Hay fever, also called allergic rhinitis, causes cold-like symptoms such as a runny nose, nasal congestion, and sneezing and sinus pressure and pain. But unlike a common cold, hay fever isn't caused by a virus ? it's caused by an allergic response to indoor or outdoor airborne allergens, such as pollen, dust mites or pet danders.

 

Allergic rhinitis which occurs during a specific season is called "seasonal allergic rhinitis." When it occurs throughout the year, it is called "perennial allergic rhinitis."

Signs and symptoms

• Runny nose and nasal blocks (congested and stuffy nose)
• Watery or itchy eyes- allergic conjunctivitis
• Sensation of plugged ears
• Sneezing
• Cough- due to postnasal drip
• Itchy nose,  irritation in the roof of mouth or throat
• Sinus pain and facial pain
• Swollen, blue-colored skin under the eyes (allergic shiners)
• Decreased sense of smell or taste
• Sleeplessness
• Fatigue
• Irritability

Allergic rhinitis can lead to asthma and sinusitis.

Causes

• In hay fever the allergens enters the airways (mouth, nose, throat, and lungs), eye linings, and sometimes ears via direct contact.
• When the antigen (allergen) come into contact with antibody (IgE), there is release of histamine from mast cells which causes the symptoms of allergic reaction
• Common allergens
• Pollens – tree, grass, weed pollen
• Spores from fungi and moulds
• Dust mites or cockroaches
• Danders (dried skin flakes and saliva) from pets (cat, birds, dogs and others)
• Outdoor moulds- soil, vegetation and rotting woods
• Indoor moulds- attics, basements, and moist places,  

Risk factors

• Family history of hay fever
• Repeated exposures to allergen
• Other allergic conditions like eczema and asthma
• Nasal polyps

Tests and diagnosis

• Complete blood test
• Absolute esinophil count
• Skin prick test
• Allergy blood test- Radioallergosorbent ( RAST)

Complications

• Asthma
• Eczema
• Sinusitis
• Otitis media ( ear infection)

Prevention

• It’s not possible to completely avoid allergens, but minimize the exposure to allergens
• Reduce outdoor activity in the early morning when pollen counts are highest.
• Wear a dust mask when doing outdoor activities such as gardening.
• Consider removing carpeting, especially where you sleep, if you're highly sensitive to dust mites.
• Block cracks and crevices where roaches can enter.
• Wash dishes and empty garbage daily.
• Store food in sealed containers.

Treatment

• Nasal corticosteroids- Fluticasone, Mometasone, Beclomethasone and others
• Oral corticosteroids
• Antihistaminic- Diphenhydramine, Azelastine nasal spray, Loratidine, Fexofenadine and others.
• Decongestants- Nasal spray includes Phenyl ephrine, Oxymetazoline, Phenylpropnolamine and others.
• Cromolyn sodium
• Leukotriene modifiers- Motelukast and Zakirlukast
• Nasal atropine

Other treatments

Immunotherapy

• Also called desensitization therapy
• The goal is to desensitize you to specific allergens, reduce the signs and symptoms, and decrease the need for medications.
• Immunotherapy is especially effective in allergic to cat danders, dust mites, or pollen produced by trees, grass and weeds.
• In children, immunotherapy may help prevent the development of asthma.

Nasal lavage

• Rinse the nose with salt water to overcome the irritating nasal allergic symptoms
• Use an over-the-counter nasal saline spray or prepare own saltwater solution using 1/4 teaspoon of salt mixed with 2 cups of warm water.