What is Hay Fever?

Hay fever (also known as allergic rhinitis) describes an inflammatory nose condition triggered by an allergic reaction. Allergies are common substances (e.g. pollen) that are usually harmless but cause affected individuals to react irregularly. Significant inflammation around the nose can lead to symptoms such as sneezing and itchiness. According to the Australian Institute of Health and Welfare, approximately 19% of Australians experience hay fever [1]. The appearance of allergic rhinitis symptoms can be seasonal, especially during Spring where airborne pollen and spores begin to peak. Your GP can prescribe a large selection of medications to manage this condition and treat symptoms.

Types of Hay fever

There are two main categories of hay fever which are triggered by different allergens [4].

• Seasonal hay fever: Symptoms will appear and disappear throughout the year. Most people with this variant are allergic to spores and pollen, which peak during mid-spring to early summer.
• Perennial hay fever: Symptoms will appear all year round and can be triggered by exposure to allergens around the home or work (e.g. dust, pets, perfumes, etc.)

 

Hay Fever (Allergic Rhinitis) Symptoms

Signs of allergic rhinitis will usually only appear during exposure to an allergy. This is also known as an allergen. Once exposed, significant inflammatory reactions will lead to symptoms, including:

• Sneezing
• Itching throat
• Nasal congestion or excessive mucus production from the nose
• Runny and/or itchy nose
• Rash
• Headache

 

What Causes Hay Fever?

People living with hay fever will have their symptoms triggered when breathing in airborne substances they are allergic to. Examples of these substances can include [2]:

• Pollen and spores from grasses, trees and weeds. Many people with a spore and/or pollen allergy will experience more symptoms during hay fever season (e.g. mid-spring, early summer)
• Byproducts from animals, such as fur, urine, saliva and dead skin particles. In Australia, domestic animals such as cats and dogs are prevalent culprits.
• Indoor allergens, such as dust mites, mould and pest droppings (e.g. insects, mice, etc.)

Immune System

Usually, the role of the immune system is to protect the body from disease and infections. When foreign particles (i.e. viruses, bacteria) enter the body, cells called B lymphocytes will produce antibodies to eliminate them. However, the immune system in people with allergic rhinitis will overreact to harmless substances to most people. After breathing in the allergens, antibodies called immunoglobulin G (IgE) are produced. When this occurs, inflammatory cells (e.g. histamines, cytokines, etc.) will travel to the airways and nose passage [3]. Inflammation in these regions can lead to changes, such as leaky and enlarged blood vessels [4]. Eventually, these changes can lead to symptoms, such as having a runny nose, constant sneezing and an itchy throat.  

Is Hay Fever Contagious?

Hay fever is not contagious. However, this condition can be mistaken for a similar but contagious disease called infectious rhinitis (also known as the common cold) [5].  

Tests and Diagnosis

Your GP should be able to diagnose your allergic rhinitis through medical screening, physical examination and additional testing. Even more important is identifying specific allergic triggers which cause your condition. Knowing this information helps prevent future flare-ups. The tests below can be performed to identify triggers. A referral to a specialist, such as an allergist, may be required to complete some of these examinations.

Blood Testing

During this test, blood samples are taken to detect the levels of antibodies called immunoglobulin G (IgE). In normal conditions, IgE levels are usually low. In contrast, higher levels of IgE may indicate that the body is undergoing an allergic reaction. These tests can be run against specific triggers (e.g. pollen, spores, etc.) to identify an individual’s allergic rhinitis triggers [6].

Skin Allergy Testing

Skin allergy tests can quickly help identify allergic rhinitis triggers. A trial and error approach will be used to determine these triggers. Small amounts of common allergens will be placed onto the skin. A positive result appears when the skin begins to swell, itch or redden after exposure [7].  

Hay Fever Treatment

Avoiding Triggers

Prevention is better than cure and hay fever is no exception. After identifying your triggers, strategies can be developed with your GP to help reduce exposure. Examples are included in the table below.

• Allergens
• Strategies to Avoid Exposure
• Pollen and spores
• Using a dryer instead of hanging clothes outside
• Closing windows during hay fever seasons
• Using a air purifier with HEPA filters when inside
• Moulds
• Throw away any mouldy items (e.g. carpet, clothes, etc.)
• Clean any mouldy surfaces that you see
• Identify and fix leaks immediately
• Pet and animal byproducts
• Isolate your pet to a single room
• Get your pet cleaned and groomed regularly to reduce dander
• Regularly vacuum your house with cleaners that have HEPA filters

Hay Fever Medications

Your GP can prescribe hay fever medications in the form of nasal sprays, eyes drops and tablets/pills. These medications can be used to either prevent or quickly relieve hay fever symptoms. For example, antihistamines are fast-acting medications that are used to resolve inflammation in the areas affected. In contrast, daily use of corticosteroids helps prevent symptoms (especially during hay fever seasons). Your GP may prescribe you a combination of medications for optimal outcomes [8].

Immunotherapy

Immunotherapy is the closest treatment to a cure for hay fever. Small doses of the allergic substances will be injected into the body regularly over several years. The purpose of these injections is to help the immune system become less sensitive to them. At the end of the immunotherapy, the immune system will ideally tolerate these substances (s) without leading to any symptoms [8].  

Recovery - How long does hay fever last?

Episodes of hay fever will last depending on your allergy triggers. Those with seasonal hay fever may only experience symptoms during specific times of the year (e.g. seasons with high pollen counts, etc.) Whereas those with perennial hay fever may experience symptoms until the removal of the allergen. Hay fever symptoms can also decrease with age. A 23-year study showed that this condition peaks during adolescence but improves over time [9]. After following up with subjects after this period, researchers found that over 40% of hay fever sufferers had no symptoms.  

Complications

Suffering from hay fever can cause further problems, particularly if managed inappropriately. Examples include [4]:

• Nasal polyps: These are small and soft growths that appear on the passage of the nose due to constant inflammation.
• Sinusitis: Swelling and inflammation of the sinuses can cause long-term discomfort, such as a blocked and leaky nose.
• Ear infections: Blockage of the Eustachian tube, which connects to the nasal passages to the ear, can lead to infection. Symptoms can include fever, fatigue and general unwellness.
• Poor sleep: Symptoms from hay fever, such as a blocked nose or sneezing, can lead to poor sleep hygiene. This can cause fatigue and affect your daily function.

 

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    References

1. https://www.aihw.gov.au/reports/chronic-respiratory-conditions/allergic-rhinitis-hay-fever/contents/allergic-rhinitis
2. https://www.nhs.uk/conditions/allergic-rhinitis/causes/
3. Min Y. G. (2010). The pathophysiology, diagnosis and treatment of allergic rhinitis. Allergy, asthma & immunology research, 2(2), 65–76. https://doi.org/10.4168/aair.2010.2.2.65
4. Abbas M, Moussa M, Akel H. Type I Hypersensitivity Reaction. [Updated 2021 Jul 21]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan-.
5. https://www.aafa.org/rhinitis-nasal-allergy-hayfever/
6. Siles, R. I., & Hsieh, F. H. (2011). Allergy blood testing: A practical guide for clinicians. Cleveland clinic journal of medicine, 78(9), 585-592.
7. Carr, W. W., Martin, B., Howard, R. S., Cox, L., & Borish, L. (2005). Comparison of test devices for skin prick testing. Journal of allergy and clinical immunology, 116(2), 341-346.
8. https://www.allergy.org.au/images/stories/aer/infobulletins/pdf/Management_of_Allergic_Rhinitis.pdf
9. Greisner WA 3rd, Settipane RJ, Settipane GA. Natural history of hay fever: a 23-year follow-up of college students. Allergy Asthma Proc. 1998 Sep-Oct;19(5):271-5.
10. Wheatley, L. M., & Togias, A. (2015). Allergic rhinitis. New England Journal of Medicine, 372(5), 456-463.