Allergic rhinitis
Hay fever; Nasal allergies; Seasonal allergy; Seasonal allergic rhinitis; Allergies - allergic rhinitis; Allergy - allergic rhinitis
Allergic rhinitis is a diagnosis associated with a group of symptoms affecting the nose. These symptoms occur when you breathe in something you are allergic to, such as dust, animal dander, or pollen. Symptoms can also occur when you eat a food that you are allergic to.
This article focuses on allergic rhinitis due to plant pollens. This type of allergic rhinitis is commonly called hay fever or seasonal allergy.
Allergic rhinitis, or hay fever, is a collection of symptoms, predominantly in the nose and eyes, to allergens such as dust, dander and pollen. The sensitized immune system produces antibodies to these allergens, which cause chemicals called histamines to be released into the bloodstream, causing itching, swelling of affected tissues, mucus production, hives, rashes, and other symptoms. Symptoms vary in severity from person to person.
The immune system normally responds to harmful substances such as bacteria, viruses and toxins by producing symptoms such as runny nose and congestion, post-nasal drip and sore throat, and itchy ears and eyes. An allergic reaction can produce the same symptoms in response to substances that are generally harmless, like dust, dander or pollen. The sensitized immune system produces antibodies to these allergens, which cause chemicals called histamines to be released into the bloodstream, causing itching, swelling of affected tissues, mucus production, hives, rashes, and other symptoms. Symptoms vary in severity from person to person.
Blooming flowers and blossoming trees are signs that spring has arrived. But for some people, those blossoms and blooms are also signs that allergy season is under way. And that means months of sniffling, sneezing, and runny eyes ahead. You may know that you have allergies as soon as you step outside on a spring day, eat peanuts, or pet your dog. Signs of an allergy may include trouble breathing, teary eyes, hives, itching, or vomiting after you come in contact with your allergy trigger. Your doctor can also do allergy tests to find out whether you're allergic, and what triggers your allergies. The most common type of allergy test is a skin test. The doctor puts a small amount of different allergy-causing substances under your skin. Then you wait for signs of a reaction, like swelling or redness. You might also have blood tests to check for chemicals that are related to allergies. So, how are allergies treated? There are a few medicines you can buy at your local drugstore or your doctor can prescribe to treat your allergies. Antihistamines prevent histamine chemicals from triggering allergy symptoms. Decongestants shrink swollen blood vessels throughout your body, including inside your nose, perhaps helping you breathe easier. Steroid drugs reduce swelling and inflammation. And Leukotriene inhibitors block the substances that trigger allergies. If your allergy is really bugging you, your doctor may give you allergy shots. When you take allergy shots over time, eventually they can help your body get used to the substance so you don't over-react to it in the future. Usually you can relieve allergies by taking medicine and avoiding whatever it is that triggers them. But in some people, allergies to insect stings or certain foods, like peanuts, cause a life-threatening reaction. This is called anaphylaxis. And if you have a life-threatening allergic reaction, call immediately for emergency medical help.
An allergy occurs when the immune system reacts to substances (allergens) that are generally harmless and in most people do not cause an immune response. Antibodies are formed by the immune system in response to the presence of an antigen such as pollen, mold, dust or dander.
Hi. I'm Dr. Alan Greene and I would like to give you a tip for how to use nasal sprays that contain medications. This is especially useful for the steroid nasal sprays that are used to treat allergies, but also true for the ones used for a cold or other things as well. Now, the middle part of the nose between the two nostrils is called the septum and it's got cartilage in there and a lot of blood vessels where nosebleeds typically come from. And when the medication squirts straight into the septum that can cause side effects - irritation, bleeding, and other things like that. Now most of the time when people use a nasal spray what they will do is either use the same hand for both sides or use one hand for the nostril closest to you and one for the other. I'm going to suggest you do just the opposite of that. You take one hand and squirt into the other nostril. When you do that, you naturally point the stream away from the septum and avoid the side effects. It's a simple trick that works really well.
Causes
An allergen is something that triggers an allergy. When a person with allergic rhinitis breathes in an allergen such as pollen, mold, animal dander, or dust, the body releases chemicals that cause allergy symptoms.
Hay fever involves an allergic reaction to pollen.
Plants that cause hay fever are trees, grasses, and ragweed. Their pollen is carried by the wind. Flower pollen is carried by insects and does not cause hay fever. Types of plants that cause hay fever vary from person to person and from area to area.
The amount of pollen in the air can affect whether hay fever symptoms develop or not.
- Hot, dry, windy days are more likely to have a lot of pollen in the air.
- On cool, damp, rainy days, most pollen is washed to the ground.
Hay fever and allergies often run in families. If both of your parents have hay fever or other allergies, you are likely to have hay fever and allergies, too. The chance is higher if your mother has allergies.
Symptoms
Symptoms that occur shortly after you come into contact with the substance you are allergic to may include:
- Itchy nose, mouth, eyes, throat, skin, or any area
- Problems with smell
- Runny nose
- Sneezing
- Watery eyes
Symptoms that may develop later include:
- Stuffy nose (nasal congestion)
- Coughing
- Clogged ears and decreased sense of smell
- Sore throat
- Dark circles under the eyes
- Puffiness under the eyes
- Fatigue and irritability
- Headache
Exams and Tests
The health care provider will perform a physical exam and ask about your symptoms. You will be asked whether your symptoms vary by time of day or season, and exposure to pets or other allergens.
Allergy testing may reveal the pollen or other substances that trigger your symptoms. Skin testing is the most common method of allergy testing.
If your provider determines you cannot have skin testing, special blood tests may help with the diagnosis. These tests, known as IgE RAST tests, can measure the levels of allergy-related substances.
A blood test, called the eosinophil count, may also help diagnose allergies.
Treatment
LIFESTYLE AND AVOIDING ALLERGENS
The best treatment is to avoid the pollens that cause your symptoms. It may be impossible to avoid all pollen. But you can often take steps to reduce your exposure.
You may be prescribed medicine to treat allergic rhinitis. The medicine your provider prescribes depends on your symptoms and how severe they are. Your age and whether you have other medical conditions, such as asthma, will also be considered.
For mild allergic rhinitis, a nasal wash can help remove mucus from the nose. You can buy a saline solution at a drug store or make one at home using 1 cup (240 milliliters) of distilled or boiled then cooled water, half a teaspoon (3 grams) of salt, and pinch of baking soda.
Treatments for allergic rhinitis include:
ANTIHISTAMINES
Medicines called antihistamines work well for treating allergy symptoms. They may be used when symptoms do not happen often or do not last long. Be aware of the following:
- Many antihistamines taken by mouth can be bought without a prescription.
- Some can cause sleepiness. You should not drive or operate machines after taking this type of medicine.
- Others cause little or no sleepiness.
- Antihistamine nasal sprays work well for treating allergic rhinitis. Ask your provider if you should try these medicines first.
- Antihistamine eye drops can be used as needed for itchy, watery eyes.
CORTICOSTEROIDS
- Nasal corticosteroid sprays are the most effective treatment for allergic rhinitis. They work best when used nonstop, but they can also be helpful when used for shorter periods of time. They can even help when used intermittently.
- Corticosteroid sprays are generally safe for children and adults.
- Many brands are available without a prescription. For specific brands, you may need a prescription from your provider.
DECONGESTANTS
- Decongestants may also be helpful for reducing symptoms such as nasal stuffiness.
- Do not use nasal spray decongestants for more than 3 days.
OTHER MEDICINES
- Leukotriene inhibitors are prescription medicines that block leukotrienes. These are the chemicals the body releases in response to an allergen that also trigger symptoms. These medicines can cause side effects such as anxiety or depression in some people. Speak with your provider before starting these medications if you have a history of mental health issues.
ALLERGY SHOTS
Allergy shots (immunotherapy) are sometimes recommended if you cannot avoid the pollen and your symptoms are hard to control. This includes regular shots of the pollen you are allergic to. Each dose is slightly larger than the dose before it, until you reach the dose that helps control your symptoms. Allergy shots may help your body adjust to the pollen that is causing the reaction.
SUBLINGUAL IMMUNOTHERAPY TREATMENT (SLIT)
Instead of shots, medicine put under the tongue may help for grass and ragweed allergies.
Hi. I'm Dr. Alan Greene and I would like to give you a tip for how to use nasal sprays that contain medications. This is especially useful for the steroid nasal sprays that are used to treat allergies, but also true for the ones used for a cold or other things as well. Now, the middle part of the nose between the two nostrils is called the septum and it's got cartilage in there and a lot of blood vessels where nosebleeds typically come from. And when the medication squirts straight into the septum that can cause side effects - irritation, bleeding, and other things like that. Now most of the time when people use a nasal spray what they will do is either use the same hand for both sides or use one hand for the nostril closest to you and one for the other. I'm going to suggest you do just the opposite of that. You take one hand and squirt into the other nostril. When you do that, you naturally point the stream away from the septum and avoid the side effects. It's a simple trick that works really well.
Outlook (Prognosis)
Most symptoms of allergic rhinitis can be treated with medicines. More severe cases need allergy shots.
Some people, especially children, may outgrow an allergy as the immune system becomes less sensitive to the trigger. But once a substance such as pollen causes allergies, it often continues to have a long-term effect on the person.
When to Contact a Medical Professional
Contact your provider for an appointment if:
- You have severe hay fever symptoms
- Treatment that once worked for you no longer works
- Your symptoms do not respond to treatment
Prevention
You can sometimes prevent symptoms by avoiding the pollen you are allergic to. During pollen season, you should stay indoors where it is air-conditioned, if possible. Sleep with the windows closed, and drive with the windows rolled up.
References
Corren J, Baroody FM, Togias A. Allergic and nonallergic rhinitis. In: Burks AW, Holgate ST, O'Hehir RE, et al, eds. Middleton's Allergy: Principles and Practice. 9th ed. Philadelphia, PA: Elsevier; 2020:chap 40.
Cox DR, Wise SK, Baroody FM. Allergy and immunology of the upper airway. In: Flint PW, Francis HW, Haughey BH, et al, eds. Cummings Otolaryngology: Head & Neck Surgery. 7th ed. Philadelphia, PA: Elsevier; 2021:chap 35.
Liu AH, Bacharier LB, Fitzpatrick AM, , Sicherer SH. Childhood asthma. In: Kliegman RM, St. Geme JW, Blum NJ, et al, eds. Nelson Textbook of Pediatrics. 22nd ed. Philadelphia, PA: Elsevier; 2025:chap 185.
Wallace DV, Dykewicz MS, Oppenheimer J, Portnoy JM, Lang DM. Pharmacologic treatment of seasonal allergic rhinitis: synopsis of guidance from the 2017 joint task force on practice parameters. Ann Intern Med. 2017;167(12):876-881. PMID: 29181536
Version Info
Last reviewed on: 3/31/2024
Reviewed by: Deborah Pedersen, MD, MS, Allergy & Asthma Care, PC, Taunton, MA. Review provided by VeriMed Healthcare Network. Also reviewed by David C. Dugdale, MD, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.
