Hay Fever

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Introduction

What is hay fever?

Hay fever (allergic rhinitis) is your body’s response to an allergen, such as pollen, dust or mold. Symptoms of hay fever include a runny nose, congestion, sneezing, watery eyes, itching, and coughing. Though symptoms of hay fever are similar to those of a common cold, hay fever symptoms usually last for longer periods of time or appear only after exposure to a specific allergen. Up to 30% of children and adults in the United States suffer from hay fever symptoms.

If you have hay fever, your body interprets an allergen that it is exposed to, such as pollen, as a foreign intruder and mounts an immune response. In essence, it is as if your body is fighting the allergen as if it were a bacterial or viral infection, which results in the symptoms of a cold.

The most common types of allergens responsible for hay fever include tree pollens, grass, ragweed, and mold. Your symptoms may change when the amount and type of allergens change, depending on the time of year, your location, and the weather. Various media outlets in your area may publish daily levels of common allergens like tree pollen or grass pollen, which may help you cope with hay fever.

Though inconvenient and sometimes uncomfortable, hay fever is usually not a life-threatening or severe medical condition. For many people, effective treatment includes avoiding the allergens that trigger the body’s immune response and taking prescription antihistamines, decongestants, or steroids. In severe cases, allergy injections may be required.

Seek prompt medical care if you are being treated for hay fever and are having trouble breathing, or if symptoms recur or are persistent despite treatment.

Symptoms

What are the symptoms of hay fever?

The symptoms of hay fever include congestion, itchy and watery eyes, and other symptoms similar to those of a common cold. The symptoms you experience immediately after exposure to an allergen may differ from symptoms you experience the next time you are exposed to that allergen or after chronic exposure to an allergen.

Early symptoms of hay fever

You may experience hay fever symptoms immediately after exposure to an allergen like pollen. At times any of these hay fever symptoms can be severe:

  • Decreased sense of smell
  • Itchiness around your nose or mouth
  • Itchy, puffy eyes
  • Itchy skin
  • Post-nasal drip
  • Runny nose and congestion
  • Sneezing
  • Watery eyes

    Later or chronic symptoms of hay fever

    You may experience severe hay fever symptoms if you are exposed to an allergen consistently or for long periods of time. Any of these hay fever symptoms can be severe:

    • Changes in thinking, including slow or fuzzy thinking
    • Coughing with or without a sore throat
    • Earache or ears that feel plugged or clogged
    • Fatigue, lethargy and irritability
    • Headache
    • Red and itchy eyes
    • Runny nose (nasal congestion)
    • Sore throat
    • Swelling in your face, especially around the eyes

    Symptoms that might indicate a serious condition

    In some rare cases, hay fever can be a serious condition that should be immediately evaluated in an emergency setting. Seek immediate medical care (call 911) if you, or someone you are with, have serious difficulty breathing.

    Causes

    What causes hay fever?

    Your body’s immune system is very effective at fighting infections due to viruses, bacteria or parasites. Occasionally, your body mistakes something harmless like tree pollen for something dangerous like a virus or bacteria. When this occurs, your body begins to attack the allergen as if it were a threat, which prompts the symptoms of hay fever.

    Hay fever is often a genetic condition, so if you have a strong family history of hay fever, you are more at risk. Another cause of hay fever is repeated exposure. In some cases, something new that your body has never encountered will be perceived as an allergen, but you will not experience hay fever symptoms unless you are exposed a second time.

    What are the risk factors for hay fever?

    A number of factors increase the risk of developing hay fever. Not all people with risk factors will get hay fever. Risk factors include:

    • Asthma
    • Atopy
    • Autoimmune diseases
    • Birth during pollen season
    • Eczema
    • Exposure to allergens (indoor and outdoor)
    • Family history of hay fever
    • First-born birth status
    • Male gender

      Reducing your risk of hay fever

      Although it is impossible to cure hay fever, you may be able to significantly decrease your risk of hay fever by avoiding exposure to the allergens that cause your symptoms. A health care provider may be able to help you determine the allergen or allergens that cause your symptoms, if you are unsure.

      Treatments

      How is hay fever treated?

      Though there is no cure for hay fever, other than completely avoiding allergens that cause your symptoms, some treatments may make the condition much easier to endure. The most common treatments include prescription medications, such as antihistamines, corticosteroids, decongestants, and leukotriene inhibitors. Immune therapy is also used in more severe cases. You and your healthcare provider should determine which treatments are best for you to control your hay fever.

      Common treatments for hay fever

      There are a variety of treatments for hay fever, and you and your healthcare provider can decide which treatment or combination of treatments is most appropriate for you. Common treatments for hay fever include:

      • Antihistamines, such as loratadine (Claritin), which reduce the effects of the histamines that your body releases in response to allergens. Antihistamines reduce many of the common symptoms of hay fever, such as watery eyes, swelling, and itchiness. Some antihistamines can cause drowsiness.

      • Corticosteroids, such as fluticasone propionate (Flonase), which decrease your body’s sensitivity to various allergens, thereby reducing symptoms of hay fever. Corticosteroids can be sprayed into your nose. They are most effective when used on a consistent basis, not just when symptoms occur.

      • Decongestants, such as pseudoephedrine (Afrinol), which can help relieve nasal decongestion that is common with hay fever.

      • Leukotriene inhibitors, like montelukast (Singulair), which inhibit some of the substances your body releases that cause the symptoms of hay fever. Leukotriene inhibitors are most effective when used on a consistent basis, not just when symptoms occur.

      • Immunotherapy or injections, which desensitize the body to a particular allergen or allergens. Immunotherapy is best for more severe symptoms and when an allergen cannot be avoided. Immunotherapy can be highly effective or it may not work at all.

      What are the potential complications of hay fever?

      Complications of hay fever are usually mild, though more serious complications may exist in more severe cases of hay fever.

      You can help minimize your risk of serious complications by following the treatment plan you and your health care professional design specifically for you. Complications of hay fever include:

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      Medical Reviewer: William C. Lloyd III, MD, FACS
      Last Review Date: 2019 Jan 5
      1. Allergic rhinitis. PubMed Health, a service of the NLM from the NIH. http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0001816/.
      2. Fact sheet: allergic rhinitis (hay fever). American Academy of Otolaryngology — Head and Neck Surgery. http://www.entnet.org/HealthInformation/allergicRhinitis.cfm.
      3. Tierney LM Jr., Saint S, Whooley MA (Eds.) Current Essentials of Medicine (4th ed.). New York: McGraw-Hill, 2011.
      4. Westman M, Stjärne P, Asarnoj A, et al. Natural course and comorbidities of allergic and nonallergic rhinitis in children. J Allergy Clin Immunol 2012; 129:403.
      5. Greiner AN, Hellings PW, Rotiroti G, Scadding GK. Allergic rhinitis. Lancet 2011; 378:2112.
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