All About Hay Fever

Causes, Symptoms, Diagnosis and Treatment of Hay Fever

Airborne pollen is the cause of hay fever.  ADAM

What is Hay Fever?

Hay fever, or allergic rhinitis, is the most common chronic disease, affecting up to 30 percent of the population. It is the most common reason for chronic sinus and nasal problems. Children and young adults are the most common age groups affected by hay fever, although many older adults and elderly people also experience symptoms.

What Causes Hay Fever?

Hay fever is caused by an allergic reaction to airborne plant pollens, which are typically only present for part of a year, such as spring or fall.

Pollen consists of tiny, egg-shaped, powdery grains released from flowering plants, such as trees, weeds and grasses, which are carried by the wind or insects and serve to cross-pollinate other plants of the same type for reproductive purposes. When pollen is present in the air, it can land in a person’s eyes, nose, lungs and skin and cause hay fever symptoms.

Common pollens that can cause significant hay fever include:

Symptoms of Hay Fever

Hay fever is caused by inflammation and irritation of the nasal passages due to seasonal and year-round allergens. Symptoms of hay fever include sneezing, runny nose, nasal congestion, itching of the nose, and post-nasal drip. Not all people experience all of the symptoms of hay fever, and when one symptom predominates, it may be a clue as to the cause or what would work best for treatment.

Diagnosis of Hay Fever

Hay fever is diagnosed when a person has convincing symptoms, and physical exam findings are consistent with this disease. However, in order for hay fever to be properly diagnosed, allergy testing is needed.

Positive allergy tests are required to diagnose hay fever; negative allergy testing suggests non-allergic rhinitis. While allergy testing can be accomplished with skin testing or blood tests (RAST), skin testing is the preferred method of testing because it is more accurate.

Watch allergy testing being performed.

Treatment of Hay Fever

The treatment of hay fever can be accomplished in one of three ways: Avoidance, medications or immunotherapy. Many people will utilize more than one of these approaches to best treat their hay fever symptoms.


Avoidance of the causes of hay fever can often be the best way to prevent symptoms. There is essentially no cost, no medication side effects, and is theoretically curative for hay fever. However, avoidance of airborne pollens is difficult, at best. Simply opening a window or door, or walking outside, results in pollen exposure. So unless you want to live in a bubble, avoiding pollen is pretty difficult.


Most people with hay fever will require the use of medications in order to treat their symptoms. There are numerous medications available to treat hay fever, and there is no single best medicine for all people. The best medicine to treat a person’s hay fever is dependent upon various factors, such as the severity and frequency of hay fever symptoms, the types of hay fever symptoms, the form of medicine a person is willing to take (such as a pill, eye drop or nasal spray), and the side effects that may occur from taking the medication.


When avoidance and medications fail to adequately control hay fever symptoms, immunotherapy is often recommended. Immunotherapy consists of a series of injections containing small amounts of the substances to which a person is allergic. After a course of allergy shots, most people have significantly fewer hay fever symptoms, and in some cases symptoms resolve completely. While immunotherapy is typically given in the form of allergy shots in the United States, allergy drops (sublingual immunotherapy) are more frequently used in other parts of the world, although the Food and Drug Administration has not yet approved them for use in the U.S.

Living with Hay Fever

Allergy season can make people miserable with symptoms of hay fever, causing them to want to take medications. A variety of allergy medications are available for the treatment of hay fever, from over-the-counter options, to prescription drugs, to alternative remedies, including the use of neti pots/saline washes, eating local honey, and acupuncture.

Immunotherapy is the only treatment for hay fever that changes how a person’s immune system reacts to allergies, and is the only therapy that can make a person less allergic -- however, success is not guaranteed. Given the wide variety of treatment options available, almost everyone can find a treatment that will help them get through the allergy season.

Learn how pollen counts can help predict hay fever symptoms.


Wallace DV, Dykewicz MS. The Diagnosis and Management of Rhinitis: An Updated Practice Parameter. J Allergy Clin Immunol. 2008;122:S1-84.

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