Hay fever: what is it and how is it treated?

Hay fever, clinically known as seasonal allergic rhinitis, occurs when your body’s immune system overreacts to harmless substances in the air that you breathe in. It is seasonal as the substances that trigger the symptoms (allergens) are mainly present in the air during spring and summer, occasionally stretching into early autumn. 

It affects around one quarter of all UK adults, making it one of the most common immune conditions, and can develop in childhood or adulthood with 10–15% of children having hay fever too. 

Hay fever risk factors

Your risk of developing hay fever is greater if you or your family have other atopic conditions, eg atopic eczema and asthma. 

There are also environmental factors that may increase your risk, such as growing up in a smaller family, urban environments, and reduced exposure to infectious diseases — this is collectively known as the hygiene hypothesis. 

Hay fever triggers

The triggers (inhaled allergens) for hay fever in the UK are tree pollen, with high levels from February to June, grass pollen, with high levels from May to July, and weed pollen, with high levels from June to September. You can be allergic to all three types of pollen.

Hay fever symptoms

The most common symptoms of hay fever are an itchy nose, roof of the mouth (palate), and throat, sneezing, nasal congestion, and a runny nose usually with clear fluid. You may also develop post-nasal drip, where mucus from your nose runs down the back of your throat, which might cause a cough. Your eyes might become red, itchy and watery.

If you also have asthma, hay fever can make your wheezing worse. If your hay fever is severe and/or uncontrolled, you may also develop sinusitis, where your sinuses become inflamed, which can cause tenderness or pain around your cheeks, eyes and forehead.

Hay fever symptoms usually peak in their severity by the time you reach your thirties or forties. After this age, symptoms usually remain at the same intensity or ease off.

Lifestyle changes for treating hay fever

As with any allergic condition, avoidance is key to reducing your symptoms, although this can be challenging with hay fever as the allergens are in the air. 

To reduce your exposure to allergens, try to avoid spending time outdoors on high pollen days and after a thunderstorm, as windy weather can stir up more pollen in the air. 

When you’re indoors, keep your windows closed to keep pollen out and on arriving home, change your clothes and shower to get rid of any pollen you’ve carried on you.

When you’re outdoors, wear wraparound sunglasses to help block pollen from entering your eyes and apply a nasal ointment to the lining of your nasal passages to reduce how much pollen you breathe in and prevent it from irritating your nose. 

You can also use nasal douching, also known as nasal irrigation, where you rinse out your nose with salt water to remove pollen. 

Medical treatments for hay fever

In addition to lifestyle changes to reduce your hay fever symptoms, you may speak to your pharmacist or GP to discuss whether you need hay fever medication.

For mild to moderate hay fever symptoms, over-the-counter antihistamine tablets are usually recommended. Although effective at reducing symptoms, the effects are not strong enough if you have severe hay fever.

Moderate to severe hay fever symptoms are treated with daily use of an intranasal steroid spray. The nasal steroids do not enter your whole body’s blood system, and therefore can be used daily without worrying about the side effects associated with steroid tablets or injections.

The steroid spray takes at least 5–10 days to take effect and should therefore be used two weeks before the pollen season starts to prepare your nose. It is also recommended that you use nasal douching before applying your steroid spray so that the steroids are more easily absorbed through the lining of your nose.

The combination of a nasal spray and antihistamines is usually effective at reducing eye symptoms of hay fever too. However, you can also use eye drops to soothe itchy eyes.

Allergen immunotherapy

If lifestyle changes, antihistamine tablets, nasal douching and daily use of a nasal spray is still not enough to significantly ease your symptoms, you may be referred to an allergist, a doctor specialising in treating allergies.

They may recommend allergen immunotherapy. This is a disease-modifying treatment and involves training your immune system not to react to the allergens triggering your hay fever.

Allergen immunotherapy usually starts at least four months before the hay fever season and takes three years to complete. It involves exposing your body to the allergen either by applying a controlled dose under your tongue or under your skin. If it's effective, it might take up to two years before the severity of your symptoms is reduced.