Hay Fever

(Pollinosis, Seasonal Allergic Rhinitis)

The Facts

Hay fever is also known as pollinosis or seasonal allergic rhinitis. For most people, a single allergen sets their symptoms off at about the same time each year. Spring attacks are usually due to tree pollen (not hay), while grass pollens dominate in the summer and weed pollens in the autumn. This can vary slightly by region in Canada. Hay fever is also occasionally cause by airborne fungal spores. Hay fever affects about 20% to 25% of Canadians and the prevalence is increasing.

The Causes

Hay fever is an atopic or allergic disease like asthma. This means the body tends to overreact to certain types of outside particles. One way it overreacts is by releasing histamine, a chemical present in many important cells. Histamine is a major cause of the symptoms of hay fever including sneezing, runny nose, and even coughing.

Hay fever, like asthma, can be inherited. People inherit the general tendency to be allergic but not always specific allergies. For example, if a mother has hay fever caused by ragweed, her child is at an increased risk of hay fever, but the child may be allergic to other allergens. Children have a 30% to 50% chance of developing hay fever if one of their parents is affected and a 60% to 80% chance if both have hay fever.

These are some of the pollens most likely to cause an allergic reaction:

Spring: tree pollens such as oak, elm, maple, alder, birch, juniper, willow, and poplar
Summer: grass pollens such as Bermuda, timothy, sweet vernal, orchard, and Johnson; and weed pollens such as Russian thistle and English plantain
Fall: weed pollens, especially ragweed

Symptoms And Complications

Most people with hay fever know they have it. The symptoms are unmistakable – runny nose, sneezing, itching, and congestion. Other common symptoms include red, watery eyes, itchy throat, coughing, ear fullness, headaches, and irritability. There may also be breathing difficulties, especially if the person has asthma.

Hay fever usually appears regularly at the same time each year. This is how people can distinguish it from other allergies such as to house dust mites or cat dander. Another difference is while hay fever often causes red eyes, "indoor allergies" tend to leave the eyes alone.

When hay fever goes untreated it can lead to difficulty concentrating, fatigue, and poor sleeping. In children, chronically breathing through the mouth can lead to permanent changes in their mouth structure.

Making A Diagnosis

An important way to recognize hay fever is to remember exactly when the symptoms appear and disappear. Knowing these dates will give your doctor or allergist vital clues as to what's provoking the symptoms. The details of where someone lives and works and when they suffer most should help the allergist make a list of possible causes.

Sometimes, your doctor or allergist will recommend skin testing for allergies. With skin testing, small, standardized doses of the most common allergens are gently scraped on the skin. If a small rash and itchiness appears, this indicates an allergy to that substance. If the results are unclear, your doctor may order an allergen-specific immunoglobulin (IgE) test, which uses a blood sample.

If none of the skin tests produce results, this may be an indication of some other kind of rhinitis (nasal irritation), which can be confused with hay fever.

Treatment And Prevention

Prevention of hay fever may be possible if people learn to control their environment. You can help prevent or alleviate symptoms by avoiding exposure to allergens that cause all the miserable sneezing and itching.

Here are some helpful tips for hay fever sufferers:

Keep windows closed and use air conditioning at home and in the car to reduce exposure to outdoor pollens. If using air conditioning, keep the unit on the indoor cycle.
Limit or avoid doing outdoor activities during peak pollen hours (between 5 a.m. and 10 a.m.). Check daily pollen counts on TV or the internet, or in the newspaper.
If you are outdoors for extended periods of time, make sure to shower and change clothes and shoes to avoid further contact with residual pollen.
Don't mow lawns or rake leaves. These activities stir up pollen and mould.
Don't dry sheets or clothes outdoors; they may trap with pollen and mold.

However, it's not always possible to control the environment or to eliminate or avoid allergens, especially those that are airborne. Many people need medication treatment for relief. Fortunately, most people respond well to treatment. Many of these treatments may be used together.

Corticosteroid nose sprays are the mainstay of treatment for moderate-to-severe hay fever. Over-the-counter normal saline nasal irrigation and nasal sprays can also be used to rinse irritants from the nose. Decongestant nasal sprays should not be used for allergy symptoms for more than 3 days because with continued use they can actually cause more nasal congestion, a condition called rhinitis medicanmentosa.

Oral antihistamines (e.g., desloratadine*, cetirizine, fexofenadine) are commonly recommended for mild hay fever. Your doctor or pharmacist can help you choose the medication best suited to your needs. For example, many oral antihistamines are now "non-drowsy." People with certain medical conditions (e.g., glaucoma, prostate problems) should consult with their doctor before using antihistamines. Some products contain antihistamines plus decongestants for symptom relief, and people with medical conditions such as high blood pressure and diabetes must be cautious with these types of medications and should consult their doctor first.

Specific eye drops containing antihistamines such as olopatatide or ketotifen can be used to help relieve itchy, tearing eyes.

Some people may find that if they start nasal sprays and eye drops before allergy season begins, they are more effective in preventing hay fever problems. Women who are pregnant or breast-feeding should consult their doctor or pharmacist before beginning treatment for allergies.

If allergen avoidance and medical treatment for hay fever aren't effective, a good option is allergen immunotherapy. Allergen immunotherapy may be referred to as desensitization, hyposensitization, or simply allergen shots. Small amounts of the allergen are injected regularly, slowly increasing the dosage. The hope is that the immune reaction becomes weaker and weaker. Allergy shots are initially given 1 or 2 times each week. After about 6 months of weekly shots, maintenance treatment is started. Maintenance shots are usually given just once each month. After 3 to 5 years, some people are able to stop having shots.

Allergen immunotherapy isn't risk-free. Rarely, the patient may have a system-wide immune reaction called anaphylaxis, which can be fatal. People receiving allergen immunotherapy have to wait in the clinic with a physician present for half an hour after each shot in case there is a reaction. The best time to start desensitization is at the end of the annual allergic period.
There are also immunotherapy pills available that are placed under the tongue and taken daily.

*All medications have both common (generic) and brand names. The brand name is what a specific manufacturer calls the product (e.g., Tylenol®). The common name is the medical name for the medication (e.g., acetaminophen). A medication may have many brand names, but only one common name. This article lists medications by their common names. For information on a given medication, check our Drug Information database. For more information on brand names, speak with your doctor or pharmacist.