What is hay fever?

Hay fever is the common name for allergic rhinitis. It happens when you come into contact with allergens — substances you are sensitive to. Allergens may include pollens, dust mites, moulds or animal dander (dead skin cells). These allergens can trigger your immune system to have an allergic reaction.

Hay fever is common. It affects around 1 in 5 adults in Australia. Despite its name, it's not caused by hay and doesn't cause a fever.

What are the symptoms of hay fever?

Common symptoms of hay fever include:

• an itchy, runny or blocked nose
• itchy or watery eyes
• sneezing
• mouth breathing
• needing to clear your throat
• feeling like you have a cold that won't go away
• snoring during sleep

If your hay fever is severe, you may also have:

• interrupted sleep — this may lead to feeling tired during the day
• difficulty concentrating
• headaches

What causes hay fever?

Air contains tiny amounts of different substances from the environment. When you breathe in air that contains something you are allergic to, it causes symptoms of hay fever.

Common allergens that may trigger hay fever include:

• grass, weeds and tree pollens
• dust mites
• animal fur or skin flakes
• mould
• latex

You may experience hay fever symptoms during certain times of the year (such as in spring or summer). Seasonal hay fever is usually caused by pollen. If you have hay fever throughout the year, it is likely to be caused by an allergen that is in the environment all the time, such as dust.

When should I see my doctor?

Many people can manage or relieve hay fever without medical help. You should speak with your doctor about treatment options if your symptoms are:

• persistent — meaning that you have symptoms at least 4 days in a week, for at least 4 weeks or more
• moderate or severe — meaning that your symptoms affect your sleep or daily activities such as work, school, sport or leisure

Your doctor can help you by asking you in detail about your symptoms. They will ask about your home and work environment and possible triggers, assess how intense your hay fever symptoms are and how much hay fever affects your day-to-day life. They can then refer you for tests to check possible causes, and help you find ways to manage or avoid hay fever in the future.

If your symptoms are mild or occasional, you can ask your pharmacist for advice.

How is hay fever diagnosed?

To diagnose hay fever, your doctor will ask you about your symptoms and when they happen. They may also ask what over-the-counter or prescribed medicines you already take for hay fever.

It's important to tell your doctor about any triggers you have noticed in your work or home environment, and how hay fever affects your quality of life.

Your doctor may check your nose and eyes for signs of hay fever and look inside your nostrils.

Allergy testing

Allergy testing by a blood test or skin prick test, is the main way to learn if your hay fever symptoms are caused by a particular allergen. Your doctor may refer you to a clinical immunologist (a doctor who specialises in the immune system) or to allergy clinic for this test.

If you have a skin prick test, a tiny amount of a suspected allergen will be placed into your skin (usually on your forearm or back) with a small prick. If you are allergic to this specific allergen, the place where you were pricked will become swollen and itchy. This usually goes away within 2 hours. Skin prick testing may be uncomfortable. The results are available within 20 minutes.

A positive test result doesn't prove that the allergen is causing your symptoms, only that your body is sensitive to the allergen.

Taking too many allergy tests may sometimes cause confusion. It may cause you to avoid many types of allergens that may not actually be causing your symptoms. Speak with your doctor about what the results of your allergy test mean and whether you need to make changes to your lifestyle.

How is hay fever treated?

Treatment for hay fever depends on what you are allergic to and how severe your symptoms are.

Avoid allergens

If you know which allergens trigger your hay fever, avoiding them may reduce your symptoms.

If pollens are causing your hay fever, these tips may help:

• Stay indoors when it's windy and the pollen count is high, or during and after thunderstorms. You can check today's pollen count at the Pollen Forecast website.
• Wear sunglasses and carry tissues when you go outside.
• After being outside, shower when you arrive home and rinse your eyes with water.
• Avoid mowing grass if you can. Wear a mask if you need to do the mowing.
• Keep your windows closed at home and in the car. Use recirculating air conditioning in the car.
• If you're gardening at home, research which plants are less likely to trigger hay fever. Remove any plants that might trigger symptoms.
• Don't hang your clothes or bed linen outside to dry.

If dust mites are causing your hay fever, try these tips:

• Wash your bed linen in hot water once a week.
• Use a hot tumble dryer for at least 10 minutes to kill dust mites.
• Use pillow and mattress covers that protect against dust mites.
• Use a damp cloth to dust surfaces in your house once a week.

If your symptoms are caused by animal dander, you may need to keep pets outside. If your symptoms are severe you may need to discuss removing your pet from your home.

If mould is causing your symptoms, try the following:

• Clean away any mould in your house using bleach, vinegar or a special cleaning product for mould.
• Let plenty of fresh air into your house.
• Don't keep pot plants inside.
• Fix any leaking taps or pipes and dry the carpet if it gets wet.

Nasal irrigation

For some people, saline (salt water) nasal sprays or rinses will provide relief from hay fever. They clear mucus and allergens from inside your nose. They are safe and can often help relieve symptoms.

Medicines

While medicines can't cure hay fever, they can reduce your symptoms. They generally don't have many side effects.

Ask your doctor or pharmacist about the following medicines:

• intranasal corticosteroids — these are nasal sprays that reduce inflammation. Corticosteroid nasal sprays should be used every day to be effective. They can take a few days to start working. Different brands are available, so ask your doctor which one is right for you. Ask your pharmacist to show you how to use your nasal spray, to be sure you are using it correctly.
• antihistamines — these medicines block the action of histamine (a chemical that the body releases when exposed to an allergen). In this way, antihistamines reduce the symptoms of the allergic reaction. They are available as tablets, syrups, nasal sprays and eye drops. Only take these when you have symptoms.
• combination nasal sprays — these contain an antihistamine and a corticosteroid. They offer the advantages of both medicines.
• decongestant sprays — these unblock and dry your nose. They should not be used for more than a few days at a time, as longer-term use can make your symptoms worse.
• decongestant tablets — these also unblock and dry your nose, but they can have side effects such as tremors, difficulty sleeping, anxiety or increased blood pressure. Speak with your pharmacist to check if decongestant tablets are suitable for you, especially if you have high blood pressure.

Immunotherapy

Immunotherapy, also known as 'desensitisation', is a therapy that helps your body learn not to react to an allergen. Immunotherapy works by gradually exposing you to the allergen. Your doctor will give you increasing doses of allergen extracts, either by injection or under your tongue. The process takes several years.

This treatment should only be started by a medical specialist such as a clinical immunologist.

What are the complications of hay fever?

Complications of hay fever may include:

• disturbed sleep
• tiredness during the day
• headaches
• poor concentration

Hay fever may also trigger frequent ear infections in children and sinus infections in adults. Untreated hay fever may also increase your risk of developing asthma or make asthma harder to control.

It's especially important to treat your nasal symptoms if you have asthma. This is because asthma and hay fever are both associated with difficulty breathing. About 4 in every 5 people with asthma also have hay fever.

Can hay fever be prevented?

If you have hay fever, you can prevent symptoms by avoiding the allergens you are sensitive to. Read more about how to minimise your exposure.

Resources and support

For more information and support, try these resources:

• Download the AirRater app to track your hay fever symptoms and monitor allergens in the environment.
• Check the pollen count for your area at Pollen Forecast.
• Asthma Australia explains how hay fever can make asthma worse.
• Video advice on hay fever and how to use nasal sprays is provided by the National Allergy Council.
• Call healthdirect on 1800 022 222 at any time to speak to a registered nurse (known
• as NURSE-ON-CALL in Victoria) for more information and advice.