Hay fever is a misnomer: It’s not usually caused by hay and does not produce a fever. Rather, it is an allergic reaction that occurs in your eyes, nose, and throat. The proper name is allergic rhinitis, and it’s thought that almost 8 percent of people age 18 and over in the U.S. are affected by it. According to the Asthma and Allergy Foundation of America, in 2010 Americans lost more than 6 million work and school daysdue to hay fever.
Seasonal hay fever (seasonal allergic rhinitis) is generally caused by airborne pollens and outdoor mold spores that proliferate in warm weather, from spring to fall. Perennial hay fever, triggered by such allergens as household dust, animal dander, hair, fur, dog saliva, feathers, or mold spores, can flare up at any time of the year.
Symptoms of hay fever
For hay fever caused by grass, tree, and ragweed pollens, symptoms occur seasonally—typically from spring to mid-September. Other hay fever allergens are present year-round, in which case symptoms can occur anytime, indoors or outside. Symptoms of a hay fever attack include:
- Persistent sneezing, itchy or runny nose (usually with a clear discharge), and swollen nasal passages.
- Red, itchy, puffy watery eyes.
- A dry itchy throat (or roof of the mouth), itchy skin, and wheezing.
Headaches also often develop, perhaps due to congested sinuses.
What causes hay fever?
It’s your own immune system reacting to foreign substances referred to as allergens that causes the runny nose and other symptoms of hay fever. It’s not clear why some people are sensitive to specific allergens. But when an allergen enters the nose, throat, or eyes of someone who is susceptible to it, the body responds first by developing a sensitivity to it, then, upon further exposures, by releasing histamines and other inflammatory compounds (designed to fight off this foreign “invader”) into the affected areas. The resulting inflammation of the mucous membranes produces the symptoms of hay fever.
A number of different allergens can trigger rhinitis—and they vary from person to person. Ragweed, grass, and tree pollens are the worst culprits, along with mold spores. Flower pollens are too heavy to be airborne (bees carry them), so they are seldom a cause of hay fever. Grass and tree pollens become airborne in spring—the first allergy season each year. Ragweed gets going in the late summer and early fall (except on the West Coast, where it is less common), followed by an upsurge of molds and fungi that live in decomposing leaves.
Many molds are present year-round, indoors and outside. Some allergies are triggered by animal dander (actually a protein in the animal’s saliva, which is transferred to the fur during grooming and then dries and sheds with the dander), feathers, cosmetics, cigarette smoke, and dust mites, as well as other indoor pollutants. Dust mites peak in warm, humid weather.
What if you do nothing?
As long as the allergens remain present, and you remain sensitive to them, you can have attacks.
Home remedies for hay fever
The most effective treatment is to eliminate the cause of your discomfort (see next section). If you can’t and if your allergies are not severe, try one of the over-the-counter antihistamine pills, nasal sprays, or eye drops.
Sorting Out Antihistamines
Antihistamines treat the effects of histamine—sneezing, runny nose, and itchy eyes—but not nasal congestion. Here are the main types and who should consider them.
A nasal decongestant can also help, but avoid using over-the-counter nasal decongestants for more than two or three consecutive days; these products may provide temporary relief, but over the long haul they lose effectiveness and can cause the nasal passages to swell more than ever—a response known as a rebound effect. Saline nasal sprays help wash out nasal mucus; they can be used long-term. Neti pots (which look like a genie pot) work similarly (be certain to use a sterile saline solution). If you have persistent or moderate to severe allergy symptoms, try an OTC nasal steroid spray, such as triamcinolone (Nasacort) or fluticasone (Flonase), in addition to antihistamine eye drops. The steroids can dampen inflammation and combat sneezing, itchy or runny nose, and postnasal drip.
How to prevent hay fever
- Pinpoint the allergy. The first step in controlling, and maybe preventing, hay fever is to find out what you are allergic to. Maybe you know already, from years of experience, that it’s grass pollen in early spring or ragweed in the fall. If you don’t know, you should see your physician to help diagnose the allergen that triggers your symptoms. If your problem is feathers, animal dander, or a cosmetic, you will probably be able to avoid hay fever entirely.
- Don’t wait to take meds. Allergy medications work best when taken before you come in contact with allergens and develop symptoms. That way the drugs can prevent or reduce the production of chemicals responsible for allergy symptoms.
- Stay informed about pollen counts. Radio and television stations often broadcast pollen counts, and you can get local information and forecasts from the National Allergy Bureau (which also offers a mobile app) or at Pollen.com. The counts are given either numerically or described as “absent,” “low,” “moderate,” “high,” or “very high.” If you hear that pollen counts have risen, you may want to carry medication when you leave the house or postpone outdoor activity until things clear up.
- Stay indoors on bad days. When pollen counts are high, people with severe allergies should stay indoors if possible, opting to do outdoor tasks in the evening, when pollen tends to be lower. Keep windows closed and use an air conditioner if you have one. Be sure you keep the filters clean or you may end up blowing allergens around. You may be surprised to learn that a dog or cat that goes in and out of the house can carry pollen indoors, so try to avoid contact with pets if they have been outdoors.
- If you do go outdoors, wash your hair afterwards. Washing your hair after spending time outside when the pollen count is high will remove pollen and thus may prevent a nighttime sneezing attack caused by pollen that falls from your hair onto the pillow.
- Try cromolyn nasal spray (brand name NasalCrom). Available over the counter, this product is considered a safe and effective medication for preventing hay fever symptoms (see inset below).
- Check your car’s air conditioner. Just like home air conditioning, your car’s AC system can help reduce your exposure to allergens. But if your car’s air conditioner seems to be making you sneeze, the culprits are probably fungi that produce airborne spores and grow deep within the air-conditioning system. To minimize the problem, keep the car windows open part way for 10 minutes after you turn on the AC. Don’t direct the vents toward your face. If these steps don’t help, have your car treated with a disinfectant registered with the Environmental Protection Agency (EPA), available at car dealer service departments, some service stations, and most auto AC shops.
- Don’t count on air purifiers. Many large particles, such as from dust mites and pollen, settle on surfaces and don’t get filtered. Air cleaners that use ultraviolet (UV) light to “kill germs” may not be effective—most don’t provide sufficient UV exposure, and some bacterial and mold spores are UV-resistant. We generally recommend mechanical air cleaners with high-efficiency particulate arresting (HEPA) filters over electronic ones. In particular, avoid ozone-generating air purifiers; they are often described using code words for ozone such as “activated oxygen.
- Avoid smoke and other irritants. In addition to not smoking, you should also avoid smoky environments. Insect sprays, fresh paint, and other household chemicals can also be irritating.
- “Allergy-proof” your house. If you’re allergic to dust and dust mites, take steps to combat them. Remove some or all carpets and soft furnishings. Keep floors and furniture dust-free. Get rid of feather pillows; use synthetic materials instead. Enclose your mattress in a plastic casing. Wash clothing frequently.
- If you’re allergic to your pet, the best remedy is to find another home for it. If that is out of the question, at least try to keep the pet out of your bedroom. Finally, don’t overlook indoor plants. Many people with allergic rhinitis are affected by at least one plant in their home, typically ficus and yucca, followed by ivy and palm trees. Mold spores are often found on the leaves of indoor plants and can cause allergic symptoms. Such allergens from plants may become airborne and become part of household dust.
- Get assistance. If molds and fungi set you off, get somebody else to do your yard cleanup in the fall.
A Nasal Spray for Allergy Prevention
NasalCrom (cromolyn sodium, also available in generic versions) is a safe and effective spray for preventing hay fever symptoms in adults and children as young as six.
When to call your doctor
In itself, hay fever is not a serious health problem and doesn’t cause any permanent harm. But to alleviate it, you need to find out what you are allergic to. If you don’t know, you should see a physician, who may be able to determine what triggers your attacks. You should also call a doctor if any type of secondary infection develops in your sinuses—signaled by pain, fever, a green or yellow discharge, or tenderness in the sinus areas or the teeth.
What your doctor will do
Your doctor will want a history of symptoms and a family history of known allergies, and will also ask about hobbies or work that may cause exposure to allergens. You may be referred to an allergy specialist. A physical examination of the upper respiratory tract will be made. If allergic rhinitis is suspected, skin tests will be made to confirm it. A blood sample may be taken and examined for antibodies, which in some cases can be helpful in determining treatment.
If medication is warranted, your doctor may prescribe a nasal steroid spray, such as budesonide (Rhinocort). Such sprays are considered the gold standard in terms of effectively treating nasal allergy symptoms, especially if the symptoms are moderate to severe. They can have uncomfortable side effects for some people, however, and some doctors opt to prescribe antihistamines instead. The steroid sprays begin to help within 12 hours, though the maximal effect may not occur for seven days or more. The drugs may cause dryness, irritation, burning, or bleeding of nasal passages and sore throat. If you have severe rhinitis and don’t respond to other drugs, oral corticosteroids may be prescribed for short-term use.
If symptoms are severe, an allergy specialist may also recommend allergy shots. These desensitize you to specific allergens and eventually allow your body to tolerate them. Many people—children as well as adults—find the shots really do reduce symptoms. There also is evidence that allergy drops under the tongue may work as well as shots. And it’s not always necessary to repeat them annually.