Hay fever and perennial allergic rhinitis

Why do you get hay fever? © NetDoctor/Geir

Reviewed by Professor Brian Lipworth, professor of allergies and respiratory medicine

What is hay fever?
Hay fever, otherwise known as seasonal allergic rhinitis, is an allergic reaction to airborne substances such as pollen that get into the upper respiratory passages - the nose, sinus, throat - and also the eyes.

What's in a name? The name hay fever is misleading because symptoms don't just occur in autumn when hay is gathered and never include fever.

Frequent sneezing is characteristic of hay fever.

Why do you get hay fever?
Different microscopic substances get into the nose and cause the body to produce antibodies and release histamine.

Histamine irritates the upper respiratory passages, making them swell and producing the typical hay fever symptoms.

A tendency to suffer allergies is often hereditary. The most common causes of hay fever are:

tree pollen such as elder, elm, hazel and especially birch (spring hay fever).
grass pollen (summer hay fever).
mugwort and hybrids such as chrysanthemum (autumn hay fever).
house dust mites and mould fungus - particularly associated with perennial allergic rhinitis.

What are the symptoms of hay fever?

Itchy and watery eyes.
Frequent sneezing, a bunged up or runny nose.
Itching on the roof of the mouth.
Coughing.
Wheezing or a burning sensation in the throat.

What can cause hay fever?

The pollen to which you are allergic.
Genetic predisposition associated with other atopic diseases, eg eczema or asthma.

How does the doctor make the diagnosis?
Often it will be enough to tell the doctor when, where, and how your symptoms occur. Skin tests and specific blood tests can be used to confirm what exactly you are allergic to.

Good advice

If your hay fever is caused by various pollens, try to keep doors and windows shut during the pollen season.
Let someone else mow the lawn.
Check pollen forecasts. Try to avoid outdoor activities if very high.

In the long term
Hay fever sufferers are more vulnerable to other allergic respiratory diseases, eg asthma, and sleeping difficulties that can lead to chronic fatigue (because of blocked nasal passages and snoring).

If you suffer from hay fever you should do whatever you can to avoid substances that provoke hypersensitivity. Otherwise you will increase the risk of developing other, more serious, allergic diseases.

Symptoms can be controlled through treatment, but you can't get rid of the allergy itself. However, hay fever is usually more of a nuisance than a harm to health, and the symptoms of many people improve over time.

What medicine can I take?
There are numerous medicines that can be used to relieve the symptoms of hay fever. Many of these are now available over-the-counter from pharmacies and your pharmacist will be able to advise on which are most suitable for you.

The choice will often depend on which symptoms trouble you the most.

Antihistamine tablets and syrups Antihistamines prevent the histamine your body produces to the allergen from causing the allergic symptoms.

They are good at relieving sneezing, itching and runny nose and eye symptoms, but are slightly less effective at reducing a blocked nose.

There are two main types:

those that cause drowsiness, such as chlorphenamine and promethazine
newer medicines that cause less or no drowsiness, such as acrivastine, cetirizine and loratadine.

Many people prefer to use the newer medicines because they can usually be taken once daily and allow you to get on with your daily activities without problems.

Many antihistamines can be bought over-the-counter, but some, eg fexofenadine, are available on prescription only.

Antihistamine nasal sprays and drops
Antihistamines that are used directly in the nose are azelastine and levocabastine, both of which can be bought over-the-counter.

These can be used to provide rapid relief of sneezing, itching and runny nose, but have no effect on other symptoms such as itchy eyes.

They can also be used regularly to prevent nasal symptoms, but are less effective than nasal corticosteroids.

Nasal corticosteroids
There are two steroid nasal preparations that can be bought from pharmacies: beclometasone and fluticasone. Others are also available on prescription only.

Nasal steroids reduce inflammation in the nasal passages and are better than oral antihistamines at relieving most nasal symptoms, including a blocked nose. They also relieve eye symptoms.

Nasal steroids have to be used regularly to be effective. They are best started a couple of weeks before the pollen season begins.

Nasal cromoglicate
Nasal sprays containing sodium cromoglicate are also used to prevent nasal symptoms, ideally starting treatment a couple of weeks before the pollen season.

They are less effective than nasal corticosteroids, but are often the first choice for young children.

Nasal decongestants
Nose drops and sprays containing decongestants such as xylometazoline (eg Otrivine nasal spray, Sudafed nasal spray) can be bought over-the-counter to treat a blocked nose.

They should only be used for a few days, otherwise they can cause 'rebound congestion' when you stop using them.

Antihistamine eye drops
Antihistamine eye drops can be useful if eye symptoms are your biggest problem. They include antazoline, azelastine and levocabastine, which you can buy from pharmacies.

The drops provide rapid relief from itchy, red, watery eyes.

Cromoglicate eye drops
Drops containing sodium cromoglicate (eg Clarityn allergy eye drops, Optrex allergy eye drops) or nedocromil sodium should be used regularly, as with nasal cromoglicate products, to prevent the allergic reaction occurring.

Cromoglicate drops can be bought from pharmacies and are also suitable if eye symptoms prevail.

Immunotherapy (desensitising vaccines)
This treatment is only used when allergen avoidance and medicines have proved ineffective at treating a severe allergy.

Injections of small amounts of the known allergy-causing substance are given to create tolerance to the allergen and prevent the immune system producing too much histamine when it encounters it.

This treatment has to take place over a long time and requires strict adherence.

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