Hay fever: spot the symptoms and find the best treatment

6th June, 2022 • 13 min read

If you get hay fever, the symptoms can ruin both your day and your sleep. Think itchy, swollen eyes, a blocked or runny nose, and mucus making you cough – not to mention the tiredness that often goes along with it.

It’s one of the most common allergic conditions, and during ‘hay fever season’, it can be difficult to control if you don’t have the right treatments for you.

But the good news is that hay fever can usually be managed and treated with some simple lifestyle changes and self-care tips, plus medication from a pharmacist. If these don't work your doctor may prescribe these.

So read on to find out more about it, including how best to deal with your symptoms – so you can get on with enjoying life to the full.

What is hay fever?

First up – hay fever is definitely not an allergy to hay! It’s a very common problem, which is also known as seasonal

allergic rhinitis
.

Allergic rhinitis is an

allergy
, where your body’s immune system reacts to a substance – an ‘allergen’ – that’s usually harmless to other people. With hay fever, the allergen is a fine powder called pollen, which is made by grasses, trees and weeds at certain times of the year. (
Other types of allergic rhinitis
can be caused by allergens such as dust mites and pets.)

Your body’s reaction to pollen triggers the release of a chemical called histamine, which is designed to help you get rid of the pollen that’s bothering you. But histamine in your nose, eyes and airways makes them inflamed, bringing on hay fever symptoms such as itching and sneezing (see below).

Who gets hay fever?

Hay fever is very common:

  • in the UK, up to 20% of people have it at some point in their life
  • in the US, between 15% and 30% of adults report hay fever symptoms
  • it’s most common up to the age of 20, with symptoms peaking between the ages of 15 and 19
  • the number of people who have it gets lower with age – although recent studies suggest it’s becoming more common

You might be more likely to get hay fever – or your symptoms might get worse at certain times – if:

  • you have
    asthma
    or
    eczema
    , or other allergies
  • a parent, brother or sister has asthma or allergies
  • your mother smoked during your first year of life
  • you live in an area of high air pollution
  • you exercise outdoors
  • you work somewhere that constantly exposes you to allergens – such as a florist
  • you’re pregnant – about a third of women find hay fever symptoms are worse during pregnancy. Read more about
    hay fever in pregnancy

What are the common symptoms of hay fever?

Hay fever symptoms commonly include:

  • sneezing and an itchy, runny or blocked nose – these often come on within minutes of contact with pollen
  • itchy, red or watering eyes
  • coughing
  • an itchy throat or mouth
  • headaches
    and a feeling of blocked sinuses
  • feeling
    tired

If you also have allergic asthma, you may have:

These symptoms can last for weeks or months – unlike symptoms of a cold, which usually only last a week or 2. (Read about how to tell the

difference between hay fever, a cold and COVID-19.

They’re also more likely when the pollen count is at its highest (see below).

If you’re worried about your symptoms but aren’t sure if it’s hay fever, try our

Smart Symptom Checker
to help you work out what to do next.

What are the different types of pollen allergies?

There are about 30 types of pollen that cause hay fever. You can have an allergy to grass, tree or weed pollen, and more than 1 type of pollen.

Trees, grasses and weeds have ‘pollen seasons’, when they release pollen:

  • tree pollen – in the UK and US, this is typically released from about March until May (although sometimes as early as January). About a quarter of people with hay fever in the UK are allergic to a tree pollen
  • grass pollen – in the UK and US, this is generally released from around mid May to July (but could be throughout the year in the southern US). Most people with hay fever are allergic to a grass pollen
  • weed pollen (from plants such as dock, mugwort and nettles) – in the UK and US, this is usually released from about late June to September. It’s a less common cause of hay fever

What is a pollen count?

A pollen count measures how much pollen is in the air in a 24-hour period – the higher the count, the more pollen there is.

A high pollen count tends to trigger hay fever symptoms, and your symptoms may get worse the higher it gets.

For grass pollen, a count between 50 and 150 is thought of as high. But people react differently to pollen counts, as well as different types of pollen. Some people will have more of a reaction to lower counts than others.

There are also pollen ‘forecasts’, which give an idea of how high the pollen count is likely to be over the next few days. These can help you plan your activities, and take action to prevent your hay fever symptoms if necessary.

How to deal with hay fever at home

Hay fever symptoms can really affect your enjoyment of everyday life. But following good ‘hay fever hygiene’ can help to reduce them.

Inside, try:

  • keeping your windows and doors shut when possible – especially on days when the pollen count is high
  • dusting with a damp cloth, rather than a dry one – this helps stop pollen being spread about your house
  • vacuuming regularly – ideally using a vacuum cleaner that has a built-in high-efficiency particulate air (HEPA) filter
  • avoiding keeping fresh flowers in your house, if you find they trigger your symptoms or make them worse. Lilies are common culprits, as they release a lot of pollen into the air, while roses are less likely to cause problems, as they release only small amounts
  • washing your bedding and blankets regularly to remove any pollen build-up
  • drying your washing inside – to help stop pollen being brought indoors on your laundry
  • avoiding
    smoking
    – or allowing other people to smoke – this can irritate the lining of your nose, eyes, throat and airways, and make hay fever symptoms worse

Outside, try:

  • putting Vaseline around your nostrils to trap pollen before it gets into your nose
  • wearing wraparound sunglasses to stop pollen getting into your eyes
  • showering and changing your clothes when you get home to remove any pollen
  • keeping any grass in your garden short and regularly mown – to stop it from flowering
  • avoiding playing or walking in areas of long grass – which are more likely to be flowering
  • keeping your car windows closed as much possible
  • checking the pollen count before you go out – and adjusting your activities if it’s high

Read more about

natural ways to manage hay fever
.

How a pharmacist can help

Your pharmacist is usually the first place to go for advice and treatment to help with hay fever symptoms. If they think you have hay fever, they may recommend 1 of the following:

Antihistamines

  • these medicines block the action of the histamine your body releases when you come into contact with pollen
  • this reduces your reaction, and therefore your symptoms
  • they’re available as tablets, syrups, nasal sprays and eye drops
  • there are non-drowsy and drowsy types – you might need to try both to see what works for you
  • read more about
    antihistamines
    , including how to get the best from them and the possible side effects

Nasal decongestant sprays

  • these can help relieve a blocked nose – a common hay fever symptom
  • they reduce the swelling of blood vessels in your nose, which helps to open up your nasal passages
  • you shouldn’t use them for longer than a week
  • longer use can cause dryness and irritation, or even make your symptoms worse
  • get advice from your doctor or pharmacist before using them if if you’re
    pregnant
    or breastfeeding, or you have
    high blood pressure
    , an
    overactive thyroid gland
    , an
    enlarged prostate
    or
    glaucoma

Steroid nasal sprays

  • these medicines can reduce inflammation in your nose
  • your pharmacist may suggest them if: your main symptom is a blocked nose; you’ve tried antihistamines and they haven’t helped; you’re pregnant or breastfeeding
  • they work best if you start using them a couple of weeks before you think your symptoms will start (ie the start of the grass pollen season)
  • you need to use them regularly during the pollen season

Read more about

steroid nasal sprays
, including how to get the best from them and managing any side effects

Eye drops

  • these can help with eye symptoms such as redness, itchiness and watering (allergic
    conjunctivitis
    )
  • they contain either antihistamines or an anti-inflammatory called sodium cromoglicate
  • it can take several weeks before they help with symptoms
  • some can cause side effects, such as a stinging or burning sensation

Doctor’s tip

“Rinsing your nasal passages with a sterile saline wash from a pharmacy can be a simple way to relieve nasal congestion and make breathing easier,” says Dr Roger Henderson. “Called ‘nasal irrigation’, it helps to flush out mucus and allergens, and you can do it several times a day if needed.” (Read more about this and other

hay fever home remedies worth trying
.)

When to see a doctor

If you’ve tried self-care and pharmacy treatments for hay fever symptoms and they haven’t helped, see your doctor.

They can check that it’s definitely hay fever that’s causing your symptoms, and prescribe other treatments if needed.

How is hay fever diagnosed?

A description of your symptoms and what seems to trigger them is usually enough information for your doctor to diagnose hay fever.

Before your appointment, try keeping a diary of your symptoms and when they appear (the trackers in the

Healthily app
can help you do this).

They may also ask if you have chest symptoms – such as wheezing – or any other allergies or health conditions.

Allergy tests
aren’t usually needed, unless:

  • your symptoms are severe
  • treatment doesn’t work
  • it’s affecting your daily life – such as stopping you from going to work, or causing trouble sleeping (
    insomnia
    )
  • you’re also getting other health problems, such as asthma or sinus infections (
    sinusitis
    )

If tests are needed, the 2 main options for hay fever are:

  • skin prick test – an allergy specialist puts a pollen allergen on the skin of your arm and pricks the surface with a small needle. If you’re allergic to it, you’ll have a reaction – your skin may go red, swell up or become itchy. (This test may not be suitable if you’re taking antihistamines or have eczema)
  • blood test
    – a blood sample is taken from a vein in your arm and tested for an antibody called immunoglobulin E (IgE). When you have hay fever, your body makes this when it comes into contact with pollen

How might your doctor treat hay fever?

If your doctor diagnoses hay fever, they may prescribe or recommend purchasing the following from a pharmacy or supermarket, rather than giving you a prescription, as per government policy:

  • antihistamines – these are the same as antihistamines from a pharmacy, but some people may need to have them prescribed by a doctor. This is more common if you have a serious underlying condition such as kidney failure, you’re pregnant, or you’re taking medication that could interact with antihistamines
  • steroid nasal sprays – while you can get some steroid nasal sprays from a pharmacy, others are only available from a doctor
  • other nasal sprays – there are several other types of nasal spray that can help with hay fever symptoms. You might be prescribed 1 of these if: you can’t use antihistamines; your nose is still running despite using an antihistamine and a steroid spray; you need a combination of steroids and antihistamines to manage your symptoms
  • eye drops – while you can get some eye drops for hay fever from a pharmacy, other types are only available on prescription. These can be faster-acting, or work when pharmacy drops don’t
  • steroid tablets
    – if your hay fever is severely affecting your quality of life, you may be given a short course of these medicines to quickly improve your symptoms. (
    Steroid injections
    aren’t used to treat hay fever any more, as it’s not clear if they’re safe and effective in the long term)

If you’re referred to an allergy specialist for hay fever treatment, they may suggest:

  • montelukast – if you have asthma as well as hay fever, you might be given this medicine to take as a tablet once a day. It works by helping to prevent the inflammation that causes your airways to narrow
  • immunotherapy – this long-term treatment might be an option if your hay fever is severe and other treatments haven’t worked. It involves having injections or tablets that contain slowly increasing doses of pollen, to help reduce your reaction to it. Read more about
    immunotherapy for allergies

Your health questions answered

Does paracetamol help with hay fever?

Paracetamol
has no effect on preventing allergies or hay fever, and isn’t a treatment for them. But if your hay fever causes headaches or sinus pain, simple painkillers such as paracetamol can help relieve these symptoms. Always read the leaflet that comes with them, and never take more than the recommended dose.”

Can Botox help with hay fever?

“This type of treatment is

more often used for cosmetic purposes
, but it may also be able to help hay fever symptoms. Though it’s only been tried in a small number of people, applying botulinum toxin A (Botox) into the nose either as an injection or gel does seem to reduce nasal symptoms such as sneezing, itching and a blocked nose – for up to 8 weeks (injection) or 2 weeks (gel). It may be worth trying if you have chronic nasal inflammation and other treatments have failed – although it isn’t routinely available, and can be expensive.”

Important: Our website provides useful information but is not a substitute for medical advice. You should always seek the advice of your doctor when making decisions about your health.