Hay fever, also known as allergic or seasonal rhinitis, is an allergic response that causes cold-like symptoms. Seasonal rhinitis typically occurs in the spring and fall seasons due to pollens and other environmental allergens. However, we can also see perennial or non-seasonal rhinitis and non-allergy-induced disease (vasomotor rhinitis) where the exact cause remains undetermined. While signs may mimic infectious diseases such as COVID-19, flu, the common cold, or RSV, hay fever is not contagious and occurs due to allergens, not viral or bacterial causes.
If you've ever wondered about the intricacies of hay fever or sought ways to make its symptoms more bearable, this article is your comprehensive guide to unmasking the seasonal woes and finding effective solutions.
What causes hay fever?
Hay fever develops with exposure to an allergen. An allergen is something that causes the immune system to send chemicals to the body in an attempt to defend itself. Histamine is one of the weapons against the allergen, causing nose, eyes, throat, and skin swelling. When the body reacts to an invader such as a virus, bacteria, or other infectious agent, the chemicals released help rid the body of the infection. In the case of allergies, the immune system sees the allergen as foreign and responds. Sadly, the body continues to do so with repeated exposure, contributing to chronic symptoms.
Allergens are proteins and include dust, dust mites, pollen, pet proteins shed in dander, saliva, urine, feces, and molds. Seasonal hay fever most commonly results from pollen-induced allergies. The most frequent triggers include pollen from numerous flowers, trees, grasses, and ragweed. The term hay fever is a misnomer. Unlike infectious diseases, allergic rhinitis doesn’t usually have a fever associated with it. While hay may trigger allergic signs in individuals, it isn’t the major allergen trigger.
Types of rhinitis
Allergic and non-allergic rhinitis affect millions globally. We can see subtypes of this disease; often, they are collectively referred to as hay fever. However, triggers vary and are not always allergy-driven.
- Seasonal allergic rhinitis/hay fever. It is induced by allergies, most commonly outside, such as various pollens. Various grasses, ragweed, and birch tree pollen are common triggers of seasonal allergic rhinitis.
- Non-seasonal allergic rhinitis/perennial rhinitis. This type occurs at any time of the year. It may result from indoor allergens such as dust, dust mites, pollen, chemical irritants, cigarette or wood fire smoke, food allergies, or pets. It can occur alongside seasonal disease.
- Vasomotor rhinitis/idiopathic rhinitis. This term is used when rhinitis signs are present despite negative allergy testing results. The exact cause in these cases is often unknown. Patients with this type usually develop symptoms in response to chemical irritants, perfumes, smoke, air pollutants, and related triggers. Various medications, weather changes, hormonal imbalances (e.g., menopause), and even eating can also trigger this form. Unlike allergic rhinitis, this form has a higher occurrence rate in females.
- Food allergy. Food allergy can manifest in many ways, including with rhinitis symptoms. It may be indicative of a cross-reactivity reaction, discussed below.
- Infectious diseases. Common respiratory infections cause short-term rhinitis signs and can worsen underlying allergy symptoms when present.
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 with no gender predisposition, and symptoms vary from one individual to another. Still, allergy triggers vary with geographical location due to various allergens in different regions.
You may be more likely to develop hay fever if you or a family member already have other related diseases such as asthma or eczema (skin condition).
Those with allergic rhinitis may also have:
- Other types of allergies
- Eczema (atopic dermatitis)
- A history of repeated exposure to an allergen (e.g., at home or work)
- A history of exposure to cigarette smoke during the first year of life
- Concurrent food allergies
Medications that cause rhinitis
Non-steroidal anti-inflammatory meds (NSAIDs) like ibuprofen, certain meds used to treat high blood pressure, birth control, some sedatives, antidepressants, and nasal decongestant sprays when used too often, can all contribute to rhinitis signs. Their use can exacerbate pre-existing seasonal or perennial allergic diseases or can trigger vasomotor rhinitis in non-allergic individuals.
Symptoms of rhinitis
For some, rhinitis symptoms do not negatively impact life; however, for others, they can be quite bothersome and disrupt leisure activities. Symptoms may affect one’s ability to get a good night’s sleep, impact one’s ability to participate in outdoor pursuits, and fluctuate based on the seasons and indoor and outdoor air quality conditions. Chronic symptoms can affect concentration and may lessen one’s interactions with friends, family, and the environment when not properly controlled.
Common allergic rhinitis symptoms include:
- Runny nose
- Nasal congestion (stuffy nose)
- Watery, itchy, or red eyes
- Itchy nose, mouth, throat, tongue
- Postnasal drip (drainage or phlegm in the throat)
- Fatigue (commonly associated with chronic, unrelated allergic disease or non-allergic rhinitis)
What about allergy cross-reactivity ?
When two substances’ proteins are very similar — for example, pollen and the proteins in other substances, usually a food — an allergic reaction might develop, known as cross-reactivity. For instance, those sensitive to birch tree pollen may likely experience an adverse reaction after consuming apples. Similar reactions may occur for those with tree nut allergies.
Suppose you suffer from seasonal allergies, have ever eaten a fruit or veggie such as celery or an apple, and suddenly developed an itchy throat or mouth. In that case, you may suffer from this type of reaction. Talk to your healthcare provider or avoid that food when feasible.
Diagnosing hay fever
A healthcare professional, including your primary care provider or an asthma specialist, 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.
Testing may be warranted to determine if allergic disease is the culprit. The gold standard involves intradermal skin testing, which involves putting tiny amounts of different allergens under the skin with a small poke or scrape. The provider waits 15–30 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 reliable form of testing.
Blood tests are available if skin testing does not work, you cannot have the testing done for medical reasons, or you are unavailable. However, this is not the preferred method because scientific evidence fails to show results as accurate as skin testing.
Allergies cannot be cured; however, they can be managed. Various allergy management methods include medications (over-the-counter [OTC] and prescription), environmental management, avoidance, and allergy shots.
For those with non-seasonal allergies or a combination of seasonal and non-seasonal triggers and those with vasomotor rhinitis, control of symptoms can be more difficult, often requiring multiple modes of treatment, and flares may be common recurrences.
Treatment begins by reducing exposure to allergens. Sometimes, this can be challenging. With seasonal allergies, limiting time outside on high pollen days can be beneficial. Check the pollen index in your area. Use air conditioning and air purifiers in the home and close windows and doors. Change clothes after spending time outside, and consider showering off any potential contaminants.
With non-seasonal allergies, avoidance may be even more difficult. Pay attention to the air quality index, as higher levels may make allergy flares more likely. Avoid triggers like cigarette smoke, wood-burning fires, and related exposures.
Various medications can improve your rhinitis symptoms. Medications come in several forms and are often available OTC or by prescription. Your healthcare provider can determine which is best for your symptoms and when to take it. Be sure to discuss this with your healthcare provider.
Antihistamines block the histamines (chemicals) released by the body in response to exposure to allergens. These meds can decrease the allergic response and the symptoms that result. These medications may cause you to become drowsy and dry mouth, among other side effects. They are available OTC and by prescription. Examples include Loratadine, Cetirizine, and Fexofenadine orally and topically (intranasal or ocular) may include Zaditor® or Astropro®.
Decongestants 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 these to patients with underlying heart conditions, high blood pressure, or migraines. Caution: These medications can raise blood pressure, cause headaches, and disrupt sleep. Without medical direction, you should only take these for short periods (5–7 days). Because they are to be used cautiously with underlying conditions, speak with your healthcare provider before reaching for these.
Corticosteroid nasal sprays, eye drops, and inhalers
This class of medications, steroids, helps reduce swelling and inflammation, decreasing symptoms. They are available OTC and by prescription, including Flonase®, Nasonex®, and Nasacort®. There are also numerous generics available. However, using these medications increases one’s risk of thrush (oral fungal infection). It may also increase the risk of other infectious illnesses.
Leukotriene is another chemical released by the body that contributes to clinical signs of rhinitis. These prescription modifiers work either by working against the receptor (antagonist), preventing the chemical from binding (montelukast or zafirlukast), or preventing the body from making the compound Zyflo® (zileuton) (synthesizer inhibitor).
For those with underlying asthma, allergies may cause lower airway disease to flare. In asthmatics with allergies or vasomotor rhinitis, additional supportive medications may be needed, and asthma meds may need to be adjusted based on the season. There are several mechanisms of action for this general category. Still, regardless of the method, this class of drugs helps dilate (open up) the smaller airways. Examples include inhaled options such as albuterol, salbutamol, vilanterol, formoterol, or Spiriva®. Other options may be oral and include theophylline or aminophylline. These medications may have side effects that can be significant. Discuss with your physician if these are right for you.
If you have underlying conditions, may be pregnant, or are lactating, consult a healthcare professional before reaching for any OTC medications or when discussing possible prescription medications to treat rhinitis symptoms.
Allergy immunotherapy and home remedies
Allergy shots, or immunotherapy, provide microdoses of an allergen via a small needle or oral means, weekly then monthly. This slow incremental increase in exposure helps acclimate the body to the allergen, lessening the body’s negative immune response. They are available for patients whose symptoms are not controlled by other medications and when symptoms are severe or impact other diseases.
People may also ask about homeopathic remedies such as honey, which has some benefits for those with cough and other rhinitis signs, nasal saline flushes/irrigators, and even simple saline nasal sprays. However, sufficient data on the non-medication methods to manage rhinitis symptoms varies depending on the therapy and manner of use. Talk with a healthcare provider to learn the most up-to-date information.
How to prevent allergic rhinitis
While there are no ways to prevent rhinitis (allergic and non-allergic), lifestyle changes may help make symptoms more tolerable. For those with asthma and rhinitis, these steps may help prevent the worsening of lower airway disease. Of course, avoiding the triggers may reduce symptoms. However, this isn’t always possible. Nonetheless, by considering the following, one may minimize ill effects.
- Do not touch your face or rub your nose.
- Wash hands often using soap and water.
- Avoid opening your home or car windows during spring, summer, and fall when pollen is high or all year round for perennial or vasomotor rhinitis.
- Use hypoallergenic covers on pillows, mattresses, and box springs.
- Use clean air filters (HEPA) on vacuums and heating and cooling systems.
- Have air purifiers (with HEPA filters) in the main living areas of your home.
- Avoid triggers such as bonfires, cigarette and cigar smoke, perfumes, paints, and other chemicals.
- Remove carpeting or vacuum carpets routinely.
- Ensure the humidity level in your home is well controlled, not too dry or too moist. Either purchase a humidifier or have one connected to your heating system for winter and use a dehumidifier in warmer weather.
- Yearly cleaning of your home’s cleaning ducts can lessen in-home allergens.
- Participate in indoor activities when pollen counts and air quality indices indicate the outside environment poses a risk.
Living with allergic rhinitis
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 irritant exposure and are most common in the spring and fall. Non-allergic rhinitis can be more challenging to manage and, when combined with seasonal or perennial allergies, makes management even more difficult. While avoiding triggers is always important, it isn’t always feasible. Medications, hygiene practices, air purifiers in the home, HEPA filters, and other steps may reduce symptoms.
If you have signs consistent with rhinitis and are not treating them but they negatively affect your ability to concentrate, enjoy the outdoors, interact with friends, or participate in normal leisure activities, consult your healthcare provider to see if allergy testing is warranted. Further, discuss medication options that will be safe for you and any underlying health conditions.
- 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).
- American Academy of Allergy Asthma & Immunology. Oral allergy syndrome (OAS).
- Cleveland Clinic. Vasomotor rhinitis.