Allergic Rhinitis

Hay Fever

Definition
Hay fever, also called allergic rhinitis, causes cold-like symptoms such as a runny
nose, congestion, sneezing and sinus pressure. But unlike a cold, hay fever isn't
caused by a virus — it's caused by an allergic response to indoor or outdoor airborne
allergens, such as pollen, dust mites or pet dander. Some people have hay fever year-
round. For others, hay fever gets worse at certain times of the year, usually in the
spring, summer or fall. One of the most common allergic conditions, hay fever affects
about one in five people.

For some people hay fever symptoms are a minor, temporary nuisance. But if your
symptoms are more persistent, they can make you miserable and affect your
performance at work, school or leisure activities. Finding the right hay fever treatment
probably won't completely eliminate your symptoms — but for most people, it makes
a big difference.

Symptoms
Signs and symptoms of hay fever usually develop immediately after you're exposed to
specific allergy-causing substances (allergens) and can include:

 Runny nose and nasal congestion

 Watery or itchy eyes
 Sneezing
 Cough
 Itchy nose, roof of mouth or throat
 Sinus pressure and facial pain
 Swollen, blue-colored skin under the eyes (allergic shiners)
 Decreased sense of smell or taste

Hay fever symptoms that can interfere with your day-to-day activities and have an
impact on your quality of life include:

 Sleeplessness
 Fatigue
 Irritability

Your symptoms may start or worsen at a particular time of year, triggered by tree
pollen, grasses or weeds. If you're sensitive to indoor allergens such as dust mites,
cockroaches, mold or pet dander, you may have year-round symptoms.

Although hay fever can begin at any age, you're most likely to develop it during
childhood or early adulthood. It's common for the severity of hay fever reactions to
change over the years. For most people, symptoms tend to diminish slowly, often over
decades.

Is it hay fever? Or is it a cold?

Signs and symptoms can be different. Here's how to tell which one's causing your
symptoms:

Hay fever Colds

Signs and Runny nose with thin, watery Runny nose with watery or thick
symptoms discharge; no fever yellow discharge; low-grade fever
Immediately after exposure to One to three days after exposure to
Onset
allergens cold virus
As long as you're exposed to
Duration Five to seven days
allergens

Causes
During a process called sensitization, your immune system mistakenly identifies a
harmless airborne substance as something harmful. Your immune system then starts
producing allergy-causing antibodies. The next time you come in contact with the
substance, these antibodies recognize it and signal your immune system to release
chemicals such as histamine into your bloodstream. These immune system chemicals
cause a reaction that leads to the irritating signs and symptoms of hay fever.

Hay fever can be triggered by either seasonal or year-round (perennial) allergens.

Many people have allergy symptoms all year long, but their symptoms get worse
during certain times of the year.

Seasonal hay fever triggers include:

 Tree pollen, common in the spring

 Grass pollen, common in the late spring and summer
 Weed pollen, common in the fall
 Spores from fungi and molds, which can be worse during warm-weather
months

Year-round hay fever triggers include:

 Dust mites or cockroaches

 Dander (dried skin flakes and saliva) from pets such as cats, dogs or birds
 Cockroaches
 Spores from indoor and outdoor fungi and molds

Hay fever doesn't mean you're allergic to hay. Despite its name, hay fever is almost
never triggered by hay, and it doesn't cause a fever.
Risk factors
The following risk factors may increase your risk of developing hay fever:

 Family history of allergies

 Male gender
 Birth during pollen season
 Being a firstborn child
 Exposure to cigarette smoke during your first year of life
 Exposure to dust mites

When to seek medical advice

See your doctor if:

 You think you or your child may have hay fever

 Your symptoms are ongoing and bothersome
 Allergy medications aren't working for you
 Allergy medications work, but cause side effects that are a problem
 You have another condition that can worsen hay fever symptoms, such as
nasal polyps, asthma or frequent sinus infections

Many people — especially children — get used to irritating hay fever symptoms. But
you don't have to suffer; getting the right treatment can reduce your symptoms. In
some cases, treatment may help prevent more-serious allergic conditions such as
asthma or eczema.

You may want to see an allergy specialist for evaluation and treatment if:

 Your symptoms are severe

 Hay fever is a year-round nuisance
 Allergy medications are not controlling your symptoms
 Your allergy medications are causing side effects
 You're thinking about allergy shots (immunotherapy)
Tests and diagnosis

Positive reaction to allergy test

Your doctor will ask detailed questions about your personal and family medical
history, your signs and symptoms, and your usual way of treating them. Your doctor
will also perform a physical examination to look for additional clues about the causes
of your signs and symptoms. He or she may also recommend one or both of the
following tests:

 Skin prick test. During skin testing, small amounts of purified allergen extracts are pricked
into the skin of your arm or upper back and you're observed for signs of an allergic
reaction. If you're allergic, you develop a raised bump (hive) at the test location on your
skin. Allergy specialists usually are best equipped to perform allergy skin tests.
 Allergy blood test. A blood test (sometimes called the radioallergosorbent, or RAST, test)
can measure your immune system's response to a specific allergen by measuring the
amount of allergy-causing antibodies in your bloodstream, known as immunoglobulin E
(IgE) antibodies. A blood sample is sent to a medical laboratory, where it can be tested for
evidence of sensitivity to possible allergens.

Complications
Other health problems that often occur along with hay fever include:

 Asthma. If you have asthma, you may have signs and symptoms such as
difficulty breathing, shortness of breath, a tight feeling in the chest, coughing
and wheezing.
 Eczema. Also called dermatitis, this condition causes swollen, red or itchy
skin.
 Sinusitis. Prolonged sinus congestion due to hay fever may increase your
susceptibility to sinusitis — an infection or inflammation of the membrane
that lines the sinuses.
 Ear infection. In children, hay fever often is a factor in middle ear infection
(otitis media).
Treatments and drugs
There are a number of over-the-counter and prescription medications available that
help relieve hay fever symptoms. They include pills, liquids, nasal sprays and
eyedrops. Many people get the best relief from a combination of allergy medications.
You may need to try several medications to identify what works best for you. Over-
the-counter medications may be enough to relieve your symptoms; or, you may need a
prescription from your doctor.

If your child has hay fever, talk with your doctor about the best treatment. Some
medications are approved for use in children, while others are only approved for
adults. If you want to try an over-the-counter medication for your child, be sure to
read the labels carefully.

Medications for hay fever include:

 Nasal corticosteroids. These nasal sprays help prevent and treat the
inflammation caused by hay fever. For many people they're the most effective
hay fever medications, and they're often the first medication prescribed.
Examples include fluticasone (Flonase), fluticasone (Veramyst), mometasone
(Nasonex) and beclomethasone (Beconase). Although these medications can
start to work after a few days of treatment, you may not notice any
improvement until after you've used them for a week or so. Nasal
corticosteroids are a safe long-term treatment for most people. Side effects can
include an unpleasant smell or taste and nose irritation.
 Oral corticosteroids. Corticosteroid medications in pill form, such as
prednisone, are sometimes used to relieve severe allergy symptoms. Because
the long-term use of oral corticosteroids can cause serious side effects such as
cataracts, osteoporosis and muscle weakness, they're usually prescribed only
for short periods of time.
 Antihistamines. These oral medications and nasal sprays can help with
itching, sneezing and runny nose, but have less effect on congestion. They
work by blocking histamine, an inflammatory chemical released by your
immune system during an allergic reaction. Older over-the-counter
antihistamines such as diphenhydramine (Benadryl) and clemastine (Tavist)
work as well as newer ones, but can make you drowsy. Newer oral
antihistamines are less likely to make you drowsy, but are more costly than the
older antihistamines. Over-the-counter examples include loratadine (Claritin,
Alavert) and cetirizine (Zyrtec). Fexofenadine (Allegra) is available by
prescription. The prescription antihistamine nasal spray azelastine (Astelin)
starts to relieve symptoms within minutes of use. It can be used up to eight
times a day, but can cause drowsiness. Side effects include a bad taste in the
mouth right after use.
 Decongestants. These medications are available in over-the-counter and
prescription liquids, tablets and nasal sprays. Over-the-counter oral
decongestants include Sudafed, Actifed and Drixoral. Nasal sprays include
phenylephrine (Neo-Synephrine) and oxymetazoline (Afrin). Because oral
decongestants can raise blood pressure, avoid them if you have high blood
pressure (hypertension). Oral decongestants can also worsen the symptoms of
prostate enlargement, making urination more difficult. Don't use a
 decongestant nasal spray for more than two or three days at a time because it
can cause rebound congestion when used longer.
 Cromolyn sodium. This medication (NasalCrom) is available as an over-the-
counter nasal spray that must be used several times a day. It helps relieve hay
fever symptoms by preventing the release of histamine. Cromolyn sodium
doesn't have serious side effects, and it's most effective when started before
signs and symptoms develop.
 Leukotriene modifiers. Montelukast (Singulair) is a prescription tablet taken
to block the action of leukotrienes — immune system chemicals that cause
allergy symptoms such as excess mucus production. It has proved effective in
treating allergic asthma, and it's also effective in treating hay fever. Possible
side effects include headache. Less common side effects include abdominal
pain, cough, dental pain and dizziness. Like antihistamines, this medication is
not as effective as inhaled corticosteroids. It's often used when nasal sprays
cannot be tolerated, or when mild asthma is present.
 Nasal atropine. Available in a prescription nasal spray, ipratropium bromide
(Atrovent) helps relieve a severe runny nose by preventing the glands in your
nose from producing excess fluid. It's not effective for treating congestion,
sneezing or postnasal drip. Mild side effects include nasal dryness, nosebleeds
and sore throat. Rarely, it can cause more-severe side effects such as blurred
vision, dizziness and difficult urination. The drug is not recommended for
people with glaucoma or men with an enlarged prostate.

Other treatments for hay fever include:

 Immunotherapy. If medications don't relieve your hay fever symptoms, your

doctor may recommend allergy shots (immunotherapy or desensitization
therapy). Over a period of three to five years, you receive regular injections
containing purified allergen extracts. The goal is to desensitize you to specific
allergens, reduce your signs and symptoms, and decrease your need for
medications. Immunotherapy may be especially effective if you're allergic to
cat dander, dust mites, or pollen produced by trees, grass and weeds. In
children, immunotherapy may help prevent the development of asthma.
 Nasal lavage. To help with irritating nasal symptoms, your doctor may
recommend that you rinse your nose with salt water. Use an over-the-counter
nasal saline spray or prepare your own saltwater solution using 1/4 teaspoon of
salt mixed with 2 cups of warm water. Both can be extremely effective at
relieving congestion.

Prevention
There's no proven way to avoid getting hay fever — but you can prevent allergy
symptoms by avoiding the things that trigger your reactions.

While the evidence isn't clear yet, doctors think reducing a child's exposure to allergy-
causing substances such as dust mites may help delay or prevent hay fever. This may
be especially true in children with a family history of allergies.
Minimize your exposure
It's not possible to completely avoid allergens, but you can reduce your signs and
symptoms by taking some steps to limit your exposure to them. It helps to know
exactly what you're allergic to so that you can take steps to avoid your specific
triggers.

Pollen or molds

 Close doors and windows during pollen season.

 Don't hang laundry outside — pollen can stick to sheets and towels.
 Use air conditioning in your house and car.
 Use an allergy-grade filter in the ventilation system.
 Avoid outdoor activity in the early morning when pollen counts are highest.
 Stay indoors on dry, windy days.
 Use a dehumidifier to reduce indoor humidity.
 Use a high-efficiency particulate air (HEPA) filter in your bedroom.
 Avoid mowing the lawn or raking leaves, which stirs up pollen and molds.
 Wear a dust mask when doing outdoor activities such as gardening.

Dust mites

 Use allergy-proof covers on mattresses, box springs and pillows.

 Wash sheets and blankets in water heated to at least 130 F (54 C).
 Use a dehumidifier or air conditioner to reduce indoor humidity.
 Vacuum carpets weekly with a vacuum cleaner equipped with a small-particle
or HEPA filter.
 Consider removing carpeting, especially where you sleep, if you're highly
sensitive to dust mites.

Cockroaches

 Block cracks and crevices where roaches can enter.

 Fix leaky faucets and pipes.
 Wash dishes and empty garbage daily.
 Sweep food crumbs from counters and floors.
 Store food, including pet food, in sealed containers.
 Consider professional pest extermination.

Pet dander

 Remove pets from the house, if possible.

 Bathe pets weekly. Using wipes designed to reduce dander also may help.
 Keep your pet out of the bedroom.

Alternative medicine
While there isn't much evidence about how well they work, a number of people still
try herbal remedies, supplements and alternative treatments for hay fever. These
include:
 Herbal remedies and supplements. Extracts of the shrub butterbur may have
some effectiveness in preventing seasonal allergy symptoms. If you do try
butterbur, be sure to use a product that's labeled "PA-free," which indicates it's
had potentially toxic substances removed. Though their benefits are unclear,
other alternative therapies for seasonal allergies include cat's-claw, choline,
goldenseal, stinging nettle, belladonna and bromelain. Some people also claim
locally produced honey helps reduce allergic reactions.
 Alternative therapies. Some people claim that probiotics, acupuncture and
hypnosis may help with seasonal allergy symptoms. However, there's no solid
evidence supporting the effectiveness of these treatments.