Hay Fever (Allergic Rhinitis)

Symptoms, Causes, and Treatment

Hay fever, also known as Allergic Rhinitis, is a common condition with cold-like symptoms, such as runny nose, nasal congestion, and sneezing. But unlike the common cold, hay fever is not caused by a virus. Instead, it’s caused by an allergic response to indoor/outdoor allergens like pollen, dust mites, tiny skin flecks, or saliva shed by pets.

Did you know hay fever is the fifth most common disease in the US, costing the country $2 billion to $5 billion per year? One in five Americans suffers from the condition.

Though hay fever is not a serious condition, it can affect your performance at school, work, or in day-to-day life. So, it’s important to learn about the causes, symptoms, and treatment of hay fever.

Signs and Symptoms of Hay Fever

Symptoms of hay fever may appear at different times of the year.

Common symptoms

  • Runny nose and nasal congestion
  • Watery, itchy, red eyes
  • Cough
  • Sneezing
  • Itchy nose
  • Swollen, blue-colored skin under the eyes
  • Fatigue
  • Postnasal drip

Severe symptoms

  • Sweat
  • Headache
  • Loss of taste and smell
  • Facial pain due to blocked sinuses
  • Itchiness in throat, nose, and ears

These symptoms can negatively affect your quality of life by causing irritability, insomnia, sinus inflammation, ear infection, and other issues. Those with asthma may also experience more breathlessness and wheezing from hay fever symptoms.

How to Tell if it’s Cold or Hay Fever?

As you see, hay fever symptoms are very similar to the symptoms of a cold. So, how do you tell the difference?

Characteristics Cold Hay Fever / Allergies
When it occurs Mostly in winter. Any time of the year. Sometimes seasonally.
When it begins Several days after infection. Immediately after exposure to allergy triggers.
How long does it last 3-14 days During exposure and for a short time after - usually days to months.
Cough Most often Sometimes
Aches Sometimes Never
Fatigue Sometimes Sometimes
Fever Rarely Never
Watery and itchy eyes Rarely Often
Runny or stuffy nose Often Sometimes
Sore throat Often Often

Put simply, if your symptoms last longer than 14 days, it could be time to see an allergist. Most people for which common colds linger longer or turn into bacterial sinus infections have inhalant allergies. Those allergies are the underlying culprit that predisposes them to infections and lingering colds.

Causes of Hay Fever

Despite its name, hay fever is not caused by hay grass. Nor is fever a usual symptom of allergies. There is more to hay fever than just a single allergen or a high temperature.

Symptoms of hay fever begin immediately after exposure to the allergens. Your immune system identifies those allergens as harmful substances, triggering a hypersensitive immune reaction. That reaction involves the immune system’s production of antibodies that signal blood vessels to widen - and our body to produce inflammatory chemicals. It is this response that causes hay fever symptoms.

There are two types of hay fever:

Seasonal: Occurs mainly in spring, summer, and early fall. It is caused by allergic sensitivity to pollen from grass, trees, and weeds.

Perennial: May occur at any time of the year. It is caused by dust mites, cockroaches, pet hair, mold, or hidden food allergies.

Diagnosis of Hay Fever

Hay fever is almost never immediately dangerous, and allergy testing is not required to diagnose it. But you should see a doctor, preferably an otolaryngologist (ear, nose, and throat doctor) who specializes in inhalant allergies, if:

  • Your symptoms aren’t responding to OTC (over-the-counter) allergy medications.
  • Your symptoms last longer than a week.
  • You have other conditions, like asthma.
  • You experience severe symptoms.
  • Allergy medications cause bothersome side effects.

In such cases, your doctor will ask about your symptoms and family medical history. They could recommend one of the following tests:

Skin Prick Test: The doctor pricks small amounts of material that triggers allergies into your upper back or arm. If you’re allergic, pricking develops a raised bump at the allergen’s site.

Allergy Blood Test: This test measures the presence and amount of allergy-causing antibodies in your blood, called immunoglobulin E (IgE) antibodies.

Treatment for Hay Fever

You may be able to lessen symptoms by limiting your exposure to allergy-causing substances. To do so, try to reduce your contact with mold and dust by cleaning and ventilating your rooms regularly and avoid going outdoors when the pollen count is high. Pollen counts are available on most weather apps.

If your condition is not severe, OTC medications may relieve your symptoms. For severe symptoms, prescription medications are needed.

Medications for hay fever include:

  • Nasal corticosteroids: Topical nasal steroid sprays that prevent and treat nasal inflammation and runny nose. Now available OTC and by prescription.
  • Decongestants: Available as OTC and prescription liquids, tablets, and nasal sprays.
  • Cromolyn sodium: OTC nasal spray that can be used several times a day.
  • Leukotriene modifier: Prescription tablet that blocks the leukotrienes, an inflammatory mediator released in the chronic phase of an allergic reaction.
  • Nasal ipratropium: Prescription nasal spray to prevent a runny nose.
  • Oral corticosteroids: Pills that relieve hay fever symptoms.
  • Antihistamines: Nasal sprays, eye drops, and oral medications that block the release of histamine that is mainly released in the acute phase of an allergic reaction. They help with itching, runny nose, and sneezing yet have no benefit for congestion.
  • Sinuses rinsing: Helps remove pollen, dust, and other debris while relieving nasal symptoms. Budesonide is an effective medication for sinus rinsing.

Medications only temporarily relieve symptoms (usually by 30%) for a short duration yet do not stop the expected worsening of your allergies over time. Regardless of if medications alleviate your symptoms, immunotherapy is still the best treatment. This is the only way to treat the underlying disease and not just the allergy symptoms.

Sublingual allergy drops are safe, convenient, improve quality of life, and reduce long-term medication needs.


For seasonal hay fever, stay indoors as much as possible during times when pollen counts are high. If you elect immunotherapy, you should start treatment three months before the start of the triggering season. For perennial hay fever, avoid triggering allergens.

Consistent immunotherapy treatment can help hay fever reduce symptoms by building up your immunity. Continuing treatment for 3-5 years results in long-term desensitization against pollen.

Hay fever symptoms can be effectively managed, controlled, and eliminated with proper treatment. Start making positive life changes to keep your condition at bay.

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