Patient information from BMJ

Hay fever

Last published:Aug 16, 2021

If you sneeze, get a blocked nose, and have puffy eyes at the same time every year, you probably have hay fever, which is an allergy to some types of pollen. It can be annoying but there are treatments that can help.

Things such as pet hair, mould, and dust mites can cause similar symptoms to those caused by hay fever, and the treatments are often the same. But this information mainly deals with symptoms caused by pollen.

What is it?

Hay fever is an allergy. Allergies happen when your body overreacts to something that's harmless to most people. If you have hay fever you're allergic to the pollen or spores that plants release into the air.

The amount of pollen in the air depends on the time of year. For example, in the UK the hay fever season runs from around April to August, although it varies from year to year and from place to place around the country.

What are the symptoms?

Hay fever can make you sneeze a lot. You may also get a runny, itchy, or blocked nose. Severe hay fever can give you a tickly cough, make your eyes water and turn red, and make your throat or ears itch.

There are other allergies that cause similar symptoms to hay fever. Hay fever usually affects people for a few weeks or months at the same time every year. But if you get symptoms more often you may be allergic to something else, such as animal fur.

If your doctor isn't sure whether you have hay fever or another allergy, he or she can do tests to find out.

You should tell your doctor if you cough or wheeze when you have hay fever. Your doctor may want to check whether you have asthma.

What treatments work?

There are several good treatments for hay fever. Most of them come as tablets or as a spray you breathe in through your nose. You can buy some treatments from a pharmacy, but for some you will need a prescription from your doctor.

Avoiding pollen

It helps to avoid pollen as much as you can, although sometimes it's not possible. With the right treatment you shouldn't have to stop doing the things you want to do.

You'll probably find your symptoms are worse when the pollen count is high - the pollen count is a measure of how much pollen is in the air at a particular time.

You'll often see pollen counts mentioned in weather reports, or you can look them up online. For example, in the UK you can get pollen forecasts from the Met Office website (metoffice.gov.uk). 

There are some things you can do to avoid the worst pollen levels.

• Pollen levels tend to be higher on warm, dry, breezy days. They're worst in the morning, before 10 a.m. So try to minimise the time you spend outside at these times.

• It may help if you avoid drying your clothes outdoors. This can help keep pollen off your clothes.

• When you're outside, close-fitting sunglasses may help keep pollen out of your eyes.

• If you're driving, keep the car windows closed and use air conditioning, if you have it. If you have air conditioning in your home, use it in the recycler/indoor mode.

• Things like air pollution, tobacco smoke, or insect repellent sprays can all make your hay fever worse. So you may want to avoid these too.

Medicines for hay fever

Antihistamines and similar medicines

If you have mild hay fever, antihistamines may be the only treatment you need. They come as tablets, liquids, and nasal sprays. You can buy some antihistamines from a pharmacy, but you'll need a doctor's prescription for others.

Antihistamines can help reduce the symptoms of hay fever, such as a runny nose and sneezing. They don't help as much with a blocked nose.

The most common side effect of antihistamines is drowsiness. If you feel drowsy after taking antihistamines you shouldn't drive or use heavy machinery. You may want to talk to your doctor about trying a different antihistamine.

Some newer antihistamines are less likely than older ones to cause drowsiness. But you should still be cautious about things like driving, especially if you have never taken antihistamines before.

If you find that antihistamines don't help much with your symptoms, or that they only help with some of them, you could ask your doctor about taking more than one medicine.

For example, medicines called leukotriene receptor antagonists seem to work better than antihistamines for a blocked nose.

Another medicine that can help with a stuffy, runny, or blocked nose is sodium cromoglicate nasal spray. But doctors usually only recommend it if other treatments haven't worked.

Steroid sprays and tablets

If you've tried antihistamines and you still have symptoms that are quite severe, you may want to try a steroid nasal spray.

The steroids used for hay fever (their full name is corticosteroids) are not the same as the anabolic steroids that some bodybuilders use. You can use a steroid nasal spray together with an antihistamine.

Steroids can help with sneezing, a runny and itchy nose, and feeling blocked up. They probably work better than antihistamines, but doctors don't recommend using them unless other treatments haven't worked.

You need to take a steroid spray once or twice a day, and keep taking it every day through the hay fever season.

Your spray will work best if you start using it about two weeks before the hay fever season starts. It can sometimes cause nosebleeds or irritation in your nose.

You will need a prescription for most nasal steroid sprays, especially if they are for children. Your doctor may be cautious about prescribing them for children unless their symptoms are severe. This is because of concerns that steroids can slow children's growth.

If your symptoms are severe your doctor might recommend a short course (usually only a few days) of steroid tablets.

But your doctor will want to make sure that you take the lowest possible dose that is helpful. This is because steroids used for long periods can cause side effects, including raised blood sugar.

Decongestants

For a badly blocked nose, decongestants seem to help if you take them together with an antihistamine. You may be able to buy a decongestant called pseudoephedrine from a pharmacy, either on its own or combined with an antihistamine in one tablet.

You could also try decongestant nasal sprays or tablets, but you shouldn't take these for longer than 3 to 5 days. After that, they can make your blocked nose worse when you stop taking them.

Pseudoephedrine can cause side effects in some people, including headaches and problems sleeping. Decongestant tablets aren't usually recommended for children with hay fever.

When the usual treatments don't work

Some people's symptoms are so bad that they severely affect their quality of life. For example, they may have trouble sleeping, working, and enjoying family life.

If your symptoms affect you in this way and the usual treatments don't work your doctor may be able to refer you to a specialist.

You might be able to have a treatment called immunotherapy. This is done by giving you tiny amounts of what is causing your symptoms, so that your body gets used to it.

If the treatment goes well you are gradually given more of what is causing your symptoms, until your body can cope with no problems.

What will happen to me?

Most people who get hay fever just find it a nuisance. But severe hay fever can get in the way of everyday activities, like school, work, or sport. Hay fever can be especially difficult for children.

Most people with mild hay fever can find what they need at the pharmacy. But if your hay fever gets bad, see your doctor. He or she will be able to suggest stronger treatments than the ones you can get from a pharmacy.

The good news for many people with hay fever is that about half of people find that their hay fever improves or goes away completely as they get older.