An Overview of Hay Fever

This common allergic reaction can affect you at any age

Mid adult woman blowing nose with hankerchief in park
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Hay fever, which is also called allergic rhinitis, affects up to 30 percent of the population. It can begin at any age and affects children and adults. The symptoms, which include a stuffy, runny nose, and itchy eyes, may be triggered by a number of different factors, including plants, pollen, dust, pets, and mites.

Sometimes, it takes a while to identify the cause of your symptoms. If you are able to avoid the trigger, you might not need treatment. Often, however, it is impossible to entirely steer clear of certain triggers, like pollen, and medication can keep symptoms under control.

Symptoms

There are a number of different symptoms of hay fever, and you can experience any combination of them. If a seasonal exposure prompts your hay fever, you can have a bout that lasts for a few weeks. But if you're frequently exposed to the trigger, you can experience symptoms for last longer—even year round.

Symptoms of hay fever can include any of the following:

  • Sneezing
  • Runny nose
  • Nasal congestion
  • Itchy nose
  • Itchy eyes
  • Watery eyes
  • Red eyes
  • Cough
  • Postnasal drip
  • Itchy or irritated throat
  • Itchy ears

Do You Have a Rash?

Skin rashes, such as hives, allergic contact dermatitis, and eczema can occur from touching the same things that trigger your hay fever (like a plant or a pet).

Other Symptoms

If you have hay fever, you can be prone to other types of allergies and respiratory problems. For example, you may have food allergies. Often, people who have hay fever also have a predisposition to developing a skin rash when the hay fever is not acting up, typically from triggers that don't induce the hay fever.

Half of all people with allergic rhinitis also have non-allergic rhinitis. This manifests with the same symptoms as hay fever but is not associated with allergies. Asthma is also fairly common among people who have hay fever, and they each tend to exacerbate the other.

Complications

Allergic rhinitis may cause complications. Uncontrolled hay fever symptoms can lead to sinus infections, ear infections, and worsening of asthma.

And people with allergic rhinitis are more prone to infections since the inflammation in the nose makes it difficult to trap and fight infectious microorganisms.

Allergic rhinitis can lead to missed workdays, school days, and reduced productivity. For some people, the effect of allergic rhinitis on quality of life is comparable to that of asthma or another chronic illness.

Causes

Allergic rhinitis is caused by inflammation and irritation of the nasal passages. It is triggered by exposure to an otherwise harmless substance. After exposure, the body mounts a reaction that is similar to the reaction it has when fighting an infection.

Common Triggers

The name hay fever is a bit misleading because hay is not the only trigger. Pollen, dust, mites, mold, plants, weeds, pets, and toxins such as cigarette smoke, paint fumes, and chemical fumes can cause hay fever.

For some people, food, fabrics, cosmetics, or perfumes can trigger an attack as well.

Risk Factors

Hay fever is very common. There is a hereditary component to the condition, and many people with hay fever have relatives with allergies.

You are at a higher risk of allergic rhinitis if you have atopy or atopic dermatitis (eczema), or if you have a family history of either of these conditions. Atopy is a type of allergy characterized by an immunologic reaction called an IgE reaction.

Children of mothers who smoked during pregnancy are at a higher risk of developing the condition, as are people who live in a modernized lifestyle (i.e., urban setting, higher socioeconomic status, small family size). This is believed to be the result of the way the immune system develops when exposed to environmental factors at a young age.

Diagnosis

Diagnosis of hay fever relies on your symptoms and your physical examination. Sometimes, diagnostic testing can help identify hay fever triggers or complications.

It is often difficult to tell the difference between a common cold and hay fever, and many people often confuse one for the other when experiencing symptoms.

There are some clues that suggest that you may have allergic rhinitis:

  • You have other atopic conditions.
  • You have a family history of allergic diseases.
  • Your symptoms are associated with a season or trigger (such as a cat).
  • You experience improvement with allergy medications.
  • You have itching of your nose, eyes, ears, or the roof of your mouth.

Physical Exam

During your evaluation for hay fever, your doctor will look in your mouth, nose, and ears. Your mouth may show signs of post nasal drip. The mucous membranes in your nose can appear pale and swollen if you have hay fever. Allergies can cause fluid to accumulate behind the eardrum.

Dark circles under the eyes ( “allergic shiners”) can develop due to nasal congestion. And you can develop a horizontal crease on your nasal bridge from the upward rubbing of the nose with the palm of the hand; this is often called the “allergic salute.”

Allergy Testing

Allergy testing includes skin testing or blood tests (called a RAST). Skin testing is performed in a variety of ways, the most common being prick (or scratch) tests.

Imaging Examinations

In general, imaging tests are not a major part of a hay fever evaluation. If your doctor is concerned that your symptoms are caused by an infection or another illness (such as respiratory disease, lupus, or a tumor), then you may need an imaging evaluation, such as an X-ray or a computerized tomography (CT) scan.

Treatment

There are a number of effective ways to manage hay fever. If you know what your trigger is, and if it is avoidable, reducing your exposure to your trigger (or triggers) can help prevent attacks.

Depending on the frequency, severity, and predictability of your symptoms, you may need to take preventative medication on a regular basis. And sometimes, treatments such as eye drops can ease discomfort as well.

Over-the-counter (OTC) treatments include decongestants and antihistamines. Prescription medications such as Singulair (montelukast) and nasal steroids are often effective at controlling hay fever symptoms.

Some people benefit from immunotherapy, better known as allergy shots. These are injections of the allergen (the substance that induces your hay fever episodes) to diminish your immune response. Allergy shots often take months to work and need to be repeated, but the therapeutic effects can last for months.

A Word From Verywell

Adults are often surprised to develop the condition during their 40s and 50s because it is thought of as a condition that begins in childhood or adolescence. Interestingly, hay fever and other allergies can resolve or develop throughout life, so you can experience changes in your symptoms and new triggers as you get older.

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