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Hay fever (seasonal allergic rhinitis)

Hay fever is also known as seasonal allergic rhinitis. The symptoms include sneezing, a runny nose and itchy eyes. About one in five people in the UK have an allergy such as hay fever and these allergies are becoming more common.

Hay fever is a seasonal allergic reaction to pollen from grasses, weeds or trees, carried in the air usually during the spring and summer. These plants produce allergens – substances that can cause an allergic reaction.

An allergic reaction happens when your body's immune system reacts to an allergen because it mistakes it for a harmful invader, such as a virus. Hay fever occurs when your immune system overreacts to pollen allergens, which are harmless to most people.

Hay fever, asthma, food allergies and eczema are related allergic conditions and you’re more likely to develop them if they run in your family. This is called atopy. Your body produces a certain type of antibody called immunoglobulin E (Ig E) in response to otherwise harmless allergens, such as pollen and dust mites.

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Details

  • Symptoms Symptoms of hay fever

    If you have hay fever, you may have symptoms including:

    • sneezing
    • a blocked or runny nose (rhinitis)
    • itchy eyes, nose, throat and roof of your mouth (palate)
    • headaches caused by a stuffy nose

    These symptoms can make it difficult for you to concentrate or sleep properly. In some people, pollen may also trigger asthma.

    If you have hay fever symptoms all year round, you may also be allergic to house dust mites, pet hair and moulds. This is called perennial allergic rhinitis. Some moulds may cause seasonal symptoms, particularly in the autumn.

  • Diagnosis Diagnosis of hay fever

    Your GP will usually be able to tell if you have hay fever by asking about your symptoms and when you get them. He or she may look inside your nose and down your throat. This is to make sure you don't have any other conditions that could be causing your symptoms.

    If you have severe symptoms that are difficult to control, your GP may refer you to an allergy specialist. The specialist may do a skin-prick allergy test or blood tests. This is to measure the level of immunoglobulin antibodies for a specific allergen in your blood.

  • Treatment Treatment of hay fever

    Self-help

    You can reduce your symptoms by trying to stay indoors when you can and keeping windows closed on days when the pollen count is high.

    Medicines

    There are a range of treatments available. You can buy some of these in shops and supermarkets. Others are only available in pharmacies, and some need a prescription from your GP. Get advice from your pharmacist before starting any medication, even if you don't need a prescription for it.

    Always read the patient information leaflet that comes with your medicine and if you have any questions, ask your pharmacist for advice. Some hay fever treatments aren’t suitable for women who are pregnant or breastfeeding.

    Antihistamine tablets

    Antihistamine tablets usually reduce sneezing and a runny nose, but may not improve a blocked nose. Some antihistamines can cause drowsiness, but there are others that don’t and it’s best to try these first. Non-sedating antihistamines include loratadine and cetirizine. Always ask your pharmacist or GP for advice and read the patient information leaflet that comes with your medicine.

    Nasal sprays

    A steroid nasal spray can help prevent symptoms, especially a blocked nose, but may take some time until it becomes effective. They include mometasone and fluticasone. Nasal steroids work best if you take them at least two weeks before your symptoms usually start and then every day during hay fever season. Take it even if you have no symptoms while the pollen count is high. You shouldn’t take more than the recommended dose, even if you don't feel it's controlling your symptoms. Your GP can prescribe nasal steroids and some are available from a pharmacist.

    If you only get hay fever symptoms now and again, you could try an antihistamine nasal spray such as azelastine.

    A decongestant nasal spray such as xylometazoline can improve a runny or blocked nose. However, it's only suitable for occasional use, perhaps on days when symptoms are worst and other treatments aren’t working. Using a decongestant for more than a week can lead to 'rebound congestion' where the spray actually causes a blocked nose.

    Eye drops

    If you have itchy or sore eyes, antihistamine, sodium cromoglicate or nedocromil eye drops can help.

    Steroid tablets

    If your hay fever is seriously interfering with your life, your GP may prescribe you a short course of steroid tablets. You can use other treatments such as nasal sprays while taking the steroids.

    Immunotherapy

    If all other treatments haven’t improved your hay fever symptoms, you GP may refer you to see an allergy specialist. He or she may offer you immunotherapy. This usually involves having injections of the pollen you're allergic to over a period of three years.

    If you have hay fever that is caused by grass pollen, you can take a grass pollen extract. This is taken as a tablet that you put under your tongue. Your allergy specialist will give you the first dose, but after that you can take the tablets at home.

    You need to take the tablet every day for at least four months before the start of the summer pollen season. You may have an itching, tingling or slight swelling in your mouth for a week or two. However, there are rarely any serious or long-lasting side-effects. Studies are currently being carried out to see if the tablet helps to reduce your symptoms in the long term.

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  • Causes Causes of hay fever

    If you have hay fever, your body produces immunoglobulin when you come into contact with pollen. Antibodies are usually only released to fight infection, but with hay fever, your body believes the pollen is harmful. This antibody triggers the release of chemicals from certain cells in your nose, throat and eyes. One of these chemicals is histamine, which sets off the symptoms of hay fever.

    You may be allergic to one or more types of pollen – this will determine when your symptoms are most severe. Some possible causes include:

    • grass pollen
    • tree pollen
    • weeds, such as nettles, dock and mugwort
    • fungal spores.

    More than nine out of 10 people in the UK who have hay fever are allergic to grass pollen. Different trees produce pollen at different times of the year. One in four people in the UK with hay fever is allergic to birch tree pollen.

    Allergen Time of year when
    symptoms are worst
    Birch pollen Mid-March to early June
    Grass pollen May to August, peak in mid-June
    Weeds (nettle, dock, mugwort) May to September

    The pollen season can vary depending on where you live. It usually starts earlier in the year and lasts longer in Southern and Central UK.

  • The pollen count The pollen count

    The pollen count is the average number of pollen grains in one cubic metre of air over 24 hours. There are pollen counts for grass, tree and weed pollen and fungal spores. Weekly pollen forecasts predict how high the pollen count will be. This can be useful in helping you decide when will be the best times to start and stop treatment. The weather can affect the pollen count and it's generally higher on dry, sunny days and lower on rainy days.

  • Prevention Prevention of hay fever

    There are things you can do to help reduce your symptoms when the pollen count is high. Some of these include:

    • keeping doors and windows closed
    • staying away from areas where there is more pollen such as grassy parks, especially in the early morning and again after around 4pm when the pollen count is highest
    • wearing wrap-around sunglasses to keep pollen out of your eyes
    • taking a shower and washing your hair after going outside
    • not drying washing outside – pollen may get trapped in the fibres of clothes and bed linen
    • putting a pollen barrier cream or balm around the inside of your nostrils to reduce the amount of pollen that gets into your nose – petroleum jelly works for some people
  • FAQs FAQs

    Do any complementary therapies work for treating hay fever?

    Answer

    No, there isn't much scientific evidence to show that complementary therapies are useful for treating hay fever.

    Explanation

    Complementary therapies can be used alongside the medicines prescribed by your GP. They include acupuncture, homeopathy and herbal medicines. Some practitioners claim that these complementary therapies can relieve your hay fever symptoms or even prevent them. But there isn't much scientific evidence to prove that these therapies actually work.

    If you would like to try using a complementary therapy, let your GP know first. Always continue taking your usual medication, as complementary therapies can't be used to replace this.

    Do supermarket own-brand antihistamines work?

    Answer

    The own-brand products of big supermarkets contain the same active ingredients as the branded antihistamines, so work in exactly the same way.

    Explanation

    Most branded antihistamines are available as non-branded (generic) products. Exactly the same ingredients are available, in the same dose, in unbranded products or pharmacy or supermarket own-brands. They are often up to 90 percent less than the price of the branded version. These unbranded equivalents are known as 'generics'. The manufacturers of generic medicines sold in the UK have to follow the same stringent government rules as the manufacturers of the branded equivalent. Therefore, the active ingredient of the generic product will be chemically identical and have the same effect in the body as the branded one.

    There is no reason to pay more for the advertised and possibly more smartly packaged product. Always read the patient information leaflet that comes with your medicine and if you have questions, ask your pharmacist for advice.

    Will I have hay fever abroad?

    Answer

    It depends on which country you visit and at what time of year.

    Explanation

    The hay fever season falls at different times in different countries, depending on the climate and the type of vegetation growing there. If you get severe hay fever, it's best to go on holiday somewhere where the pollen count is low all year round. Alternatively, you could visit places that aren't in their peak pollen season.

    The grass pollen season in Mediterranean countries, such as Greece, southern France and Spain, finishes about five weeks before it does in the UK. So a good time to visit these countries is after the middle of July because the pollen count will have already passed its peak. Some local plants may cause problems at other times of the year.

    There is generally less pollen in coastal areas, especially western and northern beaches in the UK. So, if you visit the seaside, your hay fever symptoms should lessen. This is because the sea breeze blows pollen inland and brings in fresh air. Mountainous areas may also be good places to visit as they contain fewer pollen-producing plants.

    The World Allergy Association has a list of pollen counts by country, so you may be able to check pollen counts before you travel. It’s also worth checking with the National Pollen and Aerobiology Unit, which has lists of low-pollen destinations at different times of the year.

  • Resources Resources

    Further information

    Sources

    • Angier E, Willington J, Scadding G, et al. Management of allergic and non-allergic rhinitis: a primary care summary of the BSACI guideline. Prim Care Respir J 2010;19 (3):217–222. doi:10.4104/pcrj.2010.00044
    • Simon C, Everitt H, van Dorp F. Oxford handbook of general practice. 3rd ed. Oxford: Oxford University Press, 2010
    • Allergic rhinitis. NICE Clinical Knowledge Summaries. cks.nice.org.uk, published November 2012
    • What is an allergy? Allergy UK. www.allergyuk.org, published March 2012
    • Atopic eczema. Allergy UK. www.allergyuk.org, published March 2012
    • Hay fever and allergic rhinitis. Allergy UK. www.allergyuk.org, published March 2012
    • Grass. National Pollen and Aerobiology Unit. www.worcester.ac.uk, published 12 April 2013
    • Birch. National Pollen and Aerobiology Unit. www.worcester.ac.uk, published 12 April 2013
    • Mugwort. National Pollen and Aerobiology Unit. www.worcester.ac.uk, published 12 April 2013
    • Pollen calendar. National Pollen and Aerobiology Unit. www.worcester.ac.uk, published 12 April 2013
    • What are fungal spores? National Pollen and Aerobiology Unit. www.worcester.ac.uk, published 12 April 2013
    • Seasonal allergic rhinoconjunctivitis. Map of Medicine. www.mapofmedicine.com, published 21 January 2013
    • Joint Formulary Committee. British National Formulary. 65th ed. London: British Medical Association and Royal Pharmaceutical Society of Great Britain; 2013
    • Seasonal allergic rhinitis. www.mapofmedicine.com, published 21 January 2012
    • Immunotherapy. Allergy UK. www.allergyuk.org, published March 2012
    • Grazax summary of product characteristics. www.medicines.org.uk, published November 2012
    • Recording the pollen count. National Pollen and Aerobiology Unit. www.worcester.ac.uk, published 12 April 2013
    • Pollen avoidance. Allergy UK. www.allergyuk.org, published March 2012
    • Low pollen holiday destinations. National Pollen and Aerobiology Research Unit. www.worcester.ac.uk, published 12 April 2012
    • About generics. British Generic Manufacturers Association.www.britishgenerics.co.uk, accessed 23 April 2012

     

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  • Author information Author information

    Reviewed by Natalie Heaton, Bupa Health Information Team, 30 August 2013.

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