Hay fever

Hay fever is a form of allergic rhinitis: inflammation inside the nose caused by an allergy. In hay fever, the trigger is pollen released by trees, grasses or weeds. It can also affect the eyes and throat.

Symptoms can be mild, but for some people they interfere with sleep, concentration, work and time outdoors. There is no cure for hay fever, although reducing pollen exposure and choosing suitable treatment can help control symptoms.

Symptoms often appear after exposure to pollen and can include:

• Repeated sneezing and a runny or blocked nose.
• Itching in the nose, mouth, throat or ears.
• Red, itchy or watering eyes.
• A cough or a reduced sense of smell.
• Headaches or discomfort around the forehead and cheeks.
• Tiredness, particularly when symptoms disturb your sleep.

Hay fever can continue for weeks or months while the relevant pollen is in the air. A cold usually improves within one to two weeks. Fever or feeling generally unwell may have another cause, so do not assume every nasal symptom is an allergy.

Hay fever develops when the immune system reacts to pollen and releases chemicals, including histamine, which produce allergy symptoms. Different people react to different pollens.

In the UK, symptoms are commonly worse from late March to September. Tree pollen tends to be a spring trigger, grass pollen is common in summer, and weed pollen can extend symptoms into late summer or autumn. Timing varies with the weather and the type of pollen. A local pollen forecast can help you plan ahead.

Similar symptoms throughout the year may be caused by other allergens, such as house dust mites, pets or mould. These are other forms of allergic rhinitis rather than a seasonal pollen allergy.

A clinician will ask about your symptoms, when they occur, possible triggers and how they affect daily life. They may also ask about asthma, eczema, other allergies and treatments you have already tried.

Allergy testing may be considered if the cause is uncertain or symptoms are difficult to control. A test result needs to be interpreted alongside your symptoms and medical history; it is not a diagnosis on its own. Your clinician can discuss whether testing or specialist assessment would be useful.

A pharmacist can advise on treatments for mild symptoms. The best option depends on whether your main difficulty is a blocked nose, sneezing, itchy eyes or a combination of symptoms. Follow the product instructions and ask for advice if you are unsure.

Antihistamines are available as tablets, nasal sprays and eye drops. They can help with symptoms such as sneezing and itching. Some cause sleepiness, so check before driving or using machinery and ask about a less sedating option if needed.

Steroid nasal sprays reduce inflammation in the nose and may be recommended for nasal symptoms. Using the spray correctly and regularly as directed is important. A pharmacist or clinician can show you the technique and advise when to start treatment.

Eye drops may help when itchy or watery eyes are a particular problem. Saline nasal sprays or ready-made rinses can also be discussed with a pharmacist. Decongestant nasal sprays are only for short-term use: using them for too long can make congestion worse.

Check with a pharmacist or clinician before choosing treatment for a child, during pregnancy or breastfeeding, or if you take other medicines or have another medical condition. Not every product is suitable for everyone.

If pharmacy treatment is not helping, a GP can review the diagnosis, how medicines are being used and whether prescription treatment is appropriate. For persistent symptoms despite suitable treatment, referral for specialist assessment and possible immunotherapy may be considered. Immunotherapy is a specialist treatment and is not suitable for everyone.

Avoiding pollen completely is not realistic, but these measures may reduce how much you come into contact with:

• Check the pollen forecast and reduce outdoor exposure when counts are high, particularly around freshly cut grass.
• Wear wraparound sunglasses outdoors to help protect your eyes.
• After time outside, change your clothes and shower to remove pollen.
• Keep windows closed when pollen levels are high, and avoid drying laundry outside at those times.
• Dust with a damp cloth and vacuum regularly to reduce pollen brought indoors.
• Avoid smoke, which can aggravate symptoms.

If you know when your symptoms usually start, ask a pharmacist or clinician about a treatment plan before the next pollen season.

Arrange a GP appointment if your symptoms are worsening, pharmacy medicines are not helping, sleep or everyday activities are affected, or you are unsure what is causing the problem. If you have asthma and your asthma symptoms are getting worse, seek medical advice promptly.

Severe breathing difficulty, sudden swelling of the lips, mouth, tongue or throat, or collapse are not symptoms to manage as ordinary hay fever. Call 999 immediately if these occur. Do not wait for a routine clinic appointment.

This guide provides general information and cannot diagnose your symptoms or replace advice from a healthcare professional.

Is hay fever contagious? No. Hay fever is an allergic reaction, not an infection, so you cannot pass it to another person.

Can I have symptoms all year? Yes, but year-round symptoms may point to other allergens, such as dust mites or pets, rather than pollen alone. An assessment can help distinguish possible causes.

Do I need an allergy test? Not necessarily. The pattern of symptoms may be enough to guide an initial assessment. Testing is considered when it would help clarify the cause or change management.

Can hay fever affect asthma? Pollen can trigger symptoms in people with allergic asthma. If you have asthma, follow your asthma action plan and seek medical advice if control is getting worse.

At 222 Healthcare, we can assess troublesome hay fever symptoms, review treatments you have tried and discuss a plan suited to your symptoms and medical history. Where appropriate, we can discuss allergy investigations and whether specialist input may be helpful.

Dr. Oliver Large leads our allergy clinic and holds a postgraduate Diploma in Allergy. You can request an appointment to discuss persistent symptoms or plan ahead for the pollen season.