Hay fever (seasonal allergic rhinitis)

Expert reviewer, Adrian Raby, General Practitioner
Next review due March 2021

Hay fever (seasonal allergic rhinitis) is caused by an allergic reaction to pollen. It can trigger sneezing, a blocked or runny nose and itchy eyes at around the same time each year.

Couple walking

What is hay fever?

If you have hay fever (the medical term is seasonal allergic rhinitis), your immune system reacts to pollen from grass, trees or weeds. Pollen is a type of allergen – a harmless substance that can trigger an allergic reaction in certain people.

Hay fever symptoms include a blocked or runny nose, sore or itchy eyes and sneezing. You’ll notice these symptoms at certain times of the year when pollen is carried in the air. This is usually during the spring, summer and sometimes autumn months, and occasionally for some people, the winter. See our FAQ: What is winter hay fever?

Around one in five people in the UK have an allergy such as hay fever. Hay fever is most likely to affect children and teenagers, though adults can be affected too.

Allergic rhinitis is becoming more common. Many people with hay fever also have asthma and eczema. These are called atopic conditions or atopy. You’re more likely to have atopic conditions if they run in your family.

Symptoms of hay fever

Hay fever symptoms aren’t usually serious, but if your symptoms are bad they can negatively impact on your work, home and social life. Symptoms may come and go or last for the whole of the hay fever season, depending on what you’re allergic to.

The most common hay fever symptoms include:

  • sneezing
  • a blocked or runny nose (rhinorrhoea)
  • itchy eyes, nose, throat and roof of your mouth (palate)
  • red or watery eyes
  • postnasal drip (mucus dripping down your throat from the back of your nose) – this may make you cough
  • headache, caused by a stuffy nose (the air spaces filled around your nose

A blocked nose is usually the most troublesome hay fever symptom. Red, watery or itchy eyes are also called allergic conjunctivitis. Some people with hay fever only have the eye symptoms.

Hay fever can make you feel very tired and irritable and stop you sleeping well. Some people find their hay fever makes them struggle to concentrate at work or at school and affects their usual daily activities.

In some people, pollen may also trigger asthma or make existing asthma worse. Hay fever can also cause sinusitis. Sinusitis can give you headaches, toothache or pain in your face.

Some people get hay fever-like symptoms all year round. This is called perennial allergic rhinitis, in which the allergens are usually caused by dust mites, pet hair or moulds.

Diagnosis of hay fever

If you have hay fever, you’ll probably be familiar with your symptoms and won’t need to see your GP. You can try to ease your hay fever symptoms with help from your local pharmacist. But if your symptoms don’t get better with over-the-counter treatments, it’s worth seeing your GP to check you have hay fever.

Your GP will usually be able to easily diagnose allergic rhinitis from your symptoms. They may ask when you notice your symptoms and whether you have any other allergies. They may also look inside your nose and check your eyes.

If your symptoms are unusual for hay fever, your GP may arrange for you to have an allergy test. You’ll see an allergy specialist, who may do a skin prick allergy test or blood tests to confirm what you’re allergic too.

Self-help and prevention for hay fever

If you have hay fever, the best way to prevent your symptoms is to avoid whatever’s causing them. But this isn’t always easy when you’re allergic to a substance like pollen, which is found in the air.

Here are some ways to help reduce your symptoms.

  • Keep an eye on the daily pollen count. You can check this on the Met Office website. If you know the pollen count is going to be high, you can take action before your symptoms get too bad or even start.
  • Stay indoors, and keep your doors and windows closed.
  • Keep your car windows closed when you’re driving.
  • Fit a car pollen filter and change it every time you get the car serviced.
  • Stay away from grassy areas, especially during the early morning and evening when the pollen count is highest.
  • Wear wrap-around sunglasses to keep pollen out of your eyes.
  • Take a shower and wash your hair after going outside. Change your clothes too.
  • Don’t dry your washing outside. Pollen can get trapped in the fibres of your clothes and bed linen.
  • Apply a barrier balm around the inside of your nostrils to reduce how much pollen gets into your nose – petroleum jelly works for some people.
  • Use a saline (salt water) nasal spray or rinse inside your nose or use steam inhalation to wash out the pollen.
  • If your eyes are sore or itchy, use a cold compress on them, or wash them with water, to ease your allergic conjunctivitis.

If it’s been raining, or is raining, the pollen count should be lower, so your symptoms will probably be better on these days. The pollen count is usually higher on warmer, dry days.

Medicines for hay fever

Hay fever can often be treated with over-the-counter medicines from a pharmacy, with tablets, nasal sprays or eye drops. You can also buy some of these medicines from a supermarket. There are lots of different medicines available for hay fever. Your local pharmacist can help you work out the best treatment for you, and check you’re using the medicines in the right way. If the first medicine you try doesn’t help, you may be able to try something else. You may need to use several different hay fever medicines together to keep your symptoms under control.

For some types of hay fever treatment, such as nasal sprays, you should ideally start using them two or three weeks before the hay fever season begins. You usually need to take hay fever medicines every day. You may need to keep using the treatments for several months, depending on what you’re allergic to and when your symptoms appear. See the section below on The hay fever season.

If over-the-counter medicines don’t help your symptoms, you’ll need to see your GP for other treatment options available on prescription. Be sure to read the patient information leaflet that comes with your medicine. If you have any questions, ask your pharmacist or GP for advice. Be aware that some hay fever treatments aren’t suitable if you’re pregnant or breastfeeding.

Antihistamine tablets

If your hay fever is mild, you may find that antihistamine tablets are all you need to ease your symptoms. Antihistamines usually reduce sneezing and a runny nose, but may not help so much with a blocked nose. Don’t drink alcohol while you’re taking antihistamines. Always read the patient information leaflet that comes with your medicine. If you’re unsure about anything, ask your pharmacist.

Choose the newer types of antihistamine such as cetirizine, acrivastine and loratadine, as these are less likely to make you feel drowsy. You usually only need to take these tablets once or twice a day. Even these antihistamines can make some people feel tired though, so don’t drive, cycle or use heavy machinery if you notice this side-effect. Older antihistamines, such as chlorphenamine, can make you feel drowsy and aren’t recommended for hay fever.

Nasal sprays

If your hay fever is mild, you could try an antihistamine nasal spray, such as azelastine. These sprays usually work quickly (within 15 minutes), so are useful if your nose symptoms suddenly get worse. They can help to ease a runny nose, but don’t help eye symptoms.

If your nose is very blocked, you can use a decongestant nose spray such as xylometazoline for a few days. You may find this useful before you use an antihistamine nose spray or a corticosteroid nose spray, as it will help to clear your nose. But don’t use a decongestant spray for more than seven days as using it for too long can make your blocked nose worse.

If you have a very blocked nose, a corticosteroid nasal spray, such as beclometasone or fluticasone, may be a good option for you. You can buy some of these nasal sprays over the counter from pharmacies – others are available only on prescription. Your GP can prescribe a spray that contains both a corticosteroid and an antihistamine if your symptoms are very bad. For more information, see our information about corticosteroids.

Corticosteroid nasal sprays can usually treat all hay fever symptoms, including allergic conjunctivitis (eye symptoms). But it can take a while for a corticosteroid spray to work. Use the spray at least two weeks before your symptoms usually start. Make sure you take the lowest dose that works for you. You may have some mild side-effects, such as irritation in your nose or nosebleeds. If so, you may need to try a different corticosteroid nose spray – speak to your pharmacist.

Eye Drops

If you have itchy or sore eyes (allergic conjunctivitis), you can use eye drops. Sodium cromoglicate drops usually work well and are available without a prescription from your local pharmacy. You’ll need to use these drops four times a day. Your pharmacist can show you how to put them in your eyes. Lodoxamide, nedocromil and antihistamine drops are other options if sodium cromoglicate doesn’t help.

Steroid tablets

Steroid tablets are rarely prescribed for hay fever, unless you have very severe symptoms. If you’re prescribed them by your GP, it will only be a short course of treatment.

Immunotherapy for hay fever

If all other treatments don’t work, your GP may refer you to see an allergy specialist, who may offer you immunotherapy. This is sometimes called desensitisation.

Immunotherapy involves having doses of the grass or tree pollen you’re allergic to over a period of three years. It helps ‘reset’ your immune system, so it no longer thinks the specific allergen you’re allergic to is a threat. Immunotherapy is available as injections, drops or a tablet that dissolves under your tongue (sublingual therapy). You’ll usually start the treatment four months before the hay fever season begins.

Immunotherapy isn’t suitable for everyone and can cause side-effects. It’s also expensive and time-consuming so it’s usually only offered if your hay fever symptoms are very bad.

Causes of hay fever

If you have hay fever, your body produces a type of antibody called immunoglobulin E (IgE) when you come into contact with pollen, which is a harmless substance. But with hay fever, your body mistakenly believes that the harmless pollen is actually harmful and a threat. IgE triggers the release of certain substances from cells in your nose, throat and eyes. One of these substances is histamine, which triggers the symptoms of hay fever.

You may be allergic to one or more types of pollen. The pollen you’re most allergic to will influence when your symptoms are at their worst. Some possible causes of hay fever 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 are allergic to birch tree pollen.

The hay fever season

You may notice that your hay fever symptoms change over the spring and summer months, getting worse on some days and better on others. This will depend partly on what you’re allergic to. But the hay fever season, also called the pollen season, varies from year to year. Its timing and length can be different depending on where you live. If you live in southern and central parts of the UK, you may notice the hay fever season starts earlier in the year and lasts longer.

Allergen: Tree pollen
Time of the year when symptoms are worst: Spring

Allergen: Grass pollen
Time of the year when symptoms are worst: End of spring and beginning of summer

Allergen: Weeds
Time of the year when symptoms are worst: Early spring to late autumn

The pollen count

Everyone reacts differently to pollen. Some people react to very low levels of pollen but others don’t notice any hay fever symptoms until the pollen count is very high. The pollen count is the average number of pollen grains in one cubic metre of air over 24 hours. The pollen count can be affected by the weather – it’s generally higher on dry, sunny days. It’s lower on rainy days because the rain gets rid of the pollen in the air, though it does make the grass grow which can then make hay fever worse on following days that are dry and warm.

The pollen count is classed as low, moderate, high or very high. Keeping an eye on the pollen count can help you manage your hay fever symptoms. You can check pollen counts for grass, tree and weed pollen and fungal spores on the National Pollen and Aerobiology Research Unit (NPARU) website. Daily forecasts are available from mid-March to mid-September. The Met Office also has pollen forecasts on its website during the spring and summer months. Daily forecasts often appear in newspapers and during radio and TV weather reports as well. You can also get forecasts on various apps.

If you know the pollen count is going to be high, you can take medicines and try self-help measures. See our Treatment section above for more information.

Frequently asked questions

  • Experts aren’t yet sure. Some people find complementary therapies for hay fever helpful. However, scientific research that’s been done hasn’t yet proven one way or another how well they work. This is because the results have been mixed.

    Complementary therapies can be used alongside conventional medicines, such as those you get in a pharmacy or 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. Some studies have shown promise. For example, acupuncture has helped improve hay fever symptoms in some people. However, there isn’t enough evidence to recommend these treatments and more research is needed.

    Some people find that complementary therapies work for them. However, they can sometimes affect how other medicines work or cause side-effects.

  • Most branded antihistamines bought over the counter in pharmacies or from supermarkets are available as non-branded products as well. The supermarket own brand products contain the same active ingredients as branded antihistamines in the same dose. So, they work in exactly the same way. These are called ‘generic medicines’. Generic medicines sold in the UK have to meet the same quality and safety standards as their branded equivalents. But they can be up to 90% cheaper than the original branded version. There’s no need to pay more for an advertised or more smartly packaged product, so always ask the pharmacist if there’s a generic equivalent that you can buy instead.

    Always read the patient information leaflet that comes with your medicine. If you have questions, ask your pharmacist for advice.

  • Some people can get hay fever symptoms in the winter. This is because the pollen season can also start much earlier than people think with some trees starting to release pollen in January. Whether you’re affected will depend on how much you react to different types of pollen and to how allergic you are. Peak season is in the spring months. If you’re getting the symptoms of hay fever, it’s worth speaking to your pharmacist and trying a medicine from over the counter. Or make an appointment with your GP if your symptoms get worse, and over-the-counter treatments haven’t worked.

  • Hay fever mostly develops when you’re a child or teenager and then carries on when you’re an adult. But there are some reasons why you might be getting it now as an adult.

    Your symptoms are caused by another allergen

    If you’ve never had hay fever before but notice that you’re now getting symptoms, it could be caused by another allergen that you’ve come in contact with. For example if you’ve changed job, moved house or recently got a pet you could be in contact with an allergen you hadn’t been exposed to before.

    Your hay fever hasn’t been diagnosed or has been mis-diagnosed

    Or it could be that it is hay fever but you’ve never realised that’s what it is. For example, if your symptoms have always been very mild you might not have seen your pharmacist for treatment. Or you might think your symptoms are caused by something else like a sinus problem. If you then treat your symptoms yourself with the wrong medicines such as decongestants, this can actually make symptoms worse in the long run. Furthermore, this means hay fever isn’t always diagnosed, or it’s mis-diagnosed.

    Hay fever and allergies are on the rise

    More people are getting allergies like hay fever, but it’s not known exactly why this might be. There are some theories, such as the effect of air pollution and climate change on allergies and lifestyle and environmental factors, such as living in more sterile environments, but experts don’t know these things for sure.

  • You can have hay fever symptoms abroad, depending on which country you visit and at what time of year you go. The hay fever season happens at different times in different countries. Its timing depends on the climate and the type of plants and trees that grow there. Ragweed is a common allergen in the USA, Canada and central Europe, but isn’t often seen in the UK. Olive pollen is another common allergen found abroad.

    If your hay fever is bad, it’s best to go on holiday somewhere where the pollen count is low all year round. Or you could visit places that aren’t in their peak pollen season. There’s generally less pollen in coastal areas. So, if you visit the seaside, your hay fever symptoms shouldn’t be as bad. This is because the sea breeze blows pollen inland and brings fresh air with it.

    Sometimes the hay fever season comes earlier or later than usual though. Weather changes can cause rising pollen counts when you’re not expecting them. So, it’s important to always be prepared. Check the pollen count before you travel and take your hay fever medicines with you.

    The National Pollen and Aerobiology Unit (NPARU) website has a list of low pollen destinations month by month. It’s worth checking this before you book a holiday. The website also has links to pollen forecast websites in other parts of the world.

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  • Reviewed by Graham Pembrey, Lead Health Editor, Bupa Health Content Team, March 2018
    Expert reviewer, Adrian Raby, General Practitioner
    Next review due March 2021

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