat it

Hay fever, also known as allergic rhinitis or seasonal allergies, is an allergic response that causes cold-like symptoms. Typically occurring in the spring and fall, the symptoms listed below are often predictable for people who suffer each year. These symptoms can be very irritating and result from inflammation of the nasal passages. Hay fever is not a virus or illness and is not contagious.

What causes hay fever?

Hay fever occurs when triggered by an allergen. An allergen is a substance that causes the immune system to respond in defense by sending chemicals to it. Histamine is one of the chemicals released by the immune system to fight the allergen. It causes swelling of the nose, eyes, throat, and skin.

Allergens include dust, pollen, pet dander, and mold. Pollen is the allergen that generally causes hay fever, particularly pollen from flowers, trees, grasses, or ragweed. Despite the term “hay fever,” there is no fever and the allergen at fault is not necessarily hay.

Who’s at risk?

Hay fever can begin at any age, though it often begins in childhood or early adulthood, and there is often a family history. It is shared among all ethnicities and is not particular to gender. It does vary based on location and types of allergens in those locations.

You may be more likely to develop hay fever if you or a family member already have other related diseases. Hay fever commonly coincides with:

  • Allergies
  • Asthma
  • Eczema (Atopic Dermatitis)
  • Exposure to an allergen on a continued basis, for example, at home or work
  • Exposure to cigarette smoke during the first year of life

Symptoms of Hay fever

Inflammation (swelling) of nasal passages (membranes) causes hay fever symptoms, which can be quite bothersome but do not otherwise impact overall health. Symptoms include:

  • Runny nose: Thin, clear drainage
  • Nasal congestion: A “stuffy nose”
  • Sneezing
  • Watery, itchy, or red eyes
  • Cough
  • Itchy nose
  • Postnasal drip (drainage or phlegm in the throat)
  • Fatigue

Diagnosing Hay fever

Your healthcare provider can confirm whether you have hay fever based on your physical exam and medical history. The provider may offer to explore what allergens trigger your symptoms, depending on the severity or whether it is impacting other medical conditions.

Your provider may refer you to an allergist for further treatment or skin testing. Skin testing involves putting tiny amounts of different allergens on the skin with a small poke or scrape. The provider waits 15 to 30 minutes to see if a reaction occurs, in which the skin will swell, similar to a bug bite. The test is considered generally painless and safe for adults and children. It's the most common and easiest form of testing.

Blood tests are available if skin testing does not work or is unavailable. However, this is often a less desired route by the patient, and the results take longer than skin testing. Therefore, it is generally less preferred by providers as well.

Managing symptoms

Reduce Exposure: Treatment begins by reducing exposure to allergens. Sometimes, this can be challenging. If you find that pollen triggers your symptoms, there may be times when it's harder to avoid. Limiting time outside on high pollen days can be beneficial. Check the pollen index in your area. Avoid opening windows and doors as much as possible on these days.

Medications: Allergy medications can improve your symptoms. Medications come in several forms and are often available over the counter or by prescription. Your healthcare provider can determine which is best for your symptoms and when you should take it. Be sure to discuss this with your healthcare provider.

  • Antihistamines: Antihistamines block the histamines released by the body in response to the allergen exposure. Itcan decrease the allergic response and the symptoms that result. These medications may cause you to become drowsy and are available over the counter and by prescription. Examples include Loratadine, Cetirizine, and Fexofenadine.
  • Decongestants: Decongestants are medications that relieve congestion in the nasal passages and sinuses. They are available to take by mouth or nasal spray. Examples include Afrin, Phenylephrine, and Pseudoephedrine. Providers may not recommend this use. CAUTION: These medications can raise blood pressure, cause headaches, and prevent sleep. Do not take for more than five days, and you should discuss using them with your healthcare provider. Do not take it if you have high blood pressure or a history of headaches.
  • Corticosteroid nasal sprays: Available in sprays and inhalers, these medicines reduce swelling and decrease symptoms. They are available over the counter and prescription and include Flonase and Nasacort.
  • Leukotriene inhibitors: Leukotriene is another chemical released by the body that causes a reaction. These medicines block that chemical and reduce the reactions. A prescription is required, and montelukast is the most commonly used.
  • Allergy shots are available for patients whose symptoms are not controlled by other medications and if healthcare providers believe the symptoms are severe or impact other diseases.

How to prevent hay fever

While there are no ways to prevent hay fever, lifestyle changes may help make them more tolerable. Avoiding the triggers may reduce symptoms.

  • Do not touch your face or rub your nose.
  • Wash hands often using soap and water.
  • Avoid opening the windows of your home or car during spring, summer, and fall when pollen is high.
  • Use dust covers on pillows, mattresses, and box springs.
  • Avoid letting pets on furniture and beds.
  • Use clean air filters on vacuums and heating and cooling systems.

Hay fever can be annoying, and while symptoms range from mild to severe, it is not a serious condition unless it impacts other medical illnesses. Symptoms result from exposure to irritants and are most common in the spring and fall. It may help to avoid known triggers, but it may be necessary to use medications to reduce symptoms.

References:

Asthma and Allergy Foundation of America. Rhinitis (Nasal Allergies)

Cleveland Clinic. Allergic Rhinitis (Hay Fever)

John Hopkins Medicine. Allergic Rhinitis in Children

Mayo Clinic. Hay fever

Medscape. Allergic Rhinitis

Mount Sinai. Allergic rhinitis

UpToDate. Patient education: Allergic rhinitis (Beyond the Basics)

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