Allergic Rhinitis (Hay Fever)

Overview

What is allergic rhinitis (hay fever)?

Allergic rhinitis (hay fever) is an allergic reaction to tiny particles in the air called allergens. When you breathe in allergens through your nose or mouth, your body reacts by releasing a natural chemical called histamine. Several indoor and outdoor allergens cause hay fever. Common causes include dust mites, mold, pet dander and pollen from trees and plants.

Symptoms of hay fever include sneezing, nasal congestion and irritation of the nose, throat, mouth and eyes. Allergic rhinitis is not the same as infectious rhinitis, otherwise known as the common cold. Hay fever is not contagious.

When do people usually get hay fever?

You can have hay fever any time of the year. Seasonal allergies occur in the spring, summer and early fall when trees and weeds bloom and pollen counts are higher. Perennial allergies can happen year-round. They result from irritants that are always around, such as pet dander, cockroaches and dust mites.

How common is allergic rhinitis (hay fever)?

Hay fever is very common. In the United States, around 15% to 20% of the population has allergic rhinitis. Millions of children and adults have hay fever every year.

Who might get allergic rhinitis?

Allergies are inherited (passed down through families). You’re more likely to have hay fever if you have a parent or family member with allergies. People who have asthma or eczema are more likely to develop hay fever.

Symptoms and Causes

What causes allergic rhinitis (hay fever)?

Allergic rhinitis occurs when your body’s immune system reacts to an irritant in the air. The irritants (allergens) are so tiny that you can easily inhale them through your nose or mouth.

Allergens are harmless to most people. But if you have hay fever, your immune system thinks the allergen is intruding. The immune system tries to protect your body by releasing natural chemicals into your bloodstream. The main chemical is called histamine. It causes mucous membranes in the nose, eyes and throat to become inflamed and itchy as they work to eject the allergen.

Seasonal and perennial allergies can result from many allergens, including:

  • Dust mites that live in carpets, drapes, bedding and furniture.
  • Pollen from trees, grass and weeds.
  • Pet dander (tiny flakes of dead skin).
  • Mold spores.
  • Cockroaches, including their saliva and waste.

Food allergies can also cause inflammation in the nose and throat. If you think you’re having an allergic reaction to something you ate, get medical help right away. Food allergies can be life-threatening.

What are the symptoms of allergic rhinitis (hay fever)?

Hay fever symptoms can appear throughout the year. Outdoor allergies are worse in the spring, summer and early fall. In warm weather, weeds and flowers bloom, and pollen counts are higher. Indoor allergies, such as those that result from pet dander and dust mites, can get worse in winter because people spend more time indoors.

Symptoms of hay fever include:

  • Nasal stuffiness (congestion), sneezing and runny nose.
  • Itchy nose, throat and eyes.
  • Headaches, sinus pain and dark circles under the eyes.
  • Increased mucus in the nose and throat.
  • Fatigue and malaise (general feeling of discomfort).
  • Sore throat from mucus dripping down the throat (postnasal drip).
  • Wheezing, coughing and trouble breathing.

Diagnosis and Tests

How is hay fever diagnosed?

Your healthcare provider will examine you, ask about your symptoms and evaluate you for other conditions, such as a cold or asthma. To measure your antibodies to specific allergens, your provider may take a blood sample and send it to a lab for testing. This blood test is called an immunoglobulin E (IgE) test. It can detect all types of allergies, including food allergies.

Your provider may recommend a skin prick test to determine what allergens are causing your symptoms.

What is a skin prick test?

This common test is painless and accurate, though it may be a little uncomfortable. Your provider places a small sample of different allergens on your skin (usually on your forearm or back) and scratches or pricks the skin with a needle. Scratching the skin allows the allergen to get under the surface.

If you’re allergic to the allergen, the area will become red, itchy and irritated in 15 to 30 minutes. You may develop raised, hive-like welts called wheals that show an allergic reaction. A skin prick test is a safe, effective way to determine which allergens are causing your symptoms.

Management and Treatment

How is allergic rhinitis (hay fever) treated?

Several allergy medications can improve symptoms and help you live with hay fever. These treatments come in many forms, including liquids, pills, eye drops, nasal sprays and injections. Talk to your provider before taking any medication, especially if you’re pregnant or have other health concerns. Your provider may suggest:

Antihistamines: Antihistamine medications are available with a prescription or over the counter. They work by blocking the histamine that your body releases during an allergic response. Antihistamines come as pills, liquids, eye drops, nasal sprays and inhalers. They include:

  • Loratadine (Claritin®).
  • Cetirizine (Zyrtec®).
  • Fexofenadine (Allegra®).
  • Levocetirizine (Xyzal®).

Antihistamines can cause drowsiness. Avoid alcohol when taking antihistamines, especially if you’re going to drive.

Decongestants: These medications relieve congestion in the nose and sinuses. You can take decongestants by mouth (in pill or liquid form) or use a nasal spray. They include:

  • Afrin® nasal spray.
  • Phenylephrine nasal spray (Neo-Synephrine®).
  • Pseudoephedrine (Sudafed®).

    Decongestants can increase blood pressure and cause headaches, trouble sleeping and irritability. Nasal decongestants can be addictive if used longer than five days. Be sure to talk to your provider before taking them.

Corticosteroid nasal sprays: These sprays and inhalers reduce inflammation and relieve symptoms of hay fever. The most common nasal sprays are Flonase®, Nasacort® and Rhinocort®. Side effects include headaches, nasal irritation, nosebleeds and cough.

Leukotriene inhibitors: During an allergic reaction, the body releases leukotriene, histamines and other chemicals that cause inflammation and hay fever symptoms. Available only with a prescription, these pills block leukotriene. The most common leukotriene inhibitor is montelukast (Singulair®). Some people experience changes in mood, vivid dreams, involuntary muscle movements and skin rash when taking this medication.

Immunotherapy: This treatment works by helping your body learn to tolerate allergens. Your provider gives you a series of injections (allergy shots) with a small amount of the allergen. Every time you get a shot, your provider increases the amount of the allergen. Over time, your immune system develops immunity to the allergen and stops launching a reaction to it.

Your provider might recommend immunotherapy in the form of a pill that you place under your tongue.

Prevention

Can I prevent hay fever?

There is no way to prevent hay fever, but lifestyle changes can help you live with allergies. You can relieve hay fever symptoms by avoiding irritants as much as possible. To reduce symptoms, you should:

  • Avoid touching your face and rubbing your eyes or nose.
  • Close windows in your home and car during the spring, summer and early fall when pollen counts are higher.
  • Enclose pillows, mattresses and box springs in dust mite covers.
  • Keep pets off couches and beds, and close doors to bedrooms you don’t want them to enter.
  • Use filters in your vacuum cleaner and air conditioner to reduce the amount of allergens in the air.
  • Wash your hands often, especially after playing with pets.
  • Wear a hat and sunglasses to protect your eyes from pollen when you’re outside. Change your clothes as soon as you come indoors.

Outlook / Prognosis

What is the outlook for people who have hay fever?

Hay fever can make you feel miserable, but it doesn’t cause serious health problems. Most people with hay fever manage symptoms with lifestyle changes and over-the-counter medication.

People with airborne allergies have a higher risk of ear infections and sinus infections. Because hay fever can make it tough to get a good night’s sleep, you may feel tired during the day. If you have asthma, hay fever can make your asthma symptoms worse.

Living With

When should I see my healthcare provider about hay fever?

Although hay fever doesn’t cause any serious health problems, you should see your provider to rule out other conditions, such as asthma. Seek care if hay fever symptoms are getting in the way of your daily life or making it hard for you to sleep. Your provider can help you identify the allergens that are causing a reaction and recommend treatments to help you feel better.

A note from Cleveland Clinic

Hay fever symptoms can affect your quality of life and keep you from doing the activities you love, but effective treatments are available. Millions of adults and children manage hay fever with medications and lifestyle changes. Talk to your provider about steps you can take to relieve symptoms, breathe easier and feel better.

Last reviewed by a Cleveland Clinic medical professional on 07/30/2020.

References

  • Asthma and Allergy Foundation of America. Accessed 9/1/2021.Rhinitis (Nasal Allergies). (https://www.aafa.org/rhinitis-nasal-allergy-hayfever/)
  • American Academy of Allergy, Asthma & Immunology (AAAAI). Accessed 9/1/2021.Rhinitis (Hay Fever) Overview (https://www.aaaai.org/Tools-for-the-Public/Conditions-Library/Allergies/Rhinitis-(Hay-Fever%29). (https://www.aaaai.org/conditions-and-treatments/allergies/rhinitis)
  • InformedHealth.org [Internet]. Cologne, Germany: Institute for Quality and Efficiency in Health Care (IQWiG); 2006-. . Accessed 9/1/2021.Hay fever: Allergen-specific immunotherapy (desensitization) in the treatment of allergies (https://www.ncbi.nlm.nih.gov/books/NBK279487/)
  • Wheatley LM, Togias A. . N Engl J Med. 2015 Jan 29;372(5):456-463. Accessed 9/1/2021.Allergic Rhinitis (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4324099/)

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