The symptoms of hay fever, also known as allergic rhinitis or nasal allergies, can range from being mildly annoying to making you completely miserable. Hay fever occurs when your body’s immune system treats a normally harmless substance as an intruder. These substances are called allergens. The most common allergen that causes hay fever is pollen, which is released in the air by trees in the early spring, grass in the summer, and weeds in the fall. Hay fever can also be triggered by allergens in your house, such as pet dander and dust.
When you are exposed to an allergen, your body releases chemicals to act as “defense” against the allergen. One type of chemical that your body releases is called histamine. The release of histamine results in symptoms very similar to a cold, such as a runny nose and sneezing.
The best way to treat hay fever is to avoid the substance you are allergic to. However, this isn’t always possible. The most common medications used to treat hay fever are over-the-counter (OTC) antihistamines. However, there are several other medications available. There are also alternative therapies, lifestyle recommendations, and long-term solutions that can help control your symptoms.
There is no cure for allergies. Avoiding the allergen altogether is the most effective way to treat hay fever. Unfortunately, depending on where you live, it's often not possible to completely avoid pollens in the air. So people often rely on treatments to minimize their symptoms. Luckily, there are a variety of medications available both over the counter at drug stores as well as drugs prescribed by a doctor. These hay fever treatments are the same regardless of the allergen.
It helps to know exactly what you are allergic to. That way you can change your day-to-day activities to avoid the specific allergen as much as possible. Although you can't completely avoid allergens all the time, you can reduce your symptoms by making some of the following lifestyle changes.
Tips for avoiding pollens include:
- Close doors and windows during pollen season.
- Use air conditioning.
- If you have a ventilation system, use an allergy-grade filter.
- Avoid going outside in the early morning or on dry, windy days, when pollen counts are higher.
- Use a high-efficiency particulate air filter (HEPA) filter.
- Don't mow the lawn or rake leaves.
- Wear a mask when doing outdoor activities like gardening.
- Shower or bathe before bedtime to wash off pollen in your hair and skin.
Tips for avoiding dust mites include:
- Wash sheets and blankets often, in water heated to at least 130 degrees Fahrenheit.
- Use allergy-proof dust mite covers on mattresses and pillows.
- Use a dehumidifier.
- Use air conditioning.
- Use a vacuum with a small-particle or HEPA filter and vacuum at least once a week.
- Remove carpeting, drapes, and upholstered furniture from your house or apartment.
Tips for avoiding cockroaches include:
- Empty the garbage daily.
- Block off any cracks or crevices in the wall where roaches can enter.
- Sweep food crumbs off the floor.
- Store food in sealed containers.
- If have a big problem with cockroaches, hire a professional pest exterminator.
Tips for avoiding pet dander include:
- Keep pets outside, if possible.
- Wipe down pets when they return inside.
- Bathe pets weekly.
- Keep your pets out of your bedroom.
- Vacuum often.
Tips for avoiding mold include:
- Remove houseplants.
- Clean shower curtains.
- Clean indoor trashcans frequently.
- Use a mix of water and chlorine to kill all visible mold.
- Open doors and windows to increase air movement.
- Use a dehumidifier.
- Don't use carpets in damp rooms such as the bathroom.
When a drug is “over-the-counter” (OTC), that means you don’t need a prescription from a doctor in order to purchase the drug. The two major types of OTC allergy medications are antihistamines and decongestants.
These block the effect of histamine. This is the chemical that your body makes during an allergic reaction. They are typically available in different dosages, including ones that act for four hours to more long-acting formulations that work for 12 or 24 hours. Examples include the following:
- diphenhydramine (Benadryl)
- loratadine (Claritin, Alavert)
- cetirizine (Zyrtec)
- fexofenadine (Allegra)
- nasal antihistamine azelastine (Astelin)
These work by narrowing the blood vessels and reducing blood flow. This helps clear congestion and improve breathing through the nose. They typically come as nose drops and sprays, but also can be oral tablets and liquids. They should typically be used for no more than three days since you can become dependent on them. Examples include:
- pseudoephedrine (Sudafed, Afrin nasal spray)
- oxymetazoline (Sinex nasal spray)
One prescription medication designed to relieve the symptoms of hay fever is montelukast (Singulair). This is a tablet that blocks the action of immune system chemicals called leukotrienes
Other prescription treatments include nasal steroid sprays, such as:
- beclomethasone (Q-Nasl, Beconase)
- mometasone (Nasonex)
- triamcinolone (Nasacort)
- budesonide (Rhinocort)
- longer acting antihistamines such as desloratadine (Clarinex)
Immunotherapies are also called allergy shots. Allergy shots are recommended for people who don't respond to other treatments or people who can't avoid the allergen. They offer a more long-term solution to hay fever.
Immunotherapy treatments involve injections of a diluted allergy extract. The extract helps the body eventually build tolerance to the allergen and reduce the intensity of symptoms. The shots are given at various intervals over a time period of three to five years. Improvement will take several months.
A newer form of immunotherapy for hay fever is called sublingual immunotherapy allergy tablets. Sublingual means that you take the allergen under the tongue. They are usually taken once a day. According to the American Academy of Allergy, Asthma & Immunology, the sublingual immunotherapies approved in the United States include:
- timothy grass pollen sublingual extract (Grastek) to treat timothy grass allergy
- grass pollen sublingual extract (Oralair) to treat grass pollen allergy
- short ragweed pollen sublingual extract (Ragwitek) to treat ragweed allergy
Alternative treatments for allergies do exist, but there isn't a lot of evidence about how well they actually work or if they have long-term side effects. Examples of alternative medicines for allergies include:
One example of alternative medicine is acupuncture, an ancient Chinese technique in which needles are inserted into key points of the body. Another example is Ayurvedic medicine (Ayruveda), an old system of medicine originating in India that involves a system of herbalism, yoga, massage, detoxification, dietary regulation, and other medications.
Herbal supplements and vitamins may also be used as a form of alternative medicine. Examples include:
- extracts of the butterbur shrub (Petasites hybridus)
- spirulina (a type of blue-green algae)
- milk thistle (Silybum marianum)
- stinging nettle (Urtica dioica)
- vitamin C
- vitamin A
- vitamin E
- Lactobacillus acidophilus (the bacteria found in yogurt) and other probiotics
- fish oil
- flaxseed oil
- bioflavonoids, such as quercetin, catechin, and hesperidin
- Ginkgo biloba, which contains bioflavonoids and is used as an antioxidant and anti-inflammatory
Herbs can cause side effects. They can also interact with other types of herbs, vitamins, and both prescription and OTC medications. You should only take herbs under the supervision of a doctor. More studies are needed to determine if these alternative therapies have a legitimately beneficial effect on hay fever.
As with most medications there can be risks and side effects to taking them. Always check with your doctor before taking OTC medications with other prescription drugs. Be sure to read the directions on the label to learn how much medicine to take and how often to take it. Taking more than the recommended amount can be dangerous. Call your doctor or pharmacist if you have any questions.
Certain antihistamines can cause drowsiness. It’s important to not drive or operate machinery when you first take an antihistamine. Particularly in situations where mental alertness is important (i.e. driving), avoid taking antihistamines with antidepressants (at least until you know whether or not they cause an interaction in you), and you should, of course, avoid using them with any substances already likely to impair your consciousness, such as muscle relaxants, sleeping pills, or alcohol.
According to the American Academy of Family Physicians, you should talk to your doctor before using an antihistamine if you have the following underlying medical conditions:
- high blood pressure
- chronic bronchitis
- angle-closure glaucoma
- enlarged prostate
- heart disease
- thyroid disease
- kidney or liver disease
Nasal sprays should not be used for more than three days. After three days, they can lead to rebound swelling, which can actually make your symptoms worse. Decongestants that contain the ingredient pseudoephedrine can raise your blood pressure, so you should speak with your doctor about using decongestants if you have high blood pressure.