Hay Fever 101

If you love spring blossoms and colorful fall leaves, but dread the sneezes, itchy eyes, and runny (or stuffy) nose that come along with them, then you may have hay fever.

That’s the common term for seasonal allergies. The proper name is allergic rhinitis, which means inflammation inside your nose. Hay fever symptoms mostly affect your nose, but also the eyes, skin, and roof of the mouth.

Allergies, including hay fever, result when your immune system attacks a typically harmless substance that you come across in the environment. In the case of seasonal hay fever, these include grass, tree, and weed pollens as well as outdoor molds.

This common condition affects some 40 million to 60 million Americans. You may be more likely to get it if you have:

  • Asthma or other allergies
  • Eczema
  • Parents or siblings with allergies
  • A home or job where you’re exposed to allergens (allergy triggers) on a regular basis
  • A mother who smoked before your first birthday

Most people get hay fever before they turn 20, but it can happen at any age. People of any background anywhere on the globe can get it.

Year-Round Allergies?

If it seems like you have symptoms no matter what the season, you may have perennial allergic rhinitis. Indoor allergy triggers like pet hair, dust mites, mold, and cockroaches are to blame.  If you have both seasonal and perennial rhinitis, your symptoms will worsen when pollen counts are high. More than two-thirds of springtime allergy sufferers do.

You can also develop allergies to other things in the air around you, like smoke, perfume, and car exhaust.

When to Seek Help

See a doctor if:

  • Your allergy symptoms are interfering with your quality of life
  • Your hay fever does not go away
  • The over-the-counter (OTC) medicines you take don’t work or have unpleasant side effects
  • You have other problems, likes asthma, chronic sinus infections, or polyps in your nose

Many people try to live without treating hay fever, but treatment can help ease your symptoms. Getting help for your symptoms early can put you on the right track for improving your allergies.

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Do Your Homework

Before you see the doctor, think about when and where your symptoms show up.  For example:

  • Tree pollens typically appear in early spring.
  • Grasses shed pollen in late spring and summer.
  • Ragweed produces pollen in the fall.
  • Indoor allergies might get worse in winter.
  • Indoor and outdoor molds might trigger symptoms year-round.

If your symptoms go away after about a week, you could have a cold and not an allergy.

Medications

It may take several tries to ease your symptoms. First, you should stay away from triggers as much as you can. Second, you should take the medicines you doctor suggests or prescribes as directed. That will help them work better.

Corticosteroid nasal sprays. You can use them long-term to treat symptoms like itching, runny nose, and congestion. They usually provide relief within 12 hours of your first dose. They include budesonide, fluticasone, and mometasone. 

Antihistamines. These are pills, nose sprays, and eye drops that work best on hay fever symptoms like runny nose, sneezing, and itchy eyes and skin. Options include cetirizine, fexofenadine, and loratadine. These are often preferable to older products (your doctor may call them first-generation antihistamines), which typically cause drowsiness.

Decongestants. They help relieve the swelling inside your nose that makes it stuffy. Don’t use nose drops and sprays longer than 5 days. Your nose gets used to them, and congestion returns. Your doctor may call this rebound swelling.

Cromolyn sodium. Use this OTC nasal spray several times a day to stop the release of histamines. It works best when you start before symptoms show up.

Leukotriene modifier. This medicine hinders leukotrienes, chemicals in your immune system that cause your body to make extra mucus.  A leukotriene modifier like montelukast can help when allergy symptoms come with mild asthma.

Nasal ipratropium. This prescription nose spray helps stop an extra-runny nose but doesn’t do much for symptoms like congestion or sneezing. Don’t take it if you’ve been diagnosed with glaucoma or an enlarged prostate gland.

Immunotherapy

This treatment aims to make your body less reactive. It doesn’t work for every allergen. It seems to help most with common environmental triggers.

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The first step is to find out what you’re allergic to. Your doctor will do this with a skin prick test or by injecting small doses of the allergen under your skin.

When you react, you’re allergic to that substance. After that, you’ll get shots containing small doses of the substances you’re allergic to -- usually one at a time. Your doctor will gradually increase the dose until you reach the largest amount you can tolerate. You must visit your doctor regularly, often weekly, for as many as 2 to 5 years.

In 2014, the FDA approved sublingual immunotherapy for treatment of grass and ragweed pollens. It works by placing a tablet or liquid under the tongue daily. It’s best to begin this therapy several months before allergy season begins.

Stay Away From Triggers

You can ease your allergy symptoms by avoiding or reducing your exposure to triggers. For seasonal allergies, you should:

  • Stay indoors as much as possible during peak pollen counts and windy days. Ragweed is highest in the morning. Tree and grass pollens peak in the early evening.
  • Close windows and use your air conditioner.
  • Wear glasses or sunglasses to keep pollen out of your eyes.
  • Wear a mask when you work outdoors.

For perennial allergies to indoor animals and pests:

  • Use dust mite-proof covers for pillows and mattresses.
  • Wash your sheets and blankets often in hot water.
  • Keep humidity levels down in your home with dehumidifiers and air conditioning.
  • Wash your hands after you touch animals.
  • Keep your pet out of your bedroom while you sleep
  • Replace carpets with hardwood, tile, or linoleum flooring

Saline rinses: They can ease nasal congestion and wash allergens and extra mucus out of your nose. You can use a premixed solution in a squeeze bottle or a neti pot. Use distilled, sterile, or boiled water if you decide make the saline mixture yourself. Use purified water to rinse and sterilize the bottle or neti pot after each use. Let them air dry.

Herbal remedies:  There’s some evidence that a shrub called butterbur may help hay fever symptoms. The raw plant can be toxic. Choose a product labeled “PA-free.” Other herbal remedies include capsicum, honey, vitamin C, and fish oil, but more research is needed to know how well they work.  Some people use acupuncture to treat hay fever.

The bottom line? Although there’s no cure for hay fever, if you work with your doctor, stick to your therapy plan, and avoid the triggers for your seasonal and perennial allergies, you can manage your symptoms before they manage you.

WebMD Medical Reference Reviewed by Laura J. Martin, MD on February 1, 2017

Sources

SOURCES:

American College of Allergy, Asthma and Immunology: “Allergies: Seasonal Allergies,” “Types of Allergies: Allergic Rhinitis.”

National Health Service Choices: “Hay fever.”

American Academy of Allergy, Asthma & Immunology: “Rhinitis (Hay Fever).”

Mayo Clinic: “Hay Fever.”

Medscape: “Allergic Rhinitis.”

PubMed Health: “Hay Fever and Dust Mite Allergies: Allergen-specific immunotherapy,” “Hay Fever and Dust Mite Allergies: Allergic rhinitis: Non-drug interventions,” “Hay Fever and Dust Mite Allergies: Medication for the relief of allergic rhinitis,” “What Kind of allergy tests are there?”

FDA news release: “Fighting Allergy Season with Medications.”

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