Allergic rhinitis (hay fever)

Hay fever is the common name used to describe the condition ‘allergic rhinitis’.

Hay fever causes allergic symptoms such as a recurrent runny, stuffy, itchy nose, and frequent sneezing. It can also affect the eyes (this is known as ‘allergic conjunctivitis’), sinuses, throat and ears.

Like any other allergy, allergic rhinitis is an inappropriate immune system response to an allergen – most commonly house dust mites, pet dander, pollen and mould.

The allergen comes into contact with the sensitive, moist lining in your nose and sinuses, causing your body to release histamine and other chemicals, which sets off the allergic response.

Allergic rhinitis has been found to be an extremely common ‘trigger’ for asthma in both children and adults. Allergic rhinitis can also exacerbate asthma, and it can make the diagnosis of asthma more difficult.

Around 80 per cent of people with asthma suffer from allergic rhinitis, and around one in four with allergic rhinitis have asthma.

There is now very good evidence to support the idea that asthmatics who look after their upper airways well need less asthma medication and fewer hospital or GP visits.

When treating both asthma and allergic rhinitis, the first step is to find out the cause of the problem.

Once the causes (‘triggers’) have been identified, management regimes can be put into place to minimise the impact of the allergy, and this then reduces the need for medication.

The most common triggers for people with allergic rhinitis are pollen, dust mite, pet dander, and mould allergens.

There are two types of allergic rhinitis:

1. Seasonal allergic rhinitis (hay fever): this is usually triggered by wind-borne pollen from trees, grasses and weeds. Early spring symptoms point to tree pollen, while nasal allergy in late spring and summer indicates that grass and weed pollens are the culprits. And overlapping the grass season is the weed pollen season, which usually starts in late spring and extends through to the end of summer.
2. Perennial allergic rhinitis: this is allergic rhinitis that persists year-round. It is usually caused by house dust mites, pet dander, or mould.

People with allergic rhinitis are often allergic to more than one allergen, such as dust mites and pollen, so may suffer from symptoms for months on end or all year round.

Irritants such as strong perfumes and tobacco smoke can also aggravate this condition. Foods do not play as big a role as had been thought in the past.

Symptoms of allergic rhinitis can be any combination of:

• itchy, watery, red or puffy eyes
• sneezing
• runny nose
• blocked nose
• post-nasal drip and sore throat (from mucus running down the back of the throat)
• itching in the back of the throat, nose or ears
• blocked ears
• loss of smell
• fatigue (extreme tiredness), often caused by not being able to breathe normally at night due to a blocked nose
• needing to constantly clear your throat

Diagnosis of hay fever is based on a characteristic pattern of symptoms, exposure to known allergic triggers, your medical history, and/or the time of the year (for seasonal allergic rhinitis).

See your pharmacist for advice on over-the counter medicines and products to manage hay fever.

If your hay fever is not responding to over-the-counter treatment, is severe, or the cause of your symptoms is not clear, see your GP/health practitioner for further clinical examination.

They may want to order a skin prick test or blood (RAST or Cap RAST) test to help diagnose the allergy.

This is done by either observing the reaction to small samples of allergens placed on the skin, or by measuring the amount of IgE antibody produced to a specific antigen in the blood.