Hay fever

Hay fever is a type of allergic rhinitis caused by pollen or spores. Allergic rhinitis is a condition where an allergen (something that causes an allergic reaction) makes the inside of your nose inflamed (swollen).

Hay fever affects the nose, sinuses (small air-filled cavities behind your cheekbones and forehead), throat and eyes. It causes:

  • sneezing,
  • a runny nose, and
  • itchy eyes.

Hay fever usually occurs in spring and summer, when there is more pollen in the air. Trees, grass and plants release pollen as part of their reproductive process. Mould and fungi also release tiny reproductive particles, called spores.

People with hay fever can experience their symptoms at different times of the year, depending on which pollens or spores they are allergic to.

Allergic rhinitis can be classified as either intermittent or persistent, depending on how often people experience their symptoms (see box, left)

Allergic reaction 

The symptoms of hay fever occur when the immune system (the body's defence system) overreacts to a normally harmless substance, in this case pollen. When the body comes into contact with pollen, cells in the lining of the nose, mouth and eyes release a chemical called histamine. This triggers the symptoms of an allergic reaction.

How common is it?

Hay fever is a common condition that is estimated to affect around 20% of people. Hay fever is more likely if there is a family history of allergies, particularly asthma or eczema.

Outlook

Hay fever cannot be cured completely, but there are a number of treatments available to relieve the symptoms. These include antihistamine tablets, nasal (nose) sprays and eye drops. Some can only be prescribed by a GP, but many are available over-the-counter (OTC) in pharmacies. 

For persistent hay fever, a treatment known as immunotherapy can be used to gradually increase a person's exposure to the allergen while monitoring their response. This can be effective at reducing the severity of an allergic reaction, but is not suitable for everyone.

Glossary

Allergen
An allergen is a substance, such as pollen, that reacts with the body's immune system and causes an allergic reaction.

Allergy
Allergy is the term used to describe an adverse (bad) reaction that the body has to a particular substance.

Sneezing
Sneezing is an involuntary expulsion of air and bacteria from the nose and mouth.

Allergic Rhinitis and its Impact on Asthma (ARIA) guidelines

The ARIA guidelines were developed during a World Health Organization (WHO) workshop in 1999 by a panel of experts. They were updated in 2008.

The ARIA guidelines have changed the terms that were traditionally used to describe allergic rhinitis. Allergic rhinitis is no longer described as ‘seasonal’ when it occurs during the summer months and ‘perennial’ when it occurs all year round.

Instead, allergic rhinitis can either be:

  • intermittent: symptoms are present for up to four days a week, or for up to four weeks in a row, or
  • persistent: symptoms are present for more than four days a week, or for more than four weeks in a row.

These terms have been changed to better reflect the reality of people’s symptoms.

Previously, ‘seasonal’ was used to mean an allergic reaction at a particular time of the year, usually caused by outdoor allergens, such as pollen. ‘Perennial’ meant that the allergic reaction symptoms lasted all year, and were usually caused by indoor allergens, such as dust mites.

In reality, pollens can be present and cause allergic reaction symptoms throughout the year, and those with allergies to ‘all year’ allergens, such as dust mites, may not have their symptoms all year round.

The new terms of ‘intermittent’ and ‘persistent’ define allergic rhinitis based on the frequency of the symptoms, not the time of year they appear or the allergens that cause them. 

Hay fever symptoms vary in severity and your symptoms may be worse some years than others, depending on the weather conditions and the pollen count (see below). Your symptoms may start at different times of the year depending on which types of pollen you are allergic to.

The symptoms of hay fever include:

  • frequent sneezing
  • runny or blocked nose
  • itchy, red or watery eyes (also known as allergic conjunctivitis)
  • an itchy throat, mouth, nose and ears

Less commonly, you may experience:

  • the loss of your sense of smell
  • facial pain (caused by blocked sinuses)
  • sweats
  • headaches

While symptoms of hay fever 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, asthma symptoms 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 two or three storeys high. Taking samples from this height gives a better indication of the pollen in the air from both local and distant sources. 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 usually taken every two hours, and the results are averaged for a 24-hour period. 

The pollen forecast is usually given as:

  • low: fewer than 30 grains of pollen in every cubic metre of air
  • moderate: 30-49 grains of pollen in every cubic metre of air
  • high: 50-149 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 usually 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.

Glossary

Pain
Pain is an unpleasant physical or emotional feeling that your body produces as a warning sign that it has been damaged.

Allergy
Allergy is the term used to describe an adverse (bad) reaction that the body has to a particular substance.

Allergen
An allergen is a substance, such as pollen, that reacts with the body's immune system and causes an allergic reaction.

Wheezing
Wheezing is the whistling sound made during breathing when the airways are blocked or compressed.

Sneezing
Sneezing is an involuntary expulsion of air and bacteria from the nose and mouth.

Hay fever is an allergic reaction to pollen or spores. 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 that it perceives as a threat. In this case, the allergen (the substance that you are allergic to) is pollen or spores. Your immune system (the body's natural defence system) starts to respond as if it were being attacked by a virus, and produces an antibody to attack the allergen. 

Antibodies are proteins that are produced by the body to neutralise or destroy disease-carrying organisms. If you have hay fever, your body produces an antibody called Immunoglobulin E (IgE) when you come into contact with pollen or spores. 

The production of IgE triggers the release of a number of other chemicals, including a protein called histamine. These chemicals then cause the symptoms of the allergic reaction, such as watering eyes and a runny nose.

What are you allergic to?

In Ireland, most people with hay fever are allergic to grass pollen. However, trees, mould spores and weeds can also cause hay fever. Research suggests that pollution, such as cigarette smoke or car exhaust fumes, can make allergies worse.

Pollens and spores

There are around 30 types of pollen and 20 types of spore that could cause your hay fever. The pollen that causes hay fever could come from:

  • grass: The majority of people in Ireland with hay fever are allergic to grass pollen,
  • trees: such as birch, oak, ash and cedar, or
  • weeds: such as mugwort and ragweed.

Spores that cause hay fever can come from:

  • fungi, such as wild mushrooms, and
  • mould, for example from compost heaps.

When is there most pollen?

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

  • From January to April, pollens from trees are the most common cause of hay fever.
  • From May to August, pollens from grass are the most common cause of hay fever. 
  • During the autumn, hay fever may be caused by weeds such as nettles and docks, late flowering plants, and mould and fungal spores.

The effect of the weather

The amount of sunshine, rain or wind affects how much pollen plants release and how much the pollen is 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.

Glossary

Allergy
Allergy is the term used to describe an adverse (bad) reaction that the body has to a particular substance.

Allergen
An allergen is a substance, such as pollen, that reacts with the body's immune system and causes an allergic reaction.

Antibodies
An antibody is a protein that is produced by the body to neutralise or destroy disease-carrying organisms and toxins.

Immune system
The immune system is the body's defence system, which helps protect it from disease, bacteria and viruses.

If you suspect that you have hay fever, you may want to discuss it with your pharmacist or your GP to confirm the diagnosis. This will help you decide whether you need treatment and rule out anything else that could be causing your symptoms, such as an infection.

Your GP will usually be able to make a diagnosis from a description of your symptoms. If possible, keep a diary of what times of the day or year you experience your symptoms, as this can help with the diagnosis. 

Skin prick test

If your GP cannot diagnose hay fever from your symptoms alone, you may have a skin prick test. This could be done if you have hay fever symptoms all year round (persistent allergic rhinitis), as other substances could also causes your allergy, such as:

  • house-dust mites,
  • animals,
  • chemicals, or
  • some foods.

This involves the tester pricking the surface of your skin with a needle that has a tiny amount of the allergen on it, in this case pollen. This will introduce the allergen to your blood stream and, if you are allergic to it, you should have a reaction.

If your skin around where it was pricked starts to go red, 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 are on certain medications, for example antihistamines, which will stop you having an allergic reaction, or
  • you have significant eczema, as your skin may already be red or itchy, so an allergic reaction will not be noticeable.

In this case, a blood test may be necessary to confirm your diagnosis.

The use of commercial allergy testing kits is not recommended. The testing is often of a lower standard than that provided by the the health services in Ireland. Also, it is important that the results of the test 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 test is positive for IgE, this may confirm that you have hay fever.

There are also blood tests for common allergens, to determine if you may be allergic to specific things such as grass pollen.

Glossary

Allergy
Allergy is the term used to describe an adverse (bad) reaction that the body has to a particular substance.

Allergen
An allergen is a substance that reacts with the body's immune system and causes an allergic reaction, for example pollen.

Blood
Blood supplies oxygen to the body and removes carbon dioxide. It is pumped around the body by the heart.

Antibodies
Antibodies are your body's natural defence against any foreign antigens that enter your blood. An antibody is a protein that is produced by the body to neutralise or destroy disease-carrying organisms and toxins.

The best way to control most allergies is to avoid the trigger substance. However, it is very difficult to avoid pollen, particularly during the summer months when you want to spend more time outdoors.

A range of products is available to treat the symptoms of hay fever. Some may be prescribed by your GP, but others are available over-the-counter (OTC) in most pharmacies.

If you are using OTC medicines, always read the manufacturer's instruction. If you are pregnant or breastfeeding, check with your GP before using OTC medicines to find out which ones are recommended.

The best way to decide what treatment is most appropriate for you is to speak to your GP. This is particularly important if you have asthma as well, because hay fever can often make asthma symptoms worse. Your GP may advise you to increase the dosage of your asthma medication.

For these treatments to be most effective, try to minimise your exposure to pollen. See Prevention for tips on how to do this.

Antihistamine tablets or nasal sprays

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

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

Oral (to be swallowed) antihistamine tablets can be prescribed by your GP or bought OTC. These are usually taken daily or several times a day. In the past, antihistamines caused drowsiness, but most newer types do not.

Antihistamine nasal (nose) sprays containing azelastine may be prescribed by your GP. See the box, left, for how to use them. They can taste bitter if you do not use them correctly.

Corticosteroid nasal sprays and drops

Corticosteroids (steroids) are used to treat hay fever because they have an anti-inflammatory effect. When the pollen triggers your allergic reaction, the inside of your nose becomes inflamed. Corticosteroids can reduce this 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,
  • your main symptom is a blocked nose, or
  • you are pregnant or breastfeeding.

See the box, left, for how to use them.

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

Some corticosteroid nasal sprays are available OTC. Always read the patient information leaflet that comes with the medicine. Using too much or using it incorrectly can cause side effects, such as dryness and irritation in the nose and throat.

Oral corticosteroids

If your hay fever symptoms are so severe that they impair your quality of life, your GP may prescribe a 5-10 day course of oral corticosteroids. These will quickly relieve your symptoms, but can cause side effects, such as an increase in appetite, weight gain and mood changes, including irritability or anxiety.

Injections

Long acting steroid injections have been used for treatment of Hayfever, but they are not recommended as routine management due to the risks of serious side effects and should only be used in exceptional circumstances.

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 pharmacist can advise you on the different products to choose from as many are available OTC. 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 should not be used for longer than seven days. They may cause dryness and irritation in your nasal passage, and if used on a regular basisfor more than 7 days they can make the symptoms of decongestion worse and harder to treat.

Eye drops

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

Eye drops containing the active ingredient sodium cromoglicate are the most widely used. Check the patient information leaflet for the correct way to use them. Some may cause side effects, such as a stinging or burning feeling in your eyes.  

Immunotherapy

If you have persistent hay fever symptoms which are not 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 that you are allergic to), such as pollen, and monitoring your allergic reaction.

This treatment is only carried out in specialist medical centres in case a serious allergic reaction occurs. The allergen will be given to you as an injection into your skin or a tablet that dissolves under your tongue. You will then be monitored for up to an hour.

As you get used to the allergen, the amount used is slowly increased and your allergic reaction to it should get less severe. This has been shown to improve people's tolerance of the allergen, improve their quality of life and has long-term results.

Immunotherapy may take months or even years to be effective. There is a risk of anaphylaxis (anaphylactic shock), which is a severe allergic reaction. It is not recommended for people who have persistent asthma and hay fever.

Alternative therapies

Some alternative therapies, such as acupuncture, homeopathy and herbal remedies, claim to relieve or prevent hay fever symptoms. However, the lack of evidence supporting their effectiveness means that more research is needed before they can be recommended.

If you decide to use herbal remedies, check with your GP first as some remedies, such as St John's Wort, can react unpredictably with other medication or make it less effective.

Glossary

Allergy
Allergy is the term used to describe an adverse (bad) reaction that the body has to a particular substance.

Allergen
An allergen is a substance, such as pollen, that reacts with the body's immune system and causes an allergic reaction.

Nasal spray technique

  • Gently blow your nose to try to clear it.
  • Shake the bottle of nasal spray well.
  • Close off one nostril by holding your nostril shut with your finger.
  • Put the spray nozzle in the other nostril.
  • Tilt your head forward slightly and keep the bottle of spray upright.
  • Squeeze a fine mist into your nose while breathing in slowly. Do not sniff hard.
  • Breathe out through your mouth.
  • Take a second spray in the same nostril, then repeat this procedure for your other nostril.

Nasal drop technique

  • Gently blow your nose to try to clear it.
  • Shake the container of nasal drops well.
  • Tilt your head backwards.
  • Place the drops in your nostril. You may need to gently squeeze the container to release some drops.
  • Keep your head tilted back and sniff gently to let the drops make their way into your nose.
  • Repeat for your other nostril if required.

If you are using over-the-counter (OTC) medicines, always read the patient information leaflet that comes with them. If you are pregnant or breastfeeding, check with your GP which OTC medicines are suitable.

It is very difficult to completely avoid pollen or spores. However, reducing your exposure to the substances that trigger your hay fever should ease the severity of your symptoms. Follow the advice below to avoid being exposed to excessive amounts of pollen and spores. 

  • Avoid cutting grass, playing or walking in grassy areas, and camping.
  • Wear wraparound sunglasses to stop pollen getting in your eyes when you are outdoors.
  • Change your clothes and take a shower after being outdoors to remove the pollen on your body.
  • Try to stay indoors when the pollen count is high (over 50). See Symptoms for an explanation of the pollen count.
  • Keep windows and doors shut in the house. If it gets too warm, draw the curtains to keep out the sun and keep the temperature down.
  • Do not keep fresh flowers in the house.
  • Vacuum regularly, ideally using a machine with a HEPA (high-efficiency particulate air) filter.
  • Damp dust regularly. Dusting with a wet cloth, rather than a dry one, will collect the dust and stop any pollen from being spread around. 
  • Keep pets out of the house during the hay fever season. If your pet does come indoors, wash it regularly to remove any pollen from its fur.
  • Do not 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, and can make your symptoms worse.
  • Keep car windows closed. You can buy a pollen filter for the air vents in your car. This will need to be changed every time the car is serviced.

Glossary

Allergy
Allergy is the term used to describe an adverse (bad) reaction that the body has to a particular substance.

Allergen
An allergen is a substance, such as pollen, that reacts with the body's immune system and causes an allergic reaction.

Content provided by NHS Choices www.nhs.uk and adapted for Ireland by the Health A-Z.

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