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Hay fever (seasonal allergic rhinitis)

Published by Bupa's health information team, July 2009.

This factsheet is for people with hay fever, or who would like information about it.

Hay fever is also known as seasonal allergic rhinitis. The symptoms include sneezing, a runny nose and itchy eyes. The condition affects about one in five adults in the UK and seems to be becoming more common, especially in children.

• About hay fever
• Symptoms of hay fever
• Causes of hay fever
• Diagnosis of hay fever
• Treatment of hay fever
• The pollen count
• Prevention of hay fever
• Questions and answers
• Further information
• Sources

About hay fever

If you have hay fever, it means that you're allergic to pollen from grasses, weeds or trees, and also possibly to moulds that are carried in the air, usually during the spring and summer.

These plants and moulds produce allergens - substances that can cause an allergic reaction.

An allergic reaction happens when your body's immune system reacts to an allergen, for example pollen, because it mistakes it for a harmful invader such as a virus. Hay fever is the result of your immune system overreacting to pollen allergens that are airborne during spring and summer and that are harmless to most people.

Hay fever, asthma, food allergy and eczema are related allergic conditions and the tendency to develop them seems to run in families. This is called atopy. It means that your body produces a certain type of antibody in response to allergens. This isn't produced in non-allergic people.

Symptoms of hay fever

You may have one or more from a range of symptoms. These include:

• sneezing
• a blocked or runny nose (rhinitis)
• itchy eyes, nose and throat
• headaches

As a result of these symptoms, you may find it difficult to concentrate or sleep properly. In some people, pollen may also trigger asthma.

If you have hay fever-type symptoms all year round, you may also be allergic to house dust mites, pet hair and moulds. This is called perennial allergic rhinitis.

Causes of hay fever

If you have hay fever, when you come into contact with pollen or the spores of moulds or fungi, your body produces an antibody called immunoglobulin E (IgE). Antibodies are usually only released to fight infection, but in this instance your body believes the pollen is harmful. This antibody acts for the immune system like a firework's 'touch paper', triggering the release of chemicals from certain cells in your nose, throat and eyes when there is a lot of pollen in the air. One of these chemicals is histamine - this triggers the symptoms of hay fever.

You may be allergic to one or more types of pollen - this will determine when your symptoms are most severe. Some possible causes include:

• grass pollen - half of adults in the UK who have hay fever are allergic to grass pollen, with the varieties that are most commonly responsible being rye grass and timothy.
• tree pollen - one person in four in the UK with hay fever is allergic to birch pollen, but different trees produce pollen at varying times of the year and it depends which one you're allergic to as to when your symptoms are worst
• weeds, such as ragwort and other plants, as well as spores from fungi and moulds

The pollen season can vary depending on where you live. In the UK, the pollen season usually starts earlier in the year in the south and lasts until later in the north.

Diagnosis of hay fever

Your GP will usually be able to tell you have hay fever by asking about your symptoms and when you get them. He or she may look inside your nose and down your throat to make sure you don't have any other conditions that could be causing your symptoms.

You probably won't need to have special tests, but very occasionally your GP may advise you to have a skin-prick allergy test to help determine if you're allergic to specific pollens. If you have very severe symptoms that are difficult to control, he or she may also do a RAST (radioallergosorbent test) blood test to measure the level of IgE antibodies for a specific allergen in your blood.

Treatment of hay fever

Self-help

You can reduce your symptoms by staying indoors on days when the pollen count is high so you have less contact with allergens.

Medicines

There are a range of treatments available. You can buy some of these in shops and supermarkets. Others are available in pharmacies, while for some you will need a prescription from your GP. Get advice from your GP or pharmacist before starting any medication, even if you don't need a prescription for it.

Always follow the instructions on the patient information leaflet that comes with your medicine and if you have any questions, ask your doctor or pharmacist for advice. You should also be aware that some hay fever treatments are not suitable for women who are pregnant or breastfeeding.

Nasal sprays

If you only get hay fever symptoms now and again, and they only affect your nose, you could try an antihistamine nasal spray such as azelastine. A decongestant nasal spray such as xylometazoline is an alternative that can give temporary relief from a runny or blocked nose. However, it's only suitable for occasional use because using it regularly can lead to 'rebound congestion' where the spray actually causes a blocked nose.

A steroid nasal spray can be helpful in preventing symptoms, especially a blocked nose but isn't very good at treating symptoms swiftly once they have started. A nasal steroid works best if you take it before your symptoms start and then on a daily basis through the hay fever season. Take it even if you have no symptoms while the pollen count remains high. If you don't feel it's controlling your symptoms well, don't take more than the recommended dose. Instead, ask for your GP's advice.

You can buy the nasal steroids beclometasone, budesonide and fluticasone from a pharmacy. Your GP can prescribe all of these and other, more powerful, nasal steroids.

Tablets

Tablets that contain an antihistamine are an alternative treatment. They should reduce symptoms of sneezing and a runny nose, but are less effective at relieving a blocked nose. It's important to be aware that some antihistamines can cause drowsiness. Ask your GP or pharmacist for advice and always read the patient information leaflet that comes with your medicine.

Eye drops

If you suffer from itchy or sore eyes, eye drops that contain antihistamines or sodium cromoglicate can help. Using a daily combination of eye drops and a nasal steroid is an option if you would rather not take tablets.

Steroid tablets

If you have severe hay fever that is seriously interfering with your life (for example, at exam time), very rarely your GP may prescribe you a short course of steroid tablets. You can use other treatments such as nasal sprays while taking the steroids.

Immunotherapy

If all other treatments have failed to relieve your hay fever symptoms, you may be advised by a specialist to try immunotherapy. This will involve you being given doses of the pollen to which you're allergic over a period of time - traditionally this has been by injection.

However, Phleum pratense (Grazax) is a new grass pollen vaccine that you take by placing a tablet under your tongue. It's available on prescription and needs to be taken on a daily basis for at least eight weeks, before the start of the summer pollen season. The first dose needs to be given by your GP or specialist but after that you can take the tablets at home. The medicine doesn't seem to have any serious or long-lasting side-effects, although you may have an itchy mouth for a short while. Studies are being carried out to see if the medicine is more effective if you take it for several years. This treatment is only for hay fever caused by grass pollen so may not be suitable for you.

There have been some cases of immunotherapy causing serious side-effects. However, recent studies have shown that with the oral treatment these are rare. However, because of the cost and the lack of clear evidence that oral immunotherapy works as well as alternatives, not all experts recommend it for routine use.

The pollen count

This is the average number of pollen grains in one cubic metre of air over 24 hours. Pollen counts are done daily for grass, tree and weed pollen. Pollen forecasts predict how high the pollen count will be. This can be useful in helping you decide when will be the best time to start and stop treatment. The weather can affect the pollen count and it is generally higher on sunny days and lower on rainy days.

Prevention of hay fever

There are a number of things you can do to help reduce your symptoms. Some of these include:

• keeping doors and windows closed when the pollen count is high
• staying away from areas where there is more pollen such as grassy parks, especially in the early morning and late afternoon and evening when the pollen count is highest
• wearing wrap-around sunglasses to keep pollen out of your eyes
• taking a shower and washing your hair after going outside when the pollen count is high
• not drying washing outside if counts are high - pollen may get trapped in the fibres of clothes and bed linen
• putting Vaseline on the inside of your nostrils to prevent pollen from entering your nasal passages

Further information

• Allergy UK
  01322 619898
  www.allergyuk.org

Sources

• Asthma and allergies. AAIR Charity. www.aaircharity.org, accessed 11 April 2009
• Simon C, Everitt H, Kendrick T. Oxford handbook of general practice. 2nd edition. Oxford: Oxford University Press, 2006
• O'Connell EJ. The burden of atopy and asthma in children. Allergy 2004; 59 Suppl (78):7-11
• Hay fever and rhinitis. Asthma UK. www.asthma.org.uk, accessed 11 April 2009
• Durham SR. ABC of allergies. London: BMJ Books, 2000
• Allergy and allergy tests. A guide for patients and relatives. Royal College of Pathologists. www.rcpath.org, accessed 11 April 2009
• Pollen, fungal spores and allergies. National Pollen and Aerobiology Research Unit. www.pollenuk.co.uk, accessed 11 April 2009
• Calderon MA, Alves B, Jacobson M, et al. Allergen injection immunotherapy for seasonal allergic rhinitis. Cochrane Database of Systematic Reviews 2007, Issue 1. Art. No.: CD001936. DOI: 10.1002/14651858.CD001936.pub2 www.cochrane.org
• Grazax sublingual immunotherapy against grass pollen allergy. National Prescribing Centre. www.npc.co.uk, accessed 2 May 2007
• Allergic rhinitis. Clinical Knowledge Summaries. www.cks.library.nhs.uk, accessed 11 April 2009
• Kay AB. Allergy and allergic diseases. First of two parts. N Engl J Med. 2001; 344(1):30-7
• BMJ Group. Grazax for hay fever? Drug and Therapeutics Bulletin 2008; 46:9-10
• Joint Formulary Committee, British National Formulary. 57th ed. London: British Medical Association and Royal Pharmaceutical Society of Great Britain, 2009

This information was published by Bupa's health information team and is based on reputable sources of medical evidence. It has been peer reviewed by Bupa doctors. The content is intended for general information only and does not replace the need for personal advice from a qualified health professional.

Publication date: July 2009