Hay fever (allergic rhinitis)

Hay fever is the common name for runny nose, sneezing and watery eyes caused by seasonal allergens such as plant pollens. Allergic rhinitis is the medical term for hay fever, as well as allergic reactions to non-seasonal allergens such as animal fur and dust. The two terms are often used interchangeably.

Approximately 20% of New Zealanders suffer from allergic rhinitis / hay fever. Whilst it can develop at any time of life, about one-third of sufferers first develop symptoms in childhood (usually before the age of ten years).

Symptoms can affect the nose, eyes, throat, and ears. Treatment includes avoiding allergens, medications and immunotherapy.

Causes

Rhinitis is inflammation of the nasal passage lining. Allergic rhinitis is where this inflammation is caused by an allergic reaction to particles in the environment such as pollen, dust or mould (referred to as allergens of triggers).

Some people are sensitive to only one or two allergens, while others are sensitive to many.

When a person inhales the allergen that they are allergic to, this triggers their body to release a chemical called histamine which causes the inflammation and symptoms characteristic of the condition.

The two main types of allergic rhinitis are:

Perennial allergic rhinitis

This occurs year-round and includes reactions to allergens such as house dust, animal dander (hair, fur, feathers) and moulds. It is commonly aggravated by tobacco smoke, perfumes and air pollution.

Seasonal allergic rhinitis

This type of allergic rhinitis is typically called hay fever. It most commonly occurs during spring and early summer. It is usually caused by different types of pollens from trees and grasses, as well as mould spores.

It is not known why some people are more susceptible than others to the allergens that cause allergic rhinitis. However, a person who has other allergies such as eczema (atopic dermatitis) or asthma, or who has relatives with allergies, is more likely to suffer from the condition. Living or working in an environment that constantly exposes a person to allergens can also increase the risk of developing hay fever.

Symptoms

The symptoms of allergic rhinitis are similar to those of the common cold but may last longer and often occur at a particular time of year. Symptoms include:

• Stuffy or running nose
• Frequent sneezing
• Itchy eyes, nose, roof of mouth, or throat
• Coughing
• Watery eyes
• Blocked nose
• Pressure in the nose and cheeks
• Ear fullness and popping
• Dizziness and/or nausea
• Dark circles under the eyes
• Headache
• Earache
• Snoring
• Nosebleeds.

Diagnosis

A doctor may ask when the symptoms occur or are most severe, and will try to establish whether the allergic rhinitis is perennial or seasonal. They may also examine the nasal passages, or consider testing blood for the presence of antibodies.

If allergic rhinitis causes significant interference to daily life, the doctor may refer the patient to an allergy specialist. They are likely to perform a series of skin prick tests to determine which allergens cause the most sensitivity.

Treatment

Treatment is aimed at minimising inflammation and reducing symptoms. This may be achieved by avoiding allergens and with the use of medications and immunotherapy.

Avoiding Allergens

Minimising or avoiding contact with problem allergens (which can be identified by a skin prick test) can be effective in minimising symptoms. Tips for general avoidance of allergens include:

Pollen:

• Avoid open, grassy areas, particularly in the evenings and on windy days
• Using a pollen filter in your car
• Keep doors and windows closed
• Wear sunglasses, especially wraparound sunglasses
• Change your clothes and shower after being outside
• Use air conditioning
• Be aware of pollen counts and stay indoors when counts are high.

Household dust mites:

• Remove items that collect dust
• Use an efficient vacuum cleaner fitted with a HEPA filter
• Wash bedding frequently in hot water
• Use dust mite covers on mattresses and pillow.

Animals:

• Do not keep pets
• If pets are kept, keep them outside and wash them regularly.

Other allergens:

• Avoid smoky environments
• Avoid perfumes.

Medications

Medications may be prescribed to treat hay fever. Antihistamines and decongestants, taken in tablet form or as nasal sprays or drops, can help to relieve symptoms. Antihistamines help reduce the sneezing, runny nose and itchiness while decongestants can help relieve nasal congestion.

When eye redness and irritation is a problem, the use of eye drops may be recommended.

Corticosteroid nasal sprays may be prescribed to help reduce inflammation and prevent attacks from occurring. These can be particularly effective when used as a longer-term preventative at times when symptoms are expected to be most problematic, eg: spring and early summer.

For rapid short-term relief from severe symptoms, corticosteroids tablets (eg: prednisolone) may be prescribed. However, the use of corticosteroids tablets for longer than 10 days is not recommended because their long-term use can cause serious side effects, including cataracts and osteoporosis.

Various non-corticosteroids medications may be prescribed to prevent the release of histamines or block the action of immune system chemicals.

Immunotherapy (desensitisation)

This treatment may be considered for people whose allergic rhinitis is not controlled by avoiding allergens or the use of medications. Immunotherapy involves administering a series of injections that can desensitise a person to certain allergens.

Increasing amounts of the allergen causing the problem are injected under the skin over time. This helps to reduce the immune response that triggers the body's allergic reaction. Injections may need to be given every few months for up to two or three years for this treatment to be effective. The offending allergen(s) can also be given as a tablet that dissolves under the tongue (sublingual immunotherapy).

Whilst this treatment is not effective in all cases, the majority of people who undertake it show some degree of improvement.

Information and support

For further information and support about allergic rhinitis, talk to your doctor or practice nurse, or contact:

Allergy New Zealand

Freephone: 0800 34 0800

Website: www.allergy.org.nz

References

Allergy New Zealand (2010). Allergic rhinitis (hay fever) (Web Page). Auckland: Allergy New Zealand. http://www.allergy.org.nz/A-Z+Allergies/allergic+rhinitis+hay+fever.html [Accessed: 29/05/20]
Mayo Clinic (2019). Hay fever (Web Page). Rochester, MN: Mayo Foundation for Medical Education and Research. http://www.mayoclinic.org/diseases-conditions/hay-fever/basics/definition/con-20020827 [Accessed: 29/05/20]
NHS Choices (2017). Hay Fever (Web Page). Redditch: National Health Service (NHS) England. http://www.nhs.uk/Conditions/Hay-fever/Pages/Introduction.aspx [Accessed: 29/05/20]

Last reviewed: May 2020

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