Hay Fever & Allergies

What is hay fever? 

Hay fever is the term used to describe the symptoms caused by an allergy to pollen. 

Pollen itself is harmless. However, if you have hay fever, your body has incorrectly identified pollen as an allergen. This means, when you breathe pollen in, your immune system responds by releasing a chemical called histamine to protect your body. 

Histamine triggers the symptoms of hay fever when pollen comes into contact with your mouth, nose, eyes and throat, causing inflammation and irritation.     

Also known as seasonal allergic rhinitis and hay fever rhinitis, hay fever tends to start to affect people when the pollen count (the number of grains of pollen in one cubic metre of air) exceeds 50. Usually, the pollen count is highest between late March and September.  

There are different types of pollen you can have an allergy to[2]:  

• Tree pollen – highest during spring 

• Grass pollen – highest at the end of spring and the beginning of summer 

• Weed pollen – highest in late autumn 

Most people develop hay fever when they are a child or a teenager. However, it can be triggered at any age.  

So, if you’ve never suffered from hay fever before, this doesn’t mean you won’t spontaneously develop the condition during adulthood. You are more likely to suffer from hay fever if you have a family history of the condition or other allergies.   

Hay fever symptoms 

The symptoms of hay fever allergies can vary from person to person, depending on the time of year, the type of pollen they’re allergic to and the pollen count where they live.  

However, common symptoms of hay fever can include: 

• Sneezing  

• Coughing  

• Blocked or runny nose (nasal congestion) 

• Red, itchy or watery eyes (allergic conjunctivitis) 

• Itchy throat, mouth, nose and ears  

Severe hay fever symptoms 

Unfortunately, some people can experience more severe hay fever symptoms. These can include:  

• Fatigue and irritability, due to hay fever, affecting your ability to sleep  

• A reduction in your sense of smell (anosmia) 

• Pain in your face, caused by blocked sinuses 

• Headaches, due to congestion 

• Earache 

If the symptoms you’re experiencing are affecting your quality of life, you should speak to a healthcare provider. They may be able to prescribe you with stronger medication or refer you to a specialist for further tests and treatment. 

How is hay fever diagnosed? 

Hay fever seasonal allergies can be diagnosed by a healthcare professional, such as your GP. To make a diagnosis, your GP will initially review the symptoms you’re experiencing. 

If your symptoms and triggers paint a clear picture of hay fever, your GP will be able to make a diagnosis without conducting any further tests. 

However, if the cause of your symptoms isn’t clear or your GP needs to be sure of your diagnosis to refer you for immunotherapy (see more below in the “Treatments for severe hay fever” section), they may recommend the following tests: 

• Skin prick test – an allergy specialist will place small amounts of pollen onto the skin on your arm or upper back. They will then prick or scratch your skin to allow the allergen to penetrate your skin’s outer layers. You will have to wait for 15-20 minutes without scratching your skin, during which time your body’s immune system may be activated. If it is, a localised allergic reaction will occur (typically, a red, itchy bump)  

• Blood test – a healthcare provider will take a sample of your blood and send it to a laboratory. It will then be analysed for specific allergy-causing antibodies produced in response to allergens, such as pollen. The antibodies found will provide an overview of the allergens triggering your hay fever symptoms 

How can hay fever be treated? 

There is no way to stop hay fever immediately, but there are plenty of hay fever treatments available that can help you to manage your symptoms. Which treatments are right for you depends on how severe your symptoms are. For mild to moderate hay fever, there are several highly effective over the counter medications that can be used.  

Antihistamine tablets 

Antihistamines work by blocking the production of histamine in your body. As a result, when your body identifies pollen, the usual allergic reaction caused by histamine doesn’t occur.  

Typically, antihistamines come as hay fever tablets. However, you can also buy antihistamines as liquids, syrups, creams, gels, eyedrops and nasal sprays.  

There are two main types of antihistamines: 

• Drowsy – these make you feel sleepy, which can make them ideal for taking at night if your hay fever is preventing you from sleeping. Drowsy antihistamines include chlorphenamine, cinnarizine, diphenhydramine and promethazine. Side effects include sleepiness, difficulty peeing, a dry mouth and blurred vision 

• Non-drowsy – these are more appropriate to use during the day, as hay fever makes you tired. Non-drowsy antihistamines include acrivastine, cetirizine, fexofenadine and loratadine. Side effects include drowsiness (as this is still possible in non-drowsy antihistamines), dry mouth, feeling sick and headaches 

No antihistamine has been found to be any better than another. Although, some antihistamines may be more effective for you than others, based on your unique biology[3].  

However, not all antihistamines are suitable for everyone. You should speak to a GP or pharmacist if you: 

• Are pregnant or breastfeeding 

• Are looking for a medicine for a young child 

• Are an older person 

• Are taking other medications which may interact with antihistamines 

• Have an underlying health condition, such as heart disease, liver disease, kidney disease or epilepsy 

If you need help with choosing an antihistamine to get started with, use our consultation service to get recommendations from one of our pharmacists.  

Nasal sprays 

There are two main types of nasal sprays that can be used to help manage your hay fever symptoms.  

Decongestant nasal sprays 

These nasal sprays contain decongestant medicines which reduce the swelling of the blood vessels in your nose and help open your airways[4].  

They work more quickly than antihistamine tablets. However, they have been found to increase blood pressure and cause headaches, trouble sleeping and irritability. Decongestants can also cause addiction if used for longer than five days. 

As antihistamines aren’t always effective at reducing congestion, a nasal spray can be used in combination with an antihistamine.  

Steroid nasal sprays 

Steroid nasal sprays contain corticosteroids, which are anti-inflammatory medicines. These work by reducing swelling in the nose to limit symptoms such as sneezing and a runny or blocked nose.  

Unlike decongestants, these can be used continuously for between one to three months. Although, it’s best to start using these sprays one to two weeks before your symptoms are due to start, as they can take a few days to start working properly. 

If not overused, steroid nasal sprays do not usually cause any side effects. However, using a steroid nasal spray too much over a long period of time can increase your risk of side effects, such as:  

• Nasal irritation 

• A dry, crusty nose  

• A dry, irritated throat 

• An unpleasant taste in the mouth 

• Nasal itchiness, redness and swelling 

• Nosebleeds 

Eye drops 

Eye drops used to treat hay fever contain an anti-allergic medicine called sodium cromoglicate, which stops the release of histamine[5]. This is particularly helpful for treating itchy eyes.  

You should not use hay fever eye drops for longer than two weeks in total, unless you have been specifically advised to do so by a healthcare professional. Using them for longer than four weeks may reduce the effectiveness of the medicine. 

Most adults and children can use sodium cromoglicate eye drops. However, they are not suitable for everyone. To make sure they're safe for you, you should let your doctor know if you: 

• Have ever had an allergic reaction to any medicine containing sodium cromoglicate  

• Have dry eye syndrome (when your eyes do not produce enough tears) 

• Are pregnant or breastfeeding, as you should only use medicines prescribed by a doctor  

Sodium cromoglicate eye drops can cause stinging, burning or blurred eyesight. If this occurs, hold a cool, wet flannel over your eye until the symptoms ease. If the stinging persists, you should contact your GP. 

Rarely, anaphylaxis can occur in response to sodium cromoglicate. You should call 999 if: 

• Your lips, mouth, throat or tongue become swollen 

• Your breathing becomes fast or you begin struggling to breathe  

• Your throat is tight or you have difficulty swallowing 

• Your skin, tongue or lips turn blue, grey or pale (this may be easier to see on the palms of your hands or soles of your feet if you have black or brown skin) 

• You experience confusion, drowsiness or dizziness   

• Someone faints and cannot be woken up 

• A child is limp, floppy or not responding normally  

Treatments for severe hay fever 

For severe hay fever, you can also explore a treatment called immunotherapy. During this treatment, you’ll be given small amount of pollen (under the brand name Allergovit) over time, as an injection, to gradually build up your body’s resistance to pollen’s allergic effects.  

This treatment is not a hay fever cure. However, it can significantly reduce your symptoms, and the benefits last long-term[6].  

Because you are being exposed to an allergen, you can experience allergic reactions during the treatment. However, severe allergic reactions to Allergovit are extremely rare.  

How to manage hay fever 

Once you have identified the type of pollen you are allergic to, you can identify when you’re likely to start experiencing symptoms and begin taking antihistamines around two to four weeks before this time. Antihistamines are most effective when taken this way. 

However, in addition to using antihistamines and other hay fever medications, the NHS provides the following list of things you can do to treat hay fever yourself: 

• Put Vaseline around your nostrils to trap pollen 

• Wear wraparound sunglasses, a mask or a wide-brimmed hat to stop pollen getting into your eyes 

• Shower to wash pollen off your skin and change your clothes after being outside   

• Stay indoors whenever possible 

• Keep windows and doors shut as much as possible to stop pollen getting into your house 

• Dust with a damp cloth and vacuum regularly 

• Buy a pollen filter for the air vents in your car and a vacuum cleaner with a HEPA filter 

How to prevent hay fever?  

Unfortunately, there is no way to avoid getting hay fever or to cure hay fever permanently. However, you can be proactive by making sure you start taking antihistamines early every year. You can also have other hay fever medication on hand so you that you can start using it as soon as you need it.  

In addition, it’s worth trying to lessen your exposure to pollen by staying indoors as much as possible and following the NHS advice above. However, if you experience particularly severe hay fever symptoms, you should speak to your GP to find out whether a more long-term solution, such as immunotherapy (hay fever injections), may be suitable for you. 

Sources 

1. https://www.nhsinform.scot/illnesses-and-conditions/immune-system/hay-fever/
2. https://www.kch.nhs.uk/wp-content/uploads/2023/01/pl-012.3-pollen-avoidance.pdf
3. https://www.imperial.nhs.uk/-/media/website/patient-information-leaflets/respiratory-medicine/skin-allergy-tests.pdf
4. https://www.nhs.uk/conditions/decongestants/
5. https://www.nhs.uk/medicines/sodium-cromoglicate-eye-drops/about-sodium-cromoglicate-eye-drops/
6. https://www.uhsussex.nhs.uk/resources/allergovit-desensitisation-for-hayfever-2/