Hay fever

Hay fever is a common allergic condition that affects up to one in five people at some point in their life.

Symptoms of hay fever include:

• sneezing
• a runny nose
• itchy eyes

You'll experience hay fever symptoms if you have an allergic reaction to pollen.

Pollen is a fine powder released by plants as part of their reproductive cycle. It contains proteins that can cause the nose, eyes, throat and sinuses (small air-filled cavities behind your cheekbones and forehead) to become swollen, irritated and inflamed.

You can have an allergy to:

• tree pollen, released during spring
• grass pollen, released during the end of spring and beginning of summer
• weed pollen, released late autumn

Read more about the causes of hay fever.

Many people find their symptoms improve as they get older. Around half of people report some improvement in symptoms after several years. Symptoms disappear completely in around 10-20% of people.

Hay fever treatment

There's currently no cure for hay fever, but most people are able to relieve symptoms with treatment, at least to a certain extent.

The most effective way to control hay fever would be to avoid exposure to pollen. However, it's very difficult to avoid pollen, particularly during the summer months when you want to spend more time outdoors.

Treatment options for hay fever include antihistamines, which can help to prevent an allergic reaction from occurring and corticosteroids (steroids), which help to reduce inflammation and swelling.

Hay fever can often be controlled using over-the-counter medication from your pharmacist. However, if your symptoms are more troublesome it’s worth speaking to your GP, as you may require prescription medication.

For severe and persistent hay fever, there's also a type of treatment called immunotherapy. It involves being exposed to small amounts of pollen over time, to build resistance to its allergic effects. However, this can take many months or even years to work.

Read more about treating hay fever.

Who's affected

Hay fever is one of the most common allergic conditions. It's estimated that there are more than 10 million people with hay fever in England.

You can get hay fever at any age, although it usually begins in childhood or during the teenage years. It's more common in boys than girls. In adults, men and women are equally affected.

You're more likely to develop hay fever if you have a family history of allergies, particularly asthma or eczema.

Self-help tips

It's sometimes possible to prevent the symptoms of hay fever by taking some basic precautions, such as:

• wearing wraparound sunglasses to stop pollen getting in your eyes when you're outdoors
• taking a shower and changing your clothes after being outdoors to remove the pollen on your body
• staying indoors when the pollen count is high (over 50 grains per cubic metre of air)
• applying a small amount of Vaseline (petroleum gel) to the nasal openings to trap pollen grains

Read more about preventing hay fever.

Complications

Even though hay fever doesn't pose a serious threat to health, it can have a negative impact on a person's quality of life. People with very severe hay fever often find that it can disrupt their productivity at school or work.

Inflammation of the sinuses (sinusitis) is another common complication of hay fever. Children may also develop a middle ear infection (otitis media) as a result of hay fever.

Read more about the complications of hay fever.

Hay fever symptoms vary in severity and may be worse some years, depending on the weather conditions and pollen count.

The time of year your symptoms start will depend on the types of pollen you're allergic to.

The symptoms of hay fever include:

• frequent sneezing
• runny or blocked nose
• itchy, red or watery eyes (allergic conjunctivitis)
• an itchy throat, mouth, nose and ears
• cough, caused by postnasal drip (mucus dripping down the throat from the back of the nose)

Less commonly, you may also experience:

• the loss of your sense of smell (anosmia)
• facial pain (caused by blocked sinuses)
• headaches
• earache
• tiredness and fatigue

Even though your hay fever symptoms may be mild, they can interfere with your sleep and your daily activities at school or work.

Hay fever and asthma

If you have asthma, your asthma symptoms may get worse when you have hay fever. Sometimes, the symptoms of asthma only occur when you have hay fever. These symptoms include:

• tight chest
• shortness of breath 
• coughing
• wheezing

Pollen count

Hay fever symptoms are likely to be worse if the pollen count is high. The pollen count is the number of grains of pollen in one cubic metre of air.

Air samples are collected in traps set on buildings 2 or 3 storeys high. Taking samples from this height gives a better indication of the pollen in the air. Traps on the ground would only collect pollen from nearby trees and plants.

The air is sucked into the trap and the grains of pollen are collected on either sticky tape or microscope slides (glass plates). The pollen is then counted. Samples are normally taken every 2 hours, and usually the results are averaged over a 24-hour period.

The pollen forecast is usually given as:

• low – less than 30 grains of pollen in every cubic metre of air
• moderate – 30 to 49 grains of pollen in every cubic metre of air
• high – 50 to 149 grains of pollen in every cubic metre of air
• very high – 150 or more grains of pollen in every cubic metre of air

Hay fever symptoms often begin when the pollen count is over 50. The pollen count is usually given as part of the weather forecast during the spring and summer months.

When to seek medical advice

Most cases of hay fever can be treated using over-the-counter medication. Your local pharmacist can advise you on treatments for you or your children.

You usually only need to see your GP if:

• you can't control your symptoms with over-the-counter medications, or you have troublesome side effects caused by the medication
• you're experiencing persistent complications of hay fever, such as worsening of asthma or repeated episodes of sinusitis
• the pattern of your symptoms is unusual, such as occurring during the winter or only at your workplace (it's likely that another substance other than pollen is responsible, and further testing will be needed to confirm this)

Hay fever is an allergic reaction to pollen. When these tiny particles come into contact with the cells that line your mouth, nose, eyes and throat, they irritate them and trigger an allergic reaction.

Allergic reaction

When you have an allergic reaction, your body overreacts to something it perceives as a threat. In hay fever, the allergen (the substance you're allergic to) is pollen. Your immune system (the body’s natural defence) responds as if it were being attacked by a virus.

Your immune system will release a number of chemicals designed to prevent the spread of what it wrongly perceives as an infection. These chemicals cause the symptoms of the allergic reaction, such as watering eyes and a runny nose.

Risk factors

It's unclear what causes the immune system to react in this way, but there are several factors that can increase your risk of developing hay fever. They include:

• having asthma or another allergic condition, such as eczema
• having a family history of hay fever
• being exposed to tobacco smoke and diesel exhaust particles during early childhood

Most people with hay fever are allergic to grass pollen, but it can also be caused by trees and weeds. Research suggests that pollution, such as cigarette smoke or car exhaust fumes, can make allergies worse.

Pollen

There are around 30 types of pollen that could cause your hay fever. The pollen that causes hay fever can come from a number of sources, including:

• grass – in the UK, about 9 out of 10 (90%) of people with hay fever are allergic to Timothy and Rye grass pollen
• trees – about 1 in 4 (25%) of people with hay fever in the UK are allergic to pollen from trees, including oak, ash, cedar and birch (people with an allergy to birch often also experience an allergic reaction to apples, peaches, plums and cherries because these types of fruit contain a similar protein to birch pollen)
• weeds – such as dock, mugwort and nettles; being allergic to weeds is less common and tends to occur during the autumn 

It's possible to be allergic to more than one type of pollen.

When is there most pollen?

Different trees and plants produce their pollen at different times of the year. Depending on which type of pollen you're allergic to, you may experience hay fever symptoms at different times.

In the UK, the pollen count season is usually separated into 3 periods:

• tree pollen – late March to mid-May
• grass pollen – mid-May to July
• weed pollen – end of June to September

However, the pollen count season can sometimes begin as early as January or end in November. For example, depending on the weather conditions, sometimes there can be an "early spring" or a "long summer".

The effect of the weather

The amount of sunshine, rain or wind affects how much pollen plants release and how much it's spread around. On humid and windy days, pollen spreads easily. On rainy days, pollen may be cleared from the air, causing pollen levels to fall.

During their pollen season, plants release pollen early in the morning. As the day gets warmer and more flowers open, pollen levels rise. On sunny days, the pollen count is highest in the early evening.

Your GP should be able to diagnose hay fever from a description of your symptoms. In some cases, you may be referred for allergy testing.

A diagnosis for hay fever would usually only be required:

• if your symptoms were particularly severe
• the pattern of your symptoms was unusual – for example, if you have symptoms during the winter or while indoors
• if you had experienced complications of hay fever

If possible, keep a diary of the times of day or year you experience your symptoms, as this can help with the diagnosis.

Allergy testing

Your GP may refer you to an immunologist for an allergy test if you have hay fever symptoms all year round (called persistent allergic rhinitis), or symptoms that aren't responding to treatment. Other substances could be causing your allergy, such as house dust mites, animals or certain foods.

The 2 main allergy tests are a skin prick test and a blood test.

Skin prick test

During a skin prick test, an immunologist will place the pollen allergen on your arm and prick the surface of your skin with a needle. This will introduce the allergen to your skin's immune system (mast cells) and, if you're allergic to it, you should have a reaction on the skin.

If your skin starts to go red around where it was pricked, swells up or becomes itchy, this could be an allergic reaction and would confirm that you have hay fever.

A skin prick test may not be suitable if:

• you're on certain medications, such as antihistamines, which will stop you having an allergic reaction
• you have significant eczema, as your skin may already be red or itchy, so an allergic reaction won't be noticeable

In this case, a blood test may be necessary to confirm your diagnosis (see below).

The use of commercial home allergy testing kits isn't recommended. The testing is often of a lower standard than that provided by the NHS or accredited private clinics. It's also important that the test results are interpreted by a qualified professional who has detailed knowledge of your symptoms and medical history.

Blood test

A sample of blood will be taken from a vein in your arm and tested for the presence of the Immunoglobulin E (IgE) antibody.

If you have hay fever, your body produces this antibody when it comes into contact with pollen. If your blood tests positive for IgE, this may confirm that you have hay fever.

Before going to see your GP, you could visit your pharmacist and try to treat your hay fever symptoms with over-the-counter medications, such as antihistamines.

Make an appointment to see your GP if your symptoms don't improve after using antihistamines. You may need treatment with prescription medications, such as nasal steroid medication (corticosteroids).

The various treatments for hay fever are outlined below.

Antihistamines

Antihistamines treat hay fever by blocking the action of the chemical histamine, which the body releases when it thinks it's under attack from an allergen. This stops the symptoms of the allergic reaction.

Antihistamines are usually effective at treating itching, sneezing and watery eyes, but they may not help with clearing a blocked nose.

They're available in tablet form and also as nasal sprays and eye drops.

You can use antihistamines as:

• an "as-required" treatment – you take them when you first notice you're developing the symptoms of hay fever
• a preventative treatment – for example, if you know there's going to be a high pollen count, you can take them before leaving the house in the morning

Different antihistamine tablets for hay fever include cetirizine, fexofenadine and loratadine. Azelastine is an effective antihistamine nasal spray and olopatadine is an antihistamine eye drop.

Unlike older antihistamines, these newer types shouldn't cause drowsiness, although this can occasionally happen to some people.

If you do become drowsy after using antihistamines, you should avoid driving or using heavy tools or machinery. You should also contact your GP or pharmacist, as there may be an alternative antihistamine you can take.

Corticosteroid nasal sprays and drops

Corticosteroids (steroids) are used to treat hay fever because they have an anti-inflammatory effect.

When pollen triggers your allergic reaction, the inside of your nose becomes inflamed. Corticosteroids can reduce the inflammation and prevent the symptoms of hay fever.

Your GP may prescribe corticosteroid nasal sprays or drops instead of antihistamines if:

• you have persistent hay fever that doesn't respond to antihistamines
• your main symptom is a blocked nose
• you're pregnant or breastfeeding

Corticosteroid nose drops (containing betamethasone and fluticasone) are more powerful than corticosteroid nose sprays and shouldn't be used for prolonged periods of more than 2 to 4 weeks. 

Corticosteroids are better than antihistamine tablets at preventing and relieving nasal symptoms, including sneezing and congestion. They can also relieve itchy, watery eyes. They're most effective if you start using them a couple of weeks before your symptoms begin, and work best when used regularly.

It's important that you read the instructions that come with your medication, as applying the drops or the spray incorrectly can increase your risk of developing side effects, such as:

• irritation and dryness of your nose
• bleeding from your nose
• unpleasant taste in your mouth
• itchy skin rash around your nose

Corticosteroid tablets

If you require rapid short-term relief from severe symptoms – for example, if you have an exam or driving test coming up – your GP may prescribe a course of corticosteroid tablets for 5 to 7 days.

The use of corticosteroids for longer than 10 days isn't recommended, because the longer you take steroid tablets the more likely it is you'll begin to experience unpleasant side effects, such as:

• weight gain
• changes in mood, such as feeling irritable
• acne 

Nasal decongestants

Hay fever can cause a blocked nose. A decongestant, in the form of a nasal spray, can relieve this. Decongestants reduce the swelling of the blood vessels in your nose, which opens your nasal passage and makes breathing easier.

Your GP can prescribe a nasal decongestant, but there are many available from your pharmacist. Check the ingredients, as some decongestants also contain antihistamine. If they do, they may relieve other symptoms as well. If not, the decongestant will only relieve your blocked nose.

Nasal decongestants shouldn't be used for longer than 7 days. They may cause dryness and irritation in your nasal passage, and can make the symptoms of congestion worse (this is known as rebound congestion or rhinitis medicamentosa).

Eye drops

Eye drops are available from your pharmacist to treat the hay fever symptoms that affect your eyes, such as redness, itchiness and watering (allergic conjunctivitis). The drops contain antihistamine, such as azelastine and olopatadine, to reduce the inflammation in your eyes, which will relieve the symptoms.

Eye drops containing the active ingredient sodium cromoglicate (a mast cell stabiliser) are the most widely used and have been shown to be extremely safe. Check the patient information leaflet for the correct way to use them. Some may cause side effects, such as a stinging or burning sensation in your eyes. 

Immunotherapy

If you have persistent hay fever symptoms that aren't relieved by the above treatments, your GP may refer you for immunotherapy treatment. This involves gradually introducing you to small amounts of the allergen (the substance you're allergic to), such as pollen, and monitoring your allergic reaction in a controlled environment.

Immunotherapy is only carried out in specialist medical centres, in case a serious allergic reaction, known as anaphylaxis, occurs.

The allergen can be given to you as:

• an injection into your skin – this is known as systemic injection immunotherapy (SIT)
• a tablet that dissolves under your tongue – this is known as sublingual immunotherapy (SLIT)

After the initial treatment, you'll be monitored for up to an hour.

Further doses of SLIT can safely be administered at home after an initial dose has been given under medical supervision.

To work in the first year, treatment should be started 3 months before the pollen season. As you get used to the allergen, the amount used will slowly be increased. You'll gradually start to build up immunity to the allergen, and your allergic reaction to it should get less severe. 3 years of treatment is recommended to achieve long-term pollen desensitisation.

Immunotherapy can improve your tolerance of the allergen, which can improve your quality of life and have long-term results. However, if you don't see a significant improvement in your symptoms during the first year, then the treatment is unlikely to help and shouldn't be continued.

Hay fever can lead to complications such as sinusitis and middle ear infections (otitis media). It can also have a significant impact on your daily activities.

In one study, a third of adults with hay fever reported that their symptoms had a considerable negative impact on their work, home and social life.

Children's symptoms can disrupt their schooling and lead to delays in learning and development. Unfortunately, the peak of the grass pollen season coincides with the annual GCSE examinations. 

In most cases, the negative impact can be reduced with treatment. However, see your GP if you're concerned that hay fever is becoming an increasing problem in your (or your child’s) life.

You should also make extra efforts to limit exposure to pollen. Read more about preventing hay fever.

Sinusitis

Infection of the sinuses (small, air-filled cavities behind your cheekbones and forehead) is a complication of hay fever.

This is called sinusitis and it can cause pain and tenderness in the face (near the affected sinuses). You may experience a throbbing pain that's worse when you move your head, and toothache or pain in your jaw when you eat.

The swelling of the nasal passages that occurs in hay fever can prevent mucus from draining out of the sinuses. This can make them more vulnerable to infection.

Sinusitis can usually be treated using over-the-counter painkillers. If your symptoms persist, antibiotics and corticosteroid tablets or sprays may be required.

Read more about treating sinusitis.

Middle ear infection (otitis media)

Hay fever can lead to a middle ear infection if the Eustachian tube (the thin tube that runs from the middle ear to the back of the nose) becomes blocked by a build-up of mucus.

Middle ear infections are more common in children, because their Eustachian tube is smaller than an adult's and can become blocked more easily.

Most middle ear infections will clear up within 72 hours without the need for treatment. Further treatment is usually only necessary if ear infections keep on occurring.

Read more about treating a middle ear infection.

It's very difficult to completely avoid pollen. However, reducing your exposure to the substances that trigger your hay fever should ease your symptoms.

Rubbing a small amount of Vaseline (petroleum gel) inside your lower nostrils can help to prevent pollen from entering your nasal passages.

Staying indoors

If possible, stay indoors when the pollen count is high (over 50). The tips below may help to reduce your exposure to pollen.

• Keep windows and doors shut in your house. If it gets too warm, draw the curtains to keep out the sun and lower the temperature.
• Don't keep fresh flowers in the house.
• Vacuum regularly, ideally using a machine with a high-efficiency particle arresting (HEPA) filter.
• Damp dust regularly. Dusting with a wet cloth, rather than a dry one, will collect the dust and stop any pollen being spread around. 
• Keep pets out of the house during the hay fever season. If your pet does come indoors, wash them regularly to remove any pollen from their fur.
• Don't smoke or let other people smoke in your house. Smoking and breathing in other people's smoke will irritate the lining of your nose, eyes, throat and airways, making your symptoms worse.
• If possible, avoid drying clothes outside. This will help to stop pollen being brought into your house.

Avoiding pollen outside

If you need to go outside or you're travelling, the tips below may help to reduce your exposure to pollen.

• Avoid cutting grass, playing or walking in grassy areas and camping – particularly in the early morning, evening and at night, when the pollen count is at its highest.
• Wear wraparound sunglasses to stop pollen getting in your eyes.
• Take a shower and change your clothes after being outdoors to remove the pollen on your body.
• Keep car windows closed. You can buy a pollen filter for the air vents in your car, which will need to be changed every time the car is serviced.