Hay fever: symptoms, treatment & management

How to manage hay fever

Spring is a beautiful time of year, but for up to 40% of Australians it brings with it the debilitating symptoms of hay fever.^[1]Hay fever (also called allergic rhinitis) is an allergic response to pollen. The most common pollens involved come from grasses, weeds and trees.^[1] Wattle is commonly blamed but is rarely the cause.^[2] Food allergies do not cause hay fever.^[3]Sometimes tests may be done to help determine the cause of your allergy symptoms.

There are some simple things you can do yourself to help reduce your symptoms and make the season more bearable. Also, you can discuss the treatment options with your doctor. You can book an appointment through HealthEngine today.

Symptoms of hay fever

Symptoms include sneezing, a blocked or runny nose, itchy nose, itchy watery eyes, cough, snoring and fatigue. Hay fever can cause or aggravate asthma and sinusitis.^[1,3-5] It can also lead to sleep disturbance, headaches and poor concentration.^[3]

Hay fever can be mild, moderate or severe. Severe symptoms affect day to day functioning.

DIY home treatments for hay fever

The first step in managing hay fever is to reduce your exposure to the cause (usually pollens) and manage discomfort. Here are some tips that can help:

• stay indoors as much as possible on windy days, keeping windows closed
• avoid going outside in the mornings, or immediately after a storm
• wear wrap around sunglasses when outside
• have someone else mow the lawn, or wear a mask if you must mow
• choose low-allergy plants for your garden
• use recirculating air conditioning in your car
• holiday on the coast rather than inland during allergy season
• shower after getting home
• apply a cold compress over eyelids to relieve irritation
• irrigation (e.g. saline nasal sprays, eye rinses) can help wash away allergens.^[1,2,4-6] 

Medicated hay fever treatments

Many hay fever medications are available without a prescription, but you may still like to speak to your doctor or pharmacist about the best choice of treatment for you.

Antihistamines

Taking antihistamine tablets or syrup can be very effective, especially if you suffer from both nasal and eye symptoms.^[1]Antihistamines (such as loratadine or fexofenadine) provide relief of sneezing, itchy and watery irritated eyes.^[4] They can be taken as needed or even as a preventative measure if you know you’re going to be exposed to pollens (e.g. you’re going to mow the lawn, or go out on a windy spring morning).^[1] The newer antihistamine tablets do not make you drowsy. Some of the oral antihistamines are on the Pharmaceutical Benefits Scheme (PBS) to allow people with severe hay fever to buy larger quantities.

There is one nasal antihistamine spray available over the counter, called azelastine. This is a good option if you only have occasional nasal symptoms of hay fever.

Steroid nasal sprays

Nasal sprays containing steroid are a good start in treating hay fever and may be all you need, especially if you only have nasal symptoms (e.g. sneezing and congestion). They take a while to work and require regular usage (usually daily for a number of weeks) to get good control.^[1] There are several types available over the counter. Some stronger nasal steroid sprays are available on prescription for those with severe symptoms.

Decongestants

Decongestant nasal spray (oxymetazoline) is available but should only be used for a few days. Using it for too long
causes rebound congestion and can damage the nasal passage.^[1]

Decongestant tablets (e.g. containing pseudoephedrine) help unblock the nose, but they have side effects. Some people should be cautious about taking a decongestant and others should not take them at all. Discuss with your doctor or pharmacist before using them.

Eye drops

Antihistamine and other anti-allergy eye drops are available over the counter. For more severe eye symptoms prescription treatments are available.^[6]

Other steroid medications

The best way to use steroids to fight hay fever is to apply them to where they are needed (i.e. to the nose with a spray). Rarely, in severe cases, a doctor may prescribe a short course of steroid tablets.^[1,7] 

Steroid injections for hay fever is an old fashioned treatment that was popular in its day but has since been shown to be too risky. Australian allergy guidelines no longer recommend steroid injections for hay fever.^[7]

Immunotherapy

There is no cure for hay fever or allergies- but immunotherapy can help those who have severe  symptoms despite trying other therapies.

Immunotherapy consists of injections of tiny amounts of the trigger to build up your tolerance, so that when you are exposed again, you have less reaction to it. This therapy is prescribed by a doctor who specialises in allergies. It is helpful for severe inhaled allergies or a stinging insect allergy, but not for food allergies.^[8]

Other tests and treatments

Another medication that reduces the allergic response is a nasal spray containing ipratropium bromide. This can help with a very runny nose.^[1]

There are some tests and treatments for hay fever that have not been proven to work. You may choose to try these anyway if the treatment is safe and not too expensive. Talk to your doctor or therapist about what they are offering. Ask about the risks, benefits and side effects. They may be able to direct you to some published papers about the proposed treatment.^[8] 

Some treatments are not recommended. For example, elimination diets do not tend to help hay fever, and can deprive you of important nutrients.^[8] 

For those allergic to pollens, it’s a good idea to avoid taking bee pollen extract, echinacea, or royal jelly for another condition, as they can cause a severe reaction even the first time you take them.^[9]

See your doctor if you are having persistent symptoms of hay fever. Your doctor can discuss hay fever treatments with you and help you find out which options are safe and backed by good evidence. Developing a personal treatment plan can provide relief and improve your quality of life. Use HealthEngine to find and book a convenient appointment with your doctor.

For further trusted information about hay fever and other allergies, visit the website of the Australasian Society of Clinical Immunology and Allergy (ASCIA).

References:

1. Australasian Society of Clinical Immunology and Allergy (ASCIA); Management of Allergic Rhinitis; http://www.allergy.org.au/images/stories/aer/infobulletins/pdf/Management_of_Allergic_Rhinitis.pdf; 1 October 2015.

2. ASCIA; Pollen Allergy; http://www.allergy.org.au/patients/allergic-rhinitis-hay-fever-and-sinusitis/pollen-allergy; 3 October 2015.

3. ASCIA; Is it allergic rhinitis?; https://www.allergy.org.au/images/pcc/ASCIA_PCC_Is_it_allergic_rhinitis_2017.pdf; 2 October 2015.

4. Healthdirect; Hay fever treatments; http://www.healthdirect.gov.au/hay-fever-treatments; accessed 29 September 2015.

5. ASCIA; Sinusitis and allergy; http://www.allergy.org.au/patients/allergic-rhinitis-hay-fever-and-sinusitis/sinusitis-and-allergy; 3 October 2015.

6. Eyepedia; Conjunctivitis; http://www.eyepedia.co.uk/conjunctivitis/; 29 September 2015.

7. Medicine Today; A Clinical Approach to Allergic Rhinitis; http://medicinetoday.com.au/sites/default/files/cpd/MT2014-10-016-LIN.pdf; 5 October 2015.

8. ASCIA; Unorthodox Treatments; http://www.allergy.org.au/health-professionals/papers/unorthodox-techniques-for-diagnosis-and-treatment; 2 October 2015.

9. ASCIA; Adverse Reactions to Alternative Medicines; http://www.allergy.org.au/patients/medication-allergy/adverse-reactions-to-alternative-medicines; 6 October, 2015.

This article is for informational purposes only and should not be taken as medical advice. If in doubt, HealthEngine recommends consulting with a registered health practitioner.

This article is for informational purposes only and should not be taken as medical advice. If in doubt, HealthEngine recommends consulting with a registered health practitioner.