Learn about hay fever - a common allergic condition affecting millions of people worldwide. Discover its symptoms, causes, and treatment options from our experts

Hay Fever

Humza Khizer

Overview

Hay fever or seasonal <a href="https://merisehat.pk/disease/allergic-rhinitis">allergic rhinitis</a> is a reaction to pollen from trees, grasses, and weeds. 
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The term &ldquo;hay fever&rdquo; can be misleading because people with seasonal allergic rhinitis do not have to be exposed to hay to develop this condition nor do they have to have a fever to be diagnosed with it.

Hay fever is characterized by cold-like symptoms, like a runny nose, itchy eyes, congestion, sneezing, and sinus discomfort. However, hay fever, unlike a cold, is not caused by a virus. Rather, it&rsquo;s a reaction to a harmless allergen that the body mistakes for something harmful, and triggers these symptoms. 

Symptoms typically improve when the weather changes. For instance, weed pollen is the highest from July to October while grass pollen is highest from May to August in the mid-Atlantic states. So, individuals who are allergic to one or more types of pollen will have greater symptoms at those times and do not exhibit them at other times<a href="#accordion">[5]</a>. 
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While the condition can start at any age, they normally develop after a child has turned 2 years old. Most people with seasonal allergic rhinitis have developed them by the time they are 20<a href="#accordion">[5]</a>.

According to a survey, seasonal allergies affect nearly 28.4% white, non-Hispanic adults in the US compared to 24% black, non-Hispanic, 18.8% Hispanic, and 17% Asian, non-Hispanic adults in the country. Also, approximately 1 in 5 children have a seasonal allergy<a href="#accordion">[4]</a>. 
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Signs and Symptoms

Symptoms can include: 
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<ul>
	<li>Nasal congestion </li>
	<li>Allergic conjunctivitis </li>
	<li>Sneezing</li>
	<li>Itchy ears, nose, throat, and roof of the mouth</li>
	<li>Postnasal drip, i.e., mucus collects at the back of the throat </li>
	<li>Allergic shiners, i.e., skin behind the eyes appear to be swollen and bruised </li>
	<li>Fatigue, typically caused by a lack of sleep 
	&nbsp;</li>
</ul>

Causes

Hay fever symptoms usually appear shortly after being exposed to pollen that can be found indoors or outside 

These allergens activate the immune system, which will incorrectly identify the material as hazardous. As a result, the immune system produces antibodies to protect the body. 

Antibodies cause the blood vessels to dilate and the body to create inflammatory substances, such as histamine, which is what causes hay fever symptoms. 
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<h5>Genetic Factors</h5>

If someone in the family has allergies, then the person is more likely to have them as compared to someone who has no family history. 

Asthma, eczema, and hay fever sometimes coexist because they share many genetic risk variants. 
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<h5>Environmental Triggers</h5>

These include:

<ul>
	<li>Tree pollen &ndash; early spring</li>
	<li>Grass pollen &ndash;- late spring and summer</li>
	<li>Ragweed pollen &ndash; fall</li>
	<li>Spores from indoor and outdoor fungi and molds &ndash; both seasonal and perennial 
	&nbsp;</li>
</ul>

Diagnosis

After a physical exam, the healthcare provider usually asks about the patient&rsquo;s history, onset and symptoms of the condition, and potential triggers. They may also advise one or both of the following tests: 
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<ul>
	<li>Skin Prick Test </li>
</ul>

Small amounts of allergenic material are pierced into the skin by making a small scratch on the skin. The patient is then monitored for any allergic reactions. 

A raised bump (hive) will develop at the site of the allergen implying that there might be an allergy. This usually takes 15 to 20 minutes. Allergy specialists are typically the most qualified professionals to perform allergy skin tests. 
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<ul>
	<li>Allergy Blood Test </li>
</ul>

A blood sample is submitted to a lab to see how it reacts to a specific allergen. This test measures immunoglobulin E (IgE) in the bloodstream. IgE is a natural antibody; in case the person is allergic to certain substances, the body will make more IgE in the blood than normal. 
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Treatment

Once the doctor has determined what the patient is allergic to, they can then devise a treatment plan to alleviate hay fever symptoms.

Over-the-counter drugs may be sufficient if the condition isn&rsquo;t too severe. However, most people require a combination of allergy drugs. 

NOTE: If your kid has hay fever, consult their pediatrician about treatment options. Not all drugs are safe for children to take. Read labels thoroughly. 
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<h5>Medications For Hay Fever</h5>

<ol>
	<li>&nbsp;Nasal Corticosteroids</li>
</ol>

Nasal sprays help in the prevention and treatment of hay fever, dealing particularly with nasal congestion and itchy, runny nose. Nasal sprays are the most effective hay fever treatments for many people and are frequently the first medication prescribed.

This is also because nasal corticosteroids are a safe, long-term therapeutic option for most patients. Side effects may include an unpleasant odor or taste and nose irritation. 
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<ol start="2">
	<li>&nbsp;Antihistamines</li>
</ol>

Antihistamines prevent the production of histamine during an allergic response. Antihistamines can assist with itching, sneezing, and a runny nose, but not with congestion. 

They are often administered orally. Nevertheless, there are antihistamine nasal sprays, too, that help alleviate nasal discomfort while antihistamine eye drops can relieve itching and irritation in the eyes.

Dry mouth, nose, and eyes are common antihistamine side effects. Some antihistamines taken orally may cause sleepiness. Other side effects of oral antihistamines include agitation, headaches, changes in appetite, difficulty sleeping, blood pressure, and urination issues.

NOTE: Before taking antihistamines, consult your doctor, especially if you are pregnant or breastfeeding, have glaucoma, or have an enlarged prostate. 
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<ol start="3">
	<li>&nbsp;Decongestants</li>
</ol>

Decongestants alleviate nasal stuffiness and swelling-related pressure. They are sometimes combined with other medications such as antihistamines because they do not relieve other hay fever symptoms.

Decongestants come in liquid, tablet, and nasal spray forms. They can also be purchased with or without a prescription. 

Side effects of oral decongestants include increased blood pressure, <a href="https://merisehat.pk/disease/insomnia">insomnia</a>, irritability, and headache. Moreover, using a decongestant nasal spray for more than 3 days consecutively can worsen congestion.

NOTE: If you have heart disease, high blood pressure, or are pregnant, consult your doctor before using decongestants. Decongestants may also cause urination problems if you have an enlarged prostate. 
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<ol start="4">
	<li>&nbsp;Cromolyn Sodium</li>
</ol>

Cromolyn sodium can help alleviate hay fever symptoms by avoiding histamine release. This medication is most effective if taken before symptoms appear. 

Cromolyn sodium is available over the counter as a nasal spray that must be used several times daily. It is also available with a prescription as an eye drop. 

Cromolyn sodium has no significant side effects. 
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<ol start="5">
	<li>&nbsp;Leukotriene Receptor Antagonists</li>
</ol>

Leukotrienes are chemicals produced by the immune system that cause allergy symptoms like nasal irritation and excessive mucus production. 

This prescription drug is particularly effective in the treatment of allergy-induced asthma. It is often used when nasal sprays are inconvenient or for mild asthma.

However, it can cause headaches. In rare cases, it has been associated with psychological reactions, such as insomnia, anxiety, depression, and suicidal thoughts.

NOTE: If you have an unusual psychological reaction, seek medical attention right away. 
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<ol start="6">
	<li>&nbsp;Nasal Ipratropium</li>
</ol>

Ipratropium, a prescription nasal spray, helps alleviate severe runny nose by preventing the nasal glands from producing too much mucus. It does not affect congestion, itching, or sneezing.

Mild side effects include a dry nose, nosebleeds, dry and itchy eyes, and a sore throat. More severe side effects, for example, blurred vision, dizziness, and difficulty urinating, can occur in rare cases.

NOTE: You should avoid taking this medication if you have glaucoma or an enlarged prostate. 
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<ol start="7">
	<li>Oral Corticosteroids</li>
</ol>

Corticosteroid medications, such as prednisone, sometimes treat severe allergy symptoms. Corticosteroids are typically prescribed for short periods because long-term use can result in serious side effects, such as cataracts, <a href="https://merisehat.pk/disease/osteoporosis-80">osteoporosis</a>, and muscle weakness. 
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<h5>Immunotherapy For Hay Fever</h5>

<ol>
	<li>&nbsp;Allergy Shots</li>
</ol>

Allergy shots, also known as immunotherapy or desensitization therapy, alter how the immune system reacts to allergens. The healthcare provider may suggest allergy shots if medications do not alleviate the hay fever symptoms or if there are too many side effects. 

The patient receives regular shots for 3-5 years. These injections contain trace amounts of allergens. The goal is to accustom the body to the allergens that cause hay fever symptoms and reduce the reliance on medications to alleviate them. 
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<ol start="2">
	<li>&nbsp;Under-the-tongue (sublingual) Allergy Tablets</li>
</ol>

Instead of getting shots, the patient may be asked to take relatively small amounts of allergen in the form of sublingual pills. Often, the pill is to be taken once a day. Sublingual allergy tablets do not work for all allergens but can help with ragweed pollen. 
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<h5>Nasal Saline Rinses For Hay Fever</h5>

<ol>
	<li>&nbsp;Saline Nasal Spray</li>
</ol>

Nasal sprays containing saline can lubricate dry nasal passages and thin nasal mucus. They don&#39;t require a prescription and can be used as often as needed. 
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<ol start="2">
	<li>&nbsp;Nasal Irrigation</li>
</ol>

Nasal irrigation, i.e., rinsing nasal passages with saline, is a fast and efficient method to alleviate nasal congestion. Rinsing removes mucus and allergens from the nose.

Saline irrigation solutions are available ready-made or as water-addition kits. Do not use tap water to make the saline irrigation solution because it may possess organisms that can cause infection. Use distilled or sterile water. 
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Hay fever can cause the following problems: 
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<ul>
	<li>Poor Quality Of Life: Hay fever affects everyday activities. It makes the person less productive. Most people with seasonal allergic rhinitis have to miss work or school.</li>
	<li>Worsening Asthma: Hay fever can aggravate asthma symptoms such as wheezing and coughing.</li>
	<li>Sinusitis: Long-term sinus congestion induced by hay fever may increase the likelihood of developing sinusitis, an infection or inflammation of the sinuses&#39; membrane lining.</li>
	<li>Infection Of The Ears: Hay fever frequently contributes to middle ear infections in children. 
	&nbsp;</li>
</ul>

The following factors can increase the chances of getting hay fever:

<ul>
	<li>Having additional allergies or <a href="https://merisehat.pk/disease/asthma">asthma</a></li>
	<li>Having atopic dermatitis or <a href="https://merisehat.pk/disease/eczema">eczema </a></li>
	<li>Family history</li>
	<li>Living or working in an environment where allergens are constantly present 
	&nbsp;</li>
</ul>

Although there is no way to ward off hay fever, lifestyle changes can help cope with allergies: 
&nbsp;

<ul>
	<li>Try not to touch the face or rub the eyes or nose.</li>
	<li>Keep the windows (e.g., at home or in the car) shut as much as possible during the spring, summer, and early fall seasons when pollen counts are high.</li>
	<li>Install filters in the vacuum cleaner and air conditioner (e.g., at home or in the car) to reduce the allergens in the atmosphere.</li>
	<li>Wash hands frequently.</li>
	<li>When outside, wear a hat and sunglasses to protect the eyes from pollen.</li>
	<li>Shower and change clothes after coming inside to remove pollen. 
	&nbsp;</li>
</ul>

Key Points

<ul>
	<li>Seasonal allergies are also known as seasonal allergic rhinitis or hay fever.</li>
	<li>The onset of the condition is during a certain time of the year when weeds, trees, and grasses release pollen into the air.</li>
	<li>Allergy symptoms, which usually come on suddenly and last for as long as the person is exposed to the allergen, include sneezing, nasal congestion, itchy throat and/or nose, postnasal drip, and a clear runny nose.</li>
	<li>An allergist may order a blood test or skin prick test before making a diagnosis.</li>
	<li>If reducing exposure doesn&rsquo;t help or isn&rsquo;t possible, medicines (ocular, oral, and nasal) are recommended to alleviate symptoms. 
	&nbsp;</li>
</ul>