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Hay fever

Key points

  • Hay fever is an allergic reaction to pollen and usually occurs in the spring and summer months.
  • You may be more likely to have hay fever if it runs in your family.
  • Symptoms include a blocked or runny nose, itchy eyes, sneezing and a headache.
  • Treatments include self-help, antihistamine tablets, nasal sprays, eye drops and sometimes, steroid tablets and immunotherapy.

Girl playing outside with flowers - hay fever information

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.

About hay fever

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.

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.

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.

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 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.

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 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

 

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

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For sources and links to further information, see Resources.

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  • This information was published by Bupa's Health Information Team and is based on reputable sources of medical evidence. It has been reviewed by appropriate medical or clinical professionals. Photos are only for illustrative purposes and do not reflect every presentation of a condition. The content is intended only for general information and does not replace the need for personal advice from a qualified health professional. For more details on how we produce our content and its sources, visit the about our health information page.

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