Hay Fever - Diagnosis and Treatment

Diagnosis

A healthcare provider usually starts by asking about your symptoms, possible triggers, and general health. Doctors look for signs like sneezing, nasal congestion, runny nose, itchy nose, watery eyes, or red eyes.

They also check for physical signs, such as nasal symptoms, allergic conjunctivitis, or itchy skin. Doctors use two main allergy tests:

Test Type	What Happens	What It Shows
Skin prick test	Doctors prick tiny drops of allergens into the skin. Raised bumps (wheals) mean a reaction.	Shows which airborne allergens cause symptoms.
Allergy blood test	Doctors test blood for immunoglobulin E (IgE) antibodies.	Detects allergy-causing antibodies in the immune system.

Doctors may check for a higher number of eosinophils, a type of blood cell linked with allergies. These tests help determine if sneezing, stuffy nose, or other symptoms are caused by allergic rhinitis or seasonal allergies.

Treatment

Medications Commonly Used for Allergic Rhinitis

Many medicines can help lessen hay fever symptoms. You might use these medicines alone or together, depending on your needs and your healthcare provider’s advice.

Nasal Corticosteroid Sprays

Doctors often recommend nasal corticosteroid sprays first because they help treat and prevent nasal congestion, itching, sneezing, and runny nose. Some prescription sprays combine a corticosteroid with an antihistamine for added relief.

How They Work: They reduce swelling and inflammation inside the nose.
Who Can Use Them: Most people can use them, but children and people with certain health conditions should check with a doctor first.
Side Effects: Mild side effects can include a strange taste or smell, or nose irritation.

Antihistamines

Antihistamines block histamine, which your immune system releases during an allergic reaction. These medicines help with sneezing, itching, and a runny nose, but do not work as well for nasal congestion. Antihistamines come in several forms:

Medicine Type	How Used
Oral (tablets, pills)	Swallowed
Eye drops	For itchy eyes
Nasal sprays	For nasal symptoms

Oral antihistamines can sometimes cause dry mouth, tiredness, or headaches. Some types make people sleepy, so always check medicine labels, especially for children or if you need to stay alert during the day.

Decongestants

Decongestants shrink swollen tissues in the nose and help you breathe more easily. You can find them as tablets, liquids, and nasal sprays. Decongestant nasal sprays should not be used for more than two or three days in a row. Using them too long can make symptoms worse (rebound congestion).

Possible side effects include trouble sleeping, headaches, high blood pressure, irritability, and, in some cases, trouble urinating. People with certain health problems, such as heart disease, should ask a doctor before using decongestants.

Cromolyn Sodium

Cromolyn sodium helps prevent allergy symptoms by stopping histamine from being released. It works best when you use it before symptoms start.

You can buy cromolyn sodium as a nonprescription nasal spray and get it by prescription as eye drops. You need to use it several times a day. Serious side effects are rare.

Leukotriene Blockers

Some people benefit from leukotriene receptor antagonists. This medicine, usually taken as a tablet, blocks leukotrienes—chemicals that cause allergy symptoms like extra mucus and swelling in the nose.

Headaches are the most common side effect. Rare mental health effects like mood changes, insomnia, or anxiety can happen. Only use this medicine if your healthcare provider recommends it.

Nasal Ipratropium

Doctors can prescribe nasal ipratropium to help stop a runny nose by reducing mucus production. It does not help with stuffiness, sneezing, or itching.

Side effects may include a dry nose, nosebleeds, dry eyes, or a scratchy throat. People with glaucoma or an enlarged prostate should talk to their doctor before using this medication.

Oral Corticosteroids

Doctors may prescribe steroid pills for short periods if symptoms are severe and other treatments do not help. Long-term use is not recommended because of risks like bone weakening, eye problems, and muscle weakness.

Other Options and Combination Medicines

Some people use medicines that combine antihistamines and decongestants. Combination nasal sprays or eye drops can target more than one symptom.

Children and pregnant or breastfeeding women often need different medicines or doses, so they should check with a doctor first.

Allergy Immunotherapy

Doctors may suggest allergy immunotherapy if medicines do not give enough relief or cause side effects. This treatment helps your immune system respond less to allergens.

Allergy Injections (Allergy Shots)

Doctors give allergy shots, also called subcutaneous immunotherapy, regularly over three to five years. The shots contain very small amounts of allergens like pollen, pet dander, or dust mites.

How It Works: With regular exposure, your body becomes less sensitive to the allergens.
Who May Benefit: People who do not get relief from regular medicines or want to use fewer medicines over time. Doctors often recommend allergy shots for allergies to pollen, dust mites, or animal dander.

Benefits include helping both adults and children. Allergy shots can also lower the risk of future asthma in children.

Sublingual Tablets (Under-the-tongue Immunotherapy)

For some allergens, such as certain types of pollen or dust mites, doctors may recommend sublingual tablets. You place these tablets under your tongue, and they dissolve, usually taken daily at home.

How It Works: Tablets work like shots but do not use needles.
Uses: They work best for grass pollen, ragweed, and dust mite allergies.

The tablets do not work for every allergen. It can take many months to see the full effect from immunotherapy.

Considerations for Immunotherapy

Immunotherapy does not provide quick symptom relief. You need regular appointments and monitoring, especially for allergy shots.

Immunotherapy Type	How Given	Allergens Covered	Time for Benefits
Allergy shots	Injectable	Pollen, dander, dust	Months to years
Oral tablets	Sublingual pill	Grass, ragweed, dust	Months

Doctors may not recommend immunotherapy for everyone, such as people with certain health conditions or those taking specific medicines.

Using Saltwater Nasal Rinses for Allergy Relief

Nasal saline rinses, also called saltwater washes, help clear out allergens and mucus from your nose. This makes it easier to breathe.

Saline Sprays: You can buy saline nasal sprays at most stores. They moisten dry nasal passages and can be used often without a prescription.
Nasal Irrigation (Saline Rinses): Nasal irrigation means gently pouring or squeezing a saltwater solution into your nostrils. This washes out mucus and allergens.
- Steps To Use Nasal Irrigation:
  - Choose a saline kit, neti pot, or squeeze bottle designed for nasal rinses.
  - Use only distilled, sterile, or previously boiled and cooled water to mix the solution.
  - Do not use tap water unless it is properly filtered.
  - Follow the instructions for making or using the saline solution.
  - Lean over a sink and pour or squeeze the solution through one nostril, letting it drain out the other side.
- Hygiene Tips:
  - Clean the rinse bottle or neti pot thoroughly after every use with hot, soapy water and let it air dry.
  - Using unclean equipment or unsafe water can lead to infections.
- Benefits: Nasal rinses reduce stuffiness and help clear out allergens. They are safe for daily use for both kids and adults and do not cause medication side effects.

Nasal Rinse Product	How Used	Safety Notes
Saline spray	Spray into nostrils	Can be used as often as needed
Neti pot/squeeze bottle	Pour or squeeze rinse	Use safe water, clean device after each use

When to Use: Use nasal rinses when you have nasal congestion from allergies, after being in dusty or high-pollen areas, or as a daily step during allergy seasons. Nasal rinses do not replace medicines, but they are often helpful as part of a complete allergy management plan.

Simple Ways to Manage Allergens at Home

Dealing with Airborne Plant Particles and Mold

Pollen from trees, weeds, and grass, as well as mold spores, can travel through the air and trigger allergy symptoms. You can limit exposure by following these tips:

Keep windows and doors closed during high pollen seasons.
Run air conditioners in homes and vehicles to filter incoming air.
Use high-efficiency particulate air (HEPA) filters in main living areas and bedrooms, and change or clean filters often.
Check local pollen forecasts and try to stay inside on dry, windy, or high pollen-count days.
Wear glasses or sunglasses outside to protect your eyes from pollen.
Do not hang laundry outside where pollen can cling to fabrics.
If you need to garden or do yard work, wear a mask to reduce inhaling particles.
Use a dehumidifier to keep indoor air dry and help prevent mold growth.
Clean regularly with a damp cloth or mop to trap allergens.

Steps to Minimize Dust Mite Contact

Dust mites live in fabrics, carpets, and bedding, especially in warm, damp spaces. You can limit their presence with these steps:

Cover mattresses, pillows, and box springs with special covers that keep dust mites out.
Wash bedding and stuffed toys weekly in hot water (at least 130°F or 54°C) to kill mites.

Use a dehumidifier or air conditioner to reduce humidity. Vacuum carpets regularly with a vacuum that has a HEPA or small-particle filter. If you have severe allergies, remove carpets from bedrooms or the whole home when possible.

Use a damp mop or cloth for cleaning instead of dry sweeping or dusting. This helps prevent dust from getting into the air.

Keeping Cockroaches Away

Cockroaches leave behind droppings and particles that can become airborne. You can help prevent exposure by following these steps:

Seal off tiny spaces where cockroaches can get inside.
Fix dripping faucets and leaky pipes to remove water sources.

Clean up food crumbs and spills right after meals. Store food (including pet food) in tightly closed containers. Take out trash and recycling each day. If cockroaches keep coming back, contact a pest control professional.

Managing Animal Allergens in the Home

Animals spread allergens through their skin, fur, saliva, and urine. You can lower pet dander by following these steps:

Keep pets out of bedrooms and off furniture.
Bathe dogs regularly. While bathing cats is less certain, cleaning pets can help.

Vacuum often with a HEPA-filter vacuum to collect pet dander. Wash hands after touching pets and their things. Change into clean clothes after close contact with animals.

Ask a friend or family member who is not allergic to help clean and groom pets. Remove carpets where possible if you are very sensitive. Use a damp mop and dust cloth for animal hair instead of dry methods.

Other Approaches to Treatment

Some people try alternative methods to manage hay fever, but there is limited proof that these work well. Herbal products like butterbur extract may help reduce allergy symptoms. Choose butterbur products labeled PA-free to avoid harmful substances.

People also try supplements such as spirulina and Tinospora cordifolia. Some use capsicum, honey, vitamin C, and fish oil for seasonal allergy relief. The U.S. Food and Drug Administration does not check these supplements the same way as regular medicine. Talk with a doctor before taking them.

Some people use acupuncture for allergies. While some say it helps with symptoms like sneezing or itchy eyes, clear evidence is lacking. None of these options are known to lower histamine directly.

Getting Ready for Your Visit

What Your Doctor Might Ask or Do

When you visit a health professional about allergy or hay fever symptoms, the doctor may ask about when your symptoms started, how often they happen, and how much they affect your daily activities.

They may ask if you feel tired, have trouble sleeping, or notice issues like sinus pressure, throat irritation, or ear problems such as infections or pain. If you have asthma, atopic dermatitis (eczema), or frequent sinus infections, mention it since these can connect to allergies.

Doctors look for signs that affect quality of life, such as missed days at school or work, poor sleep, or chronic fatigue. They may ask about family history, especially if close relatives have allergies, asthma, or anaphylaxis.

The health professional may perform a physical exam and check areas such as the nasal passages, throat, or ears for swelling, redness, or signs of blockage. If needed, they may refer you to an allergist for more testing, like skin or blood tests.

A table can help organize what the doctor may focus on:

Area	What Might Be Checked
Nose/Nasal passages	Swelling, blockage, mucus
Throat	Redness, irritation
Ears	Fluid, signs of otitis media
Skin	Rashes, eczema, atopic dermatitis
Lungs	Signs of asthma, wheezing

Steps You Can Take Before Your Appointment

Before you go in for an evaluation, prepare a simple list of topics to discuss. Write down your symptoms and note what makes them better or worse. Be sure to mention any ongoing problems, such as an itchy throat, sinus infections, or skin irritation.

List all medicines, supplements, or vitamins you currently use. Mark any recent travel or moves, since new environments may start symptoms. Consider bringing a friend or family member to your appointment.

They can help you remember advice or share what they have noticed about your symptoms. Questions for the doctor could include:

What tests will you need?
How can you improve symptoms like sinus pressure, poor sleep, or fatigue?
Are some treatments better for people with asthma, eczema, or frequent ear infections?
What steps can help prevent future sinusitis or anaphylaxis?
Should you see a specialist, such as an allergist?

Before your appointment, you can use non-prescription medicines like antihistamines or nasal sprays if your doctor has not told you otherwise. These may ease stuffiness, sinus issues, or throat discomfort.

Try to avoid known triggers like pollen or dust. Keep windows closed and check local pollen counts to reduce exposure. If you have severe symptoms such as trouble breathing or swelling, get emergency help right away.

Hay Fever – Diagnosis and Treatment