3. Will I always have hay fever? Will it get better or worse over time?
A seasonal allergy waxes and wanes, and can come on at any time of life, says Lavi. However, it typically starts in childhood and may get better during the teen years. "For a lot of people, it then comes roaring back in the mid-20s,” he says. For some, it may even get worse in mid-life.
The severity can vary from year to year, depending on pollen counts and other factors, says Stone. "But, in general, once you develop the allergic sensitization, it is present throughout your lifetime."
4. What treatment do you recommend for my hay fever?
Sometimes avoiding allergic triggers isn’t enough – you need allergy medicine. There are a variety of over-the-counter and prescription medications to treat allergies and their symptoms. This includes antihistamines, decongestants, nasal corticosteroids, and leukotriene blockers.
Antihistamines can help with symptoms of a runny nose, sneezing, and itching of the nose and throat, as well as eye symptoms. "Antihistamine sprays are good for congestion and are fast acting," says Lavi. Over-the-counter oral antihistamines are often the first choice of treatment for seasonal allergies. Antihistamines available over the counter include brompheniramine (Dimetapp Allergy), certirizine (Zyrtec), chlorpheniramine (Chlor-Trimeton Allergy), diphenhydramine (Benadryl Allergy), fexofenadine (Allegra), and loratadine (Alavert, Claritin).
Some are also available with a prescription.
Decongestants relieve nasal congestion. People often use them in combination with another medication, such as an antihistamine. They are available over the counter and come in both oral and nasal spray forms. Oral decongestants include phenylephrine (Dimetapp Cold Drops, Neo-Synephrine, Sudafed PE) and pseudoephedrine hydrochloride (Sudafed). Don’t use oral decongestants for more than seven days without checking with your doctor. Nasal spray decongestants, such as naphazoline (Privine), oxymetazoline hydrochloride (Afrin), and phenylephrine hydrochloride (Neo-Synephrine), should be limited to no more than three days. Longer use can lead to rebound effects where your symptoms come back, and usually worse than at the beginning, says Stone.
Nasal corticosteroids reduce inflammation from allergies and can help with a stuffy, runny, or itchy nose and sneezing. You spray these prescription medications into your nose once or twice a day, and can use them on a regular basis for symptom control during hay fever season. "But they need to be used consistently," said Lavi. "They're not designed for fast relief." Nasal steroids include Beconase, Flonase, Nasocort, Nasonex, Rhinocort, Veramyst, and generic fluticasone.
Leukotriene modifiers are available only by prescription. They are used to treat asthma and to control the symptoms of nasal allergies, and work by blocking inflammatory chemicals called leukotrienes. Singulair (montelukast) is the only leukotriene modifier approved to treat allergies.