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 more than 35 million people in the United States and Canada—people of all ages—are affected by it. According to the American Academy of Allergy, Asthma and Immunology (AAAAI), Americans lose 3.5 million workdays annually because of this condition.
Seasonal hay fever 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 out. Symptoms of a hay fever attack include.
- Persistent sneezing, runny nose (usually with a clear discharge) and swollen nasal passages
- Red, itchy, watery eyes
- A dry itchy throat (or roof of the mouth), itchy skin and wheezing
- Itchy skin, nose, throat, mouth and eyes (or any other part of the body exposed to the allergy causing agent)
- Difficulty in smelling
- Fatigue and flushing
- Cross reactivity towards certain fruits
- Puffy eyes or circles under the eyes
- Trouble concentrating
- Headaches also often develop, perhaps due to congested sinuses
What Causes Hay Fever?
It’s your own immune system reacting to irritants or 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 illness-fighting 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 irritants or 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 out. 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. If you can’t, antihistamines may help. If your allergies are not severe, try one of the over-the-counter antihistamines, which may help control symptoms; a decongestant may also bring relief. The drawback is that most antihistamines cause drowsiness. Several effective nonsedating antihistamines are available by prescription only. These are less likely to cause drowsiness, but if you want to use them, be sure to talk to your doctor or pharmacist about possible interactions these drugs can have with other medications.
Try to avoid using over-the-counter decongestants; these products may provide temporary relief, but over the long haul cause the nasal passages to swell more than ever—a response known as the rebound effect. You might ask your doctor for prescription eye drops for your itchy and watery eyes.
Sorting Out Antihistamines
Antihistamines come in many chemical classes and are sold under scores of over-the-counter brand names and as generic “allergy pills.” They are often combined with a decongestant, which may relieve symptoms temporarily. Single-ingredient products are usually the best choice, because you can take whichever you feel you need; if you find a combination drug that works best for you, that’s all right, too.
All antihistamines available over the counter cause drowsiness, but the effect can be minimized by starting at low dosages and gradually increasing them. You can also use them at bedtime, when their sedative effect isn’t a problem.
Read the labels. Antihistamines are generally not recommended for pregnant or nursing women.
If you need stronger medicine or can’t risk being sleepy, talk to your doctor about the newer prescription antihistamines. Most of these products work with just one dose a day and they also don’t cause dry mouth. Some are also nonsedating.
- Pinpoint the allergy. The first step in controlling, 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.
- Stay informed about pollen counts. If it’s pollen that bothers you, you’ll be interested to hear that the AAAI sponsors a nationwide network that collects and broadcasts more accurate pollen counts. Various collecting stations all over the country do pollen and mold counts up to three days a week, which are then faxed to the AAAI, which in turn faxes them to radio stations and newspapers. The counts are given either numerically or described as “absent,” “low,” “moderate,” “high,” and “very high.” According to the AAAI, there’s no accurate way to forecast pollen counts. But if you hear that pollen counts have risen, you can at least 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, especially between 5 am and 10 am, when pollens are most prevalent. 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 the nasal spray Nasalcrom. Available over the counter, Nasalcrom is considered a safe and effective medication for preventing hay fever symptoms.
- 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.
- Most air purifiers aren’t helpful. The few controlled studies on air-purifying machines have found that they have little, if any, effect on allergens. Very small air cleaners cannot remove dust and pollen. Electrostatic precipitators, which electrically charge airborne particles and use polarized metal plates to pull them out of the air, can pollute indoor air with ozone, aggravating allergy symptoms. The best type of filter is the HEPA (high-efficiency particulate arresting)—effective but expensive.
- Avoid smoke and other irritants. In addition to not smoking, you should also avoid smoky environments. Insect sprays, fresh paint and other households 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.
- Get assistance. If molds and fungi set you off, get somebody else to do your yard cleanup in the fall.
- Wear scarves and goggles when walking or cycling outside.
A Nasal Spray for Prevention
Nasalcrom, containing cromolyn sodium, is safe and effective for preventing such hay fever symptoms as runny nose and nasal congestion—and both adults and children as young as six can use it. However, it won’t help after the symptoms start. You need to spray before being exposed to the allergen and you must spray four times daily. Nasalcrom may take a week or so to begin working. It blocks irritating chemicals (for example, histamines) that your own cells release when you are exposed to allergens. (It’s your own immune system reacting to allergens that causes the runny nose and other symptoms.)
It’s okay to use Nasalcrom with over-the-counter antihistamines. And unlike conventional decongestant sprays, Nasalcrom does not produce rebound congestion. For severe allergies, doctors sometimes suggest using it in combination with steroid nasal sprays, which are effective against allergy symptoms, but may produce unpleasant side effects such as soreness and nasal bleeding. (Nasalcrom does not work against cold symptoms.)
In October 2012, the U.S. Food and Drug Administration (FDA) issued a warning to consumers to keep OTC and prescription nasal sprays out of the reach of young children. Accidentally swallowing these products can cause serious symptoms, such as nausea, vomiting, lethargy (sleepiness), tachycardia (fast heart beat) and coma, that may require hospitalization.
Beyond Home Remedies: 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 sinus cavities—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.
Your doctor may then prescribe antihistamines or other medications to initially treat the problem. Cortisone-based inhalants have proved effective against inflammation and some doctors prescribe them. A trovent nasal spray is sometimes effective at stopping a runny nose. Nasalcrom spray may be recommended to prevent the outbreak of hay fever symptoms.
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. And it’s not always necessary to repeat them annually.
In 2014, the first oral immunotherapy pill (Oralair) was approved in the United States. This once-daily medication is placed under the tongue and allowed to dissolve (called sublingual administration) to treat allergic rhinitis with or without conjunctivitis. The first dose is giving in a health care provider's officeto monitor for adverse reactions and severe side effectsand subsequent doses can be taken at home. Oralair is approved for children 10 years of age and older and adults 65 years of age and younger with allergies to grass pollen.
Studies show that Oralair can lessen the severity of allergy symptoms and reduce the need for allergy medications in 16 to 30 percent if people who take the drug. It contains the extracts of 5 different grass pollens. Therapy is started about 4 months before grass allergy season and continues throughout the season. Side effects in adults include itching and swelling of the ears, mouth, and tongue, and reactions in children include itching and swelling in the mouth and throat irritation. Oralair has a boxed warning cautioning about the potential for a life-threatening reactioncalled anaphylaxis.
The Complete Home Wellness Handbook
John Edward Swartzberg, M.D., F.A.C.P., Sheldon Margen, M.D., and the editors of the UC Berkeley Wellness Letter
U.S. Food and Drug Administration (FDA)
Updated by Remedy Health Media