Hayfever
Your health expert: Imran Khan, Lead Physician at Bupa
Content editor review by Victoria Goldman, August 2023
Next review due August 2026
Hayfever is an allergic reaction to pollen. It can cause sneezing, a runny or blocked nose, and itchy, watery eyes. You can usually manage hayfever symptoms with self-help measures and over-the-counter medicines.
About hayfever
If you have hayfever, your body makes antibodies (called IgE antibodies) when it comes into contact with grass, tree, weed, or other plant pollens. These antibodies trigger the release of several chemicals in your body, including histamine. If your body releases too much histamine, this can cause inflammation in your nose, eyes, throat, and sinuses. This causes hayfever symptoms.
Hayfever is also called seasonal allergic rhinitis. This is because the symptoms affect you at the same time each year. Perennial allergic rhinitis is when you have hayfever-type symptoms all year round. It’s usually caused by an allergy to house dust mites or animals, rather than pollen.
The main pollen season in the UK is late March to the beginning of September. This is when the pollen count (the amount of pollen in the air) is highest. Grass pollen is the most common trigger of hayfever symptoms.
When you get hayfever symptoms will depend on which type of pollen you’re allergic to.
- Tree pollens: from early to late spring
- Grass pollens: from late spring to early summer
- Weed pollens: from early spring to early autumn
Hayfever can affect people of all ages. It affects around 1 in 4 adults and 3 in 20 children in the UK. Most people first get hayfever symptoms as a child. Some children grow out of hayfever as they get older.
Causes of hayfever
Hayfever can run in families. You’re more likely to develop an allergy to pollen if one or both of your parents has hayfever. Many people with hayfever also have another allergic condition such as atopic eczema or asthma . Allergic conditions that run in families are called ‘atopic’ conditions.
Where you live may make you more likely to develop hayfever. You may be more likely to have hayfever if you live in:
- a damp environment
- an area with high air pollution
- a town or city rather than the countryside
Rural areas usually have higher levels of pollen than towns and cities. But air pollution may increase pollen counts and make pollen more likely to trigger allergies in some people.
Symptoms of hayfever
Hayfever symptoms can be mild or severe. If they’re very troublesome, they can affect your daily life. The most common symptoms are:
- sneezing
- an itchy nose, throat, mouth, or ears
- a runny or blocked nose
- itchy, red, watery eyes – called allergic conjunctivitis
- swollen eyelids
Hayfever may also cause:
- coughing and wheezing, especially if you also have asthma
- snoring
- mouth breathing, which can affect your teeth
- headaches
- earache
- feeling unwell, as if you have flu
- fatigue (feeling very tired)
Your hayfever symptoms may vary from year to year. They may change from day to day, and often depend on where you are at the time. Hayfever symptoms are usually worse when pollen counts are high, such as early morning and early evening. Your symptoms may be better if you’re by the coast rather than inland. Hayfever symptoms can resemble those of a viral infection such as a cold. But hayfever symptoms usually last for weeks or months, while cold symptoms usually last for up to a week.
Diagnosis of hayfever
Hayfever is usually diagnosed based on your symptoms (for more information, see our section on symptoms of hayfever). You won’t need to see a GP if your hayfever symptoms are mild. If you think you have hayfever, speak to a pharmacist. They can recommend self-help measures and over-the-counter treatments.
If your hayfever is severe, is affecting your daily life, or pharmacy treatments haven’t worked, speak to your GP.Your GP will ask about your symptoms, when you get them and how long they last. They’ll also ask about:
- your family history
- your medical history
- if you have other allergic conditions such as asthma or eczema
- if you have tried any hayfever medicines from a pharmacy
They may look inside your nose, throat, and ears to see if these are red or swollen.
You don’t usually need to have any tests to diagnose hayfever. But sometimes, if your GP isn’t sure if you have hayfever or thinks you may have other allergies as well, they may refer you to an allergy consultant.
An allergy consultant may offer you some tests.
- A blood test: this checks for IgE antibodies to different types of pollen.
- Skin prick testing: a tiny amount of pollen is put directly on your skin. Your doctor makes a tiny prick on your skin. If you’re allergic to that type of pollen, you’ll get a red, swollen mark on your skin within about 20 minutes.
Self-help for hayfever
There are lots of things you can do to ease your hayfever symptoms when the pollen count is high.
- Use a saltwater (saline) nose spray, pump, or squirt bottle to wash pollen away from the inside of your nose. You can buy this from a pharmacy.
- Put a nasal allergen barrier balm around your nostrils to stop pollen getting into your nose.
You can’t avoid pollen completely.But you can try to limit how much you’re exposed to. Check the pollen forecast every day to see when pollen counts are high in your local area. Pollen counts tend to be higher on dry, sunny, windy days.
When the pollen count is high:
- avoid walking in grassy, open spaces
- avoid drying your washing outdoors
- avoid activities that mean you’ll be exposed to high levels of pollen – for example, mowing the lawn
- keep the windows shut in your car and at home or work
- use an air purifier or air filter to remove pollen from the air inside your home
- use recirculated air in your car or buy a pollen filter for the air vents
- plan holidays to avoid the pollen season as much as possible
- shower or wash your hair after you’ve been outside
- wear wraparound sunglasses outside to protect your eyes from pollen
- dry bedding and clothes inside or in a tumble dryer rather than outdoors
- if you have a cat or dog, wipe their fur with a damp microfibre cloth when they come indoors
- wearing a face mask may stop pollen entering your nose or mouth
Treatment of hayfever
A pharmacist should be able to give you advice on suitable hayfever medicines. You can buy these medicines from a pharmacy without a prescription. You should use the medicines two or three weeks before the hayfever season begins and keep using them during the whole hayfever season.
If your hayfever symptoms affect you at the same time each year, this can help you decide when to start and stop taking your medicines.If pharmacy medicines don’t help, your GP may prescribe some different or stronger hayfever medicines. You may need to use several medicines at the same time to keep your hayfever symptoms under control.
Always read the patient information leaflet that comes with your medicine and ask your pharmacist for advice if you have any questions.
Antihistamines
Antihistamines work by blocking the effects of the chemical histamine. You can take these as tablets or use a nose spray.
Antihistamine tablets
Antihistamine tablets should ease a runny nose, sneezing and itching. But they don’t work so well for a blocked nose. There are two main types of antihistamine tablets:
- sedating ‘older generation’ antihistamines, such as chlorphenamine
- non-sedating ‘second generation’ antihistamines, such as loratadine, cetirizine, fexofenadine, and acrivastine
Sedating antihistamines can make you feel sleepy. This can affect your concentration and mean you can’t think so clearly. Non-sedating antihistamines are less likely to make you feel sleepy. But this varies from person to person, so you may still feel drowsy after taking them. If you feel sleepy after taking an antihistamine, don’t drive, cycle, or operate machinery. Antihistamines are generally safe to take. But they can react with other medicines and may cause side-effects in some people. Not everyone can take antihistamines, so talk to a pharmacist or GP if you’re taking these medicines for the first time. Children and older people may be more likely to get side-effects from some antihistamines. Carefully read the patient information leaflet that comes with your medicine.
If you’re pregnant or breastfeeding, it’s important to speak to your GP or pharmacist before taking an antihistamine. They can tell you if it’s safe to take. Some antihistamines may affect your baby. Antihistamine nose sprays.
Antihistamine nose sprays (azelastine) work more quickly than antihistamine tablets. But they won’t ease allergy eye symptoms. If you get a bitter taste in your mouth after using nasal spray you may not be using it properly, so speak to your pharmacist.
Corticosteroid nose sprays and drops
Topical corticosteroids work by reducing inflammation (swelling) in your nose. The nasal sprays and drops may contain:
- fluticasone
- beclometazone
- mometasone
- triamcinolone
Corticosteroid nose sprays are usually better at easing hayfever symptoms than antihistamine nose sprays or tablets. These will also help to ease your eye symptoms.They work best if you use them every day.It can take up to two weeks to get the full benefit.
Steroid nose sprays are generally safe to use and don’t cause any serious side-effects. They may cause some irritation and bleeding inside your nose. If this happens, stop using them.
If over-the-counter corticosteroid nasal sprays aren’t helping to ease your hayfever, your GP may prescribe a different corticosteroid nasal spray or some corticosteroid nose drops. If you have a persistently itchy nose and sneezing, they may prescribe a nasal spray containing both a corticosteroid (fluticasone) and antihistamine (azelastine).
Decongestants
If your nose is very blocked, a pharmacist or GP may recommend that you use a decongestant nasal spray for a few days. This will unblock your nose quickly. Then, you can use an antihistamine or corticosteroid nose spray to ease your hayfever symptoms. You shouldn’t use decongestant nose sprays for more than seven days, or your blocked nose may get worse again.
Decongestant tablets may help to ease a blocked nose. But these can cause side-effects and aren’t recommended for hayfever.
Allergy eye drops
If you have itchy, sore, or watery eyes, you can use allergy eye drops containing:
- antihistamines
- sodium cromoglicate
Your eyes may sting a bit when you first put the eye drops in.
Other medicines
If your hayfever symptoms are very severe, GP may prescribe other medicines. These include:
- ipratropium bromide to stop your nose producing a constant watery discharge
- a short course of corticosteroid tablets to ease your symptoms very quickly
- a leukotriene receptor antagonist (montelukast) if you have hayfever and asthma symptoms at the same time
Immunotherapy treatment
If your hayfever symptoms are very severe and other treatments haven’t worked, an allergy specialist may suggest you try immunotherapy. Immunotherapy is a specialist treatment available from some allergy clinics. Immunotherapy involves giving you gradually increasing doses of pollen every day until your immune system stops reacting to the pollen. You start the treatment a few months before the main pollen season begins. You usually need to have immunotherapy for three to five years.
There are two types of immunotherapy for hayfever:
- an injection under the skin in your upper arm (subcutaneous immunotherapy)
- a tablet or spray under your tongue (sublingual immunotherapy)
Complications of hayfever
Severe hayfever can affect your work, home and social life, especially when pollen levels are very high. Children and teenagers with hayfever may find it hard to concentrate at school.
Other complications of hayfever include:
- food allergies to fruit and vegetables – for example, apples – this is called oral allergy syndrome or pollen–food syndrome
- asthma – hayfever symptoms can make asthma worse
- sinusitis – inflammation inside your nose blocks your sinuses
- ear infections
- problems sleeping (for example, insomnia) and making sleep apnoea worse
The most common signs of hayfever are sneezing, an itchy nose or throat, runny or blocked nose, and itchy, red, watery eyes. These symptoms affect you in the spring and summer months each year. For more information, see our section on symptoms of hayfever.
The best way to treat hayfever is with medicines such as antihistamines and corticosteroid nose sprays. Limiting your exposure to pollen may also help. For more information, see our section on treatment of hayfever.
Hayfever is an allergy to pollen, usually from grass, trees, or weeds. Grass pollen is the most common trigger. You’re more likely to have hayfever if one or both of your parents has the condition. For more information, see our section on causes of hayfever.
When your hayfever starts will depend on which type of pollen you’re allergic to. In the UK, the main hayfever season begins in late March and lasts until early September. For more information, see our section: About hayfever.
Antihistamines
Corticosteroids
Food allergy
A food allergy is when your body’s immune system overreacts to particular foods
This information was published by Bupa's Health Content Team and is based on reputable sources of medical evidence. It has been reviewed by appropriate medical or clinical professionals and deemed accurate on the date of review. Photos are only for illustrative purposes and do not reflect every presentation of a condition.
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