Hay Fever

Overview

Hay fever, also called allergic rhinitis, is a common condition where your immune system overreacts to substances in the air, like pollen, dust mites, or pet dander. It causes symptoms similar to a cold, such as sneezing, a runny or stuffy nose, and itchy eyes. It is not an infection and is not contagious.

Yes, hay fever is very common. It affects more than 1 in 4 adults and around 1 in 5 children in the UK. Many people have mild symptoms, while others have more bothersome symptoms that interfere with daily life.

Hay fever can affect anyone, but it often begins in childhood or the teenage years. It is more common in people who have a family history of allergies, asthma, or eczema. It can also develop for the first time in adults, even if they have never had allergies before.

Symptoms

Common symptoms

• Frequent sneezing, often in bursts
• Runny or blocked nose
• Itchy, red, or watery eyes
• Itchy throat, mouth, or ears
• Coughing or clearing the throat
• Fatigue or feeling unwell because of poor sleep

Symptoms in children

• Constant rubbing of the nose (sometimes called the 'allergic salute')
• Mouth breathing or snoring due to a blocked nose
• Irritability or trouble concentrating in class
• Dark circles under the eyes (sometimes called 'allergic shiners')
• Ear infections or reduced hearing because of blocked Eustachian tubes

Symptoms in older adults

• In older adults, symptoms may be less obvious and can be mistaken for chronic colds or the effects of ageing
• A persistent stuffy nose or sinus pressure may be the main symptom
• Dry eyes or eye irritation can be more common
• Sleep problems due to nasal blockage may lead to daytime fatigue or confusion

Causes

Main causes

• Pollen from trees, grasses, and weeds (this is the most common cause)
• Dust mites (tiny insects that live in bedding, carpets, and soft furniture)
• Pet dander (tiny flakes of skin, saliva, or urine from cats, dogs, and other animals)
• Mould spores (small particles released by mould that grows in damp areas)

Risk factors

• Having other allergic conditions like asthma or eczema
• A family history of allergies
• Being exposed to high pollen levels during peak seasons
• Spending a lot of time outdoors when pollen counts are high
• Having a compromised immune system (for example, due to certain medications or health conditions)

When to see a doctor

See a doctor urgently if:

• You have trouble breathing, wheezing, or tightness in the chest
• Your symptoms are severe and your eyes, face, or throat are swelling
• You develop a fever, thick yellow or green mucus, or facial pain that gets worse
• Your asthma symptoms are not controlled by your usual medicines

Book a routine appointment if:

• Your symptoms do not get better with over-the-counter allergy medicines from the pharmacy
• Your symptoms are affecting your sleep, work, school, or quality of life
• You are not sure what is causing your symptoms and want a clear diagnosis
• You need advice on the best treatment options for your situation

Diagnosis

Your healthcare provider will usually diagnose hay fever by listening to your symptoms and examining your nose and eyes. They may ask about your surroundings, the seasons, and your family history. In most cases, no special tests are needed.

Tests that may be done

• Skin prick test — tiny drops of allergen extracts are placed on your skin, and a small prick lets them go under the surface. If you are allergic, you will get a small itchy bump.
• Specific IgE blood test — measures the level of allergy antibodies in your blood to certain allergens. This is useful if skin testing is not possible or if you take antihistamines that interfere with skin tests.
• Nasal endoscopy — a thin, flexible tube with a light and camera is used to look inside your nose, but this is usually only needed if you have unusual symptoms or complications.

What to expect at your appointment

The diagnosis is usually straightforward. Your provider will ask about your symptoms and examine you. If tests are needed, they will explain how they are done and what the results mean. You may be referred to an allergy specialist for severe or confusing cases.

Treatment

There is no cure for hay fever, but treatment focuses on reducing symptoms and helping you feel comfortable. Treatment options range from simple lifestyle changes to various allergy medicines. The best approach depends on the severity of your symptoms and how much they affect your daily life.

Self-care at home

• Check the pollen forecast daily and stay indoors when counts are very high
• Keep windows and doors closed during peak pollen times, especially early morning and early evening
• Wear wrap-around sunglasses to stop pollen getting in your eyes
• Shower and change clothes after being outdoors to remove pollen
• Rinse your nose with a saline (salt water) solution using a guided squeeze bottle or neti pot — but always use sterile or previously boiled water
• Use a vacuum cleaner with a HEPA filter to reduce dust, pet dander, and mould at home
• Wash bedding in hot water regularly to control dust mites

Medical treatments

Your pharmacist or doctor can recommend several types of treatment that do not require a prescription. Antihistamines come as tablets, syrups, or nasal sprays and work by blocking the allergic reaction. Corticosteroid nasal sprays reduce swelling and mucus in the nose. Eye drops can relieve itchy, watery eyes. Some treatments are available over the counter, while others require a prescription. Never take more than the recommended dose, and talk to a health professional if you are pregnant, breastfeeding, or taking other medicines. For severe or persistent cases, your doctor may refer you to an allergy clinic for allergen immunotherapy (sometimes called allergy shots or tablets) — this is a long-term treatment that tries to reduce your sensitivity to allergens.

When is surgery considered?

Surgery is very rarely needed for hay fever. For people with nasal polyps (benign growths in the nose) or chronic sinus infections that do not improve with medicines, an ear, nose, and throat specialist may consider surgery to improve drainage and breathing.

Living with this condition

Living with hay fever is about managing your exposure to triggers and using the right treatments consistently. Keep your allergy medicines close at hand, and try to start using them early in the pollen season if that is your trigger. Plan outdoor activities for times when pollen counts are lower, such as after rain. Keep track of what triggers your symptoms — a diary can help you and your doctor adjust your treatment plan.

Lifestyle tips

• Keep your living space clean and dust-free by wiping surfaces with a damp cloth
• Use allergy-proof covers for pillows and mattresses if dust mites are a trigger
• Clean or replace air conditioning filters regularly
• Keep pets out of your bedroom and wash them regularly if you are allergic to animal dander
• Dry clothes indoors rather than on an outdoor line, where pollen can stick to them

Diet and exercise

There is no specific diet that cures hay fever, but eating a balanced diet rich in fruits, vegetables, and whole grains supports your overall immune health. Some people feel better when they avoid foods that cause cross-reactions, such as raw apples, celery, or nuts if you have pollen allergies — but this is not the same for everyone. Continue to exercise, but choose indoor exercise on high-pollen days. Swimming in an indoor pool may be easier than outdoor sports during the pollen season.

Mental health and emotional wellbeing

Hay fever can be frustrating and exhausting. Constant sneezing, a blocked nose, and poor sleep can affect your mood, energy, and ability to focus. It is understandable to feel low or irritable. If you notice that you are feeling anxious, depressed, or that your symptoms are controlling your life, talk to your doctor. Remember that your feelings are valid, and treatment options are available to reduce the impact of hay fever on your daily life.

Prevention

You cannot completely prevent hay fever, but you can reduce your exposure to allergens and make symptoms less likely to appear. Taking proactive steps, especially during allergy season, can make a big difference. This includes tracking pollen counts, keeping windows closed, and using preventive medicines as advised by your doctor.

Vaccines

There is currently no vaccine for hay fever. However, allergen immunotherapy (sometimes called desensitisation) is a long-term treatment that can reduce your allergic reaction over time. It is not a vaccine, but it works in a similar way by giving small amounts of the allergen to help your immune system get used to it. This is only available at specialist allergy clinics for certain allergens.

Complications

If left untreated

• Chronic nasal congestion can lead to sinusitis (inflammation of the sinuses) and infections
• Persistent allergic conjunctivitis (eye allergy) can cause discomfort and may lead to damage to the cornea in very rare cases
• Poor sleep from nasal blockage can cause daytime fatigue and poor concentration
• For people with asthma, untreated hay fever can worsen asthma control and lead to more frequent asthma attacks

Long-term outlook

The outlook for hay fever is generally very good. With the right combination of avoiding triggers and using effective treatments, most people can keep their symptoms well controlled. Many people find that their symptoms improve with age, and some may even outgrow them. Although hay fever can be annoying and disruptive, it is a manageable condition and does not cause lasting harm to your overall health.

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