Allergic rhinitis control in older adults

Overview

Allergic rhinitis (hay fever) is a condition where the inside of your nose becomes inflamed after breathing in an allergen — something you are allergic to, like pollen, dust mites, or pet dander. It causes sneezing, a runny or blocked nose, and watery eyes.

Yes, allergic rhinitis is one of the most common long-term conditions worldwide. It affects about 1 in 5 people at some point in their lives, including many older adults.

Allergic rhinitis can affect people of all ages, but it is often underdiagnosed in older adults because symptoms might be mistaken for age-related changes or other health problems.

Symptoms

Common symptoms

• Sneezing, especially after waking up
• Runny or stuffy nose
• Itchy nose, roof of mouth, throat, or eyes
• Watery, red, or swollen eyes (allergic conjunctivitis)
• Coughing from postnasal drip (mucus running down the back of the throat)

Symptoms in children

• All these common symptoms can occur, plus sometimes nosebleeds or snoring.
• Children may also rub their nose upward constantly (called an 'allergic salute').

Symptoms in older adults

• Symptoms may be less obvious, such as a constant feeling of a blocked nose or reduced sense of smell.
• Older adults might experience more tiredness or trouble sleeping due to nasal congestion.
• Dry mouth from breathing through the nose can also be a problem.

Causes

Main causes

• Inhaling allergens like pollen from trees, grasses, or weeds (seasonal allergic rhinitis)
• House dust mites (tiny bugs found in bedding, carpets, and soft furnishings)
• Pet dander (tiny flakes of skin from cats, dogs, or other animals)
• Mould spores (especially in damp environments)

Risk factors

• Having a family history of allergies or asthma
• Living in an area with high pollen levels or indoor allergens
• Other allergic conditions like eczema or asthma
• Weakened immune system due to age or other health issues

When to see a doctor

See a doctor urgently if:

• If you develop sudden, severe symptoms like trouble breathing or swelling of your face or throat — call your local emergency number immediately.
• If you have a high fever with a severe headache and facial pain, which could indicate a sinus infection.

Book a routine appointment if:

• If your nose symptoms are bothering you and not helped by over-the-counter products from your pharmacist (like saltwater sprays or antihistamines).
• If you are unsure what is causing your symptoms or if they last for more than a few weeks.
• Before starting any new treatment, especially if you have other health conditions or take other medications.

Diagnosis

A doctor will ask about your symptoms, when they happen, and what seems to trigger them. They may also look inside your nose with a small light. Usually this is enough to diagnose allergic rhinitis, but sometimes tests are needed.

Tests that may be done

• Skin prick test: tiny amounts of common allergens are placed on your skin to see if you react with a small red bump.
• Blood test (specific IgE test): checks for allergy antibodies to specific allergens.
• Allergy patch test: used if a delayed allergic reaction is suspected (less common for rhinitis).

What to expect at your appointment

The tests are safe and usually not painful. A skin prick test might feel like a light scratch. Results come back quickly (within 20 minutes for skin test, a few days for blood test). Your doctor will explain the results and work with you on a management plan.

Treatment

Treatment for allergic rhinitis focuses on reducing exposure to allergens and controlling symptoms. Many options are available, but it is important to talk to your doctor or pharmacist before starting any new treatment, especially if you have other health problems or take other medications.

Self-care at home

• Avoid triggers: keep windows closed during high pollen seasons, use a damp cloth to clean dust, and wash bedding in hot water to kill dust mites.
• Use saline (saltwater) nasal rinses to flush out allergens and mucus.
• Apply a pet-free zone in your home, especially the bedroom.
• Shower and change clothes after being outdoors during pollen season.

Medical treatments

Your doctor may recommend treatments such as antihistamines (tablets or nasal sprays) to reduce sneezing and itching, or corticosteroid nasal sprays to reduce inflammation. These are generally safe for older adults but should be chosen carefully. Decongestant sprays should only be used for a few days as they can cause rebound congestion. In severe cases, allergen immunotherapy (allergy shots or tablets) may be an option. Always follow your doctor’s advice.

When is surgery considered?

Surgery is rarely needed for allergic rhinitis. It may be considered if nasal polyps (small growths in the nose) do not respond to medical treatment or if sinus infections keep coming back. Discuss with your ear, nose, and throat (ENT) specialist.

Living with this condition

Living with allergic rhinitis means staying on top of your triggers and treatments. Regularly cleaning your home, using protective covers on pillows and mattresses, and checking pollen forecasts can help you feel in control.

Lifestyle tips

• Wear wraparound sunglasses outdoors to protect your eyes from pollen.
• Use air purifiers with HEPA filters in rooms where you spend a lot of time.
• Keep indoor humidity below 50% to discourage dust mites and mould.
• Avoid hanging clothes outside to dry during high pollen seasons.

Diet and exercise

A healthy, balanced diet supports your overall immune system, but there is no specific diet proven to cure allergic rhinitis. Exercise is good for health, but if pollen triggers your symptoms, try exercising indoors on high-pollen days or after rain when pollen counts are lower.

Mental health and emotional wellbeing

Constant nasal symptoms, poor sleep, and feeling tired can affect your mood and concentration. It's normal to feel frustrated. If you notice low mood or anxiety, talk to your doctor. Managing your allergies well often improves mental well-being.

Prevention

Allergic rhinitis cannot always be prevented, but you can reduce the chance of symptoms by avoiding the allergens you are sensitive to. For children, early exposure to allergens is controversial; there is no proven way to prevent developing allergies entirely.

Vaccines

There is no vaccine to prevent allergic rhinitis. However, allergy shots (immunotherapy) can reduce sensitivity to specific allergens over time and are sometimes used as a 'treatment' to change how your immune system responds.

Screening programmes

There is no routine screening for allergic rhinitis. Testing is done only if you have symptoms and a doctor thinks it is needed. If you have a strong family history of allergies, you may want to watch for signs in yourself or your children.

Complications

If left untreated

• Chronic sinusitis (long-term inflammation of the sinuses) leading to facial pain and pressure
• Nasal polyps (small growths in the lining of the nose that can block airflow)
• Poor sleep quality, which can affect energy, memory, and overall health
• Increased risk of ear infections or hearing problems
• Worsening of asthma if you also have that condition

Long-term outlook

With proper management, most people with allergic rhinitis can achieve good control of their symptoms and enjoy a normal quality of life. The condition does not cause permanent damage, and treatments are safe and effective for older adults when chosen carefully. You do not have to 'just put up with it' — help is available.

Find support

Local organisations

• Your GP or local pharmacist · United Kingdom

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