Your doctor may be able to diagnose hay fever based on your medical history, a physical exam, and your symptoms. Skin tests may be recommended to determine which substances trigger your allergies.
In a skin test, the doctor applies drops containing a small amount of allergy-causing substances called allergens to your arm or back. The procedure is painless and draws no blood. Developing a red, itchy bump in 15-20 minutes strongly suggests an allergy to that substance.
Some doctors use intradermal testing, where a small drop of the substance is placed under the skin with a needle and evaluated in 15-20 minutes.
A blood test may be used to check your blood for elevated levels of antibodies produced by your immune system against certain allergens. Each test has advantages and disadvantages.
What Are the Treatments for Hay Fever?
For hay fever, the best approach is to avoid allergens and other triggers (such as smoke and dust).
Mild cases of hay fever can usually be controlled with an over-the-counter (OTC) non-sedating antihistamine, such as cetirizine (Zyrtec), desloratadine (Clarinex), fexofenadine (Allegra), or loratadine (Alavert, Claritin). Older OTC antihistamines, such as chlorpheniramine and diphenhydramine, can cause drowsiness. This drowsiness can increase the risk of accidents when driving or operating other vehicles or tools.
Antihistamines are much more effective when taken daily during your allergy season rather than only on days when you have symptoms.
Phenylephrine and pseudoephedrine are decongestants that help unblock nasal passages and are also in many over-the-counter products. If you're taking medication for a heart condition, the antibiotic erythromycin, or the antifungal drug ketoconazole, be sure to check with your doctor before taking a decongestant or antihistamine to avoid drug interactions. For severe cases, your doctor may also suggest OTC fexofenadine or prescribe desloratadine, which is typically more effective with fewer side effects than loratadine for some patients with hay fever.
The FDA has approved the prescription antihistamine nasal sprays azelastine (Astelin, Astepro) and olopatadine (Patanase) to relieve the symptoms of seasonal allergic rhinitis. These may be used in patients age 5 and older.
Some over-the-counter nasal sprays may contain a decongestant or an antihistamine. These sprays help with pain and itching by opening clogged nasal passages and reducing inflammation. Decongestant nasal sprays should not be used for more than three days in a row as they can have a rebound effect and cause more severe nasal congestion.
Regular use of the nasal spray NasalCrom, available over-the-counter, prevents the lining of the nasal passages from reacting to the allergen affecting you. More severe allergies may benefit from nasal sprays containing steroids, which are strong anti-inflammatories and help with many allergy symptoms. These medications work locally with little to no effect on the rest of the body. If used consistently and regularly, nasal steroids are typically the most effective drug treatment. They are also effective maintenance drugs for hay fever and cause few side effects at the recommended doses. They include budesonide (Rhinocort), ciclesonide (Omnaris, Zetonna), fluticasone (Flonase), mometasone (Nasonex), triamcinalone (Nasocort), and others, and require a prescription. One steroid spray, Nasacort Allergy 24HR, is available over the counter. Also, Dymista is a nasal spray that combines a steroid and an antihistamine.