Allergic Rhinitis: Hay Fever FAQ

Reviewed by Ann Hefel, RN

While most people gratefully welcome the longer days and warmer weather of spring, people with hay fever often dread the itchy eyes, runny nose and sneezing that comes with the season's pollens and mold spores. Learn answers to frequently asked questions about this common allergic condition known as hay fever (seasonal allergic rhinitis).


FAQ Topics


Question: What causes my allergies to flare up in the spring?

Answer: Pollen is the most likely cause. Your immune system has mistakenly learned to remember the pollen released by various plants as potentially harmful, and responds with the familiar allergic symptoms. Each species of plant releases pollen at about the same time every year. Trees are usually the first plants to release pollen, usually in the early spring. Grasses come next in the spring and early summer. Weeds generally release their pollen in late summer and fall. The specific types of pollen and the time of their release depend upon the local climate and vary around the country. People with seasonal rhinitis are often allergic to more than one type of pollen.


Question: What can influence the severity of the allergy season?

Answer: Weather can influence the timing and severity of the allergy season. A mild winter often leads to a more severe pollen season. The grass season varies the most. If the spring is warmer and wetter than usual, then more grass grows, which leads to a more severe season during the late spring and summer. However, rain can have benefits, as well. For instance, rain can wash pollen that has already been released out of the air.


Question: My husband suffers from asthma and allergies but hasn't had trouble with either since we moved to Colorado. However, we want to go to a place to dance, and we have been warned that it will be smoky. Will he probably need an inhaler for this? What do you suggest?

Answer: Irritants such as cigarette smoke can trigger asthma and nasal symptoms. Therefore, if you are going to be exposed to irritants like smoke, dust or other air pollution, it is wise to take along your rescue inhaler and take it at the first symptoms.


Question: I have always had normal nasal (rhinitis) symptoms, but this year, I have also developed asthma and food allergies. Is this a typical allergic response?

Answer: Some people with a history of pollen allergy develop a condition called oral allergy syndrome. This occurs when cross-reactions between allergy pollen and fresh fruit cause itchiness and swelling in the mouth and throat after eating the food allergen. Although this is usually mild, you should be evaluated by your allergist because sometimes the reaction can be severe. People with a history of nasal allergy are more likely to have asthma than individuals without allergy.


How is hay fever diagnosed?

Question: How can I tell whether I have allergies or just a cold?

Answer: Generally, allergies last longer than a cold, often for a few weeks. If you notice a pattern in which you suffer the same symptoms at the same time year after year, you are likely suffering from allergies. Frequent sneezing and itchy, watery eyes are more often associated with an allergy rather than a cold. Also, a clear nasal discharge suggests that you are suffering from allergies. When you have a cold, the mucus is usually greenish or yellowish. A low-grade fever may also indicate a cold. Sometimes it can be hard to tell the difference between seasonal allergies, a cold or another condition. That's when skin tests and an evaluation by an allergist may be necessary.


Question: I am 68 and seem to be developing allergies to flowers, tree pollen, etc. How do I find out what I'm allergic to, and do I need to start year-round treatment?

Answer: The best way to diagnose allergy is skin testing and evaluation and interpretation of your history and skin test results. It would be unusual for someone age 68 to develop new allergies, but it is not unheard of. I would recommend an evaluation with skin testing by an allergist.


Question: How can you tell the difference between an allergy and exposure to mold?

Answer: To differentiate mold allergies from other types of allergies, an evaluation by an allergist including skin testing would be required. The exact role of all molds in causing sinus and lung disease is very complicated and the focus of a lot of research.


Question: What is the difference between RAST testing and skin testing? Is one more beneficial than the other?

Answer: RAST testing is a term that is often used to describe blood test for allergy (although most currently used blood tests for allergy are no longer truly a RAST test), while skin testing involves plastic needles that are used to prick the skin of the patient. Skin testing is cheaper and more accurate than RAST testing, but occasionally, as in the case of a complicating skin disease or the lack of patient access to an allergist, RAST testing is sometimes a reasonable alternative. RAST stands for ‘radioallergosorbent test’ and measures the amount of IgE antibody in the blood — the antibody involved in allergies. Due to improved laboratory techniques, the radioallergosorbent test is no longer performed. The newer laboratory techniques more accurately measure allergy antibody levels than the old RAST testing. However, skin testing is still significantly cheaper and somewhat more accurate.


Question: What is a skin test? How does it work?

Answer: A skin test detects the presence of antibodies to a particular allergen, a substance that causes an allergic reaction. A positive test suggests that you may have an allergy to the particular substance. However, your doctor will review your skin test results and your medical history and conduct a physical exam to confirm which allergens are causing your symptoms. A skin test is performed by first placing a drop of allergen extract on the skin, then the skin is pricked with a needle. If you have a positive reaction to the extract, a red welt will appear on your skin in about 15 minutes. The size of the welt may indicate the strength of the reaction. If you do not react to the extract, you are most likely not allergic to the substance.


How is hay fever treated?

Question: How do I treat seasonal allergies?

Answer: There are three main strategies:

  1. avoidance;
  2. medication; and
  3. allergy shots (immunotherapy).

Although it can be difficult to avoid pollen, there are several steps you can take to reduce your exposure. First of all, keep your windows closed and use air conditioning even on days that are not extremely warm. Next, avoid outdoor activities during peak pollen times of the day. Grass pollens are most prevalent during afternoon and early evening, while ragweed pollens are most prevalent during early midday. Pollen counts are commonly high during dry, windy afternoons. Finally, it can be helpful to take a shower and change your clothes after spending time outside. A shower washes off the pollen that sticks to your skin or hair. Keep your outside clothes in the laundry room and away from your bedroom.

Antihistamines can reduce runny nose, sneezing and itchy, watery eyes. First generation antihistamines, such as Benadryl, are available over the counter but can cause drowsiness. There are now non-sedating (loratadine) and low-sedating (cetirizine) antihistamines that are available over the counter. Other non-sedating antihistamines are available by prescription from your doctor. Itchy eyes can be helped by antihistamine eye drops, also available by prescription. Another type of medicine that can be used for nasal allergy symptoms blocks a molecule called leukotriene. This medication is called montelukast and may be beneficial in some people. In many cases of hay fever, prescription nasal steroid sprays are often used to decrease nasal allergy symptoms. These are often more effective than antihistamine or antileukotriene pills. You should talk to your doctor to decide what medications are best for you.

Allergy Shots (Immunotherapy)
If avoidance and medications fail to control your symptoms, immunotherapy can usually help. Also known as allergy shots, immunotherapy consists of a series of injections containing the allergen that triggers your symptoms. Over time, the shots reduce your sensitivity to the allergens. Immunotherapy usually begins with injections of a very weak solution of the allergen given once or twice a week. The strength of the solution is gradually increased. Once the strongest dose is reached, shots continue about once a month until the allergy symptoms are controlled, often for three to five years. There are now newer approaches that allow the dose of allergy shots to be built up much more quickly; however, the total course of therapy is still usually three to five years.


Question: Does allergy shots (immunotherapy) cure my seasonal allergies?

Answer: No. Right now, there is no cure for allergies. Allergy shots can, however, have a protective effect for several years. Allergy shots can decrease symptoms, decrease need for other allergy medications and improve quality of life in many individuals.


Question: I have hay fever really bad in the spring and the fall; how soon before my bad season starts should I take my allergy meds?

Answer: Most medications are effective within a matter of days. Cromolyn takes a full month to be completely effective, although this is not commonly used anymore. Allergy shots may take much longer to start working. Talk to your allergist about a plan to help keep you from having bad allergy symptoms before they start.


Question: I am allergic to oak trees, and, of course, I live in the woods with only oak trees around. What is the best thing to take besides moving away?

Answer: Outdoor pollens can get indoors, so keeping the doors and windows shut is important. When conditions are dry and windy, the pollen counts are usually highest in the afternoon so working in the yard may be better in the morning and evening. There is no way to completely avoid the pollen, because even if you moved away, the pollens may be blown for many miles.


Question: What is the cause and how do I get relief for watery eyes? I am a 70-year-old male with asthma. My eyes water constantly, so much so that tears run down my face. This occurs when I go outside (e.g., grocery shopping, walking, etc.).

Answer: Watery, itchy eyes are usually related to allergic conjunctivitis, although other eye conditions can cause these same symptoms. Prescription allergy eye drops can relieve the symptoms of itchy, watery eyes. Usually if allergy is the cause, there will be eye itching as well as the watering you describe. Check with your doctor about your symptoms and to discuss evaluation and treatment options.


What are the complications with other respiratory conditions?

Question: I have COPD and problems with my sinuses. I currently use Claritin-D®. Is there another medicine that will work better to clear up the drainage? I am also on Serevent®, Atrovent®, Proventil® and Uniphyl®. I rarely take Proventil.

Answer: Medications like Claritin-D can help sinus drainage for people with allergy and sinus drainage problems. Other antihistamines and decongestants can work as well. When there are chronic sinus problems, especially with a history of allergy, nasal steroid sprays are often very helpful. Nasal saltwater rinses can also be very beneficial. You will need to talk to your doctor about these options, but most people's symptoms can be well controlled. Also be sure to talk about your other medications.


Question: I have emphysema and struggle with shortness of breath this time of the year due to allergies. What treatments and medications are recommended for those with COPD and heart problems (I had open heart surgery nine years ago)?

Answer: Standard treatment for allergies should help when they complicate COPD. The standard treatment for nasal allergies includes nasal steroid sprays, nasal saline (saltwater) washes, and antihistamines.


Question: I have a mother-in-law who lives in Napa, California. She has bad asthma and wants to move out of California. Is there a list that shows the "best places to live for asthma sufferers"? If so, can you direct me to it?

Answer: There is no list of good or bad places to live with asthma, since asthma can be triggered by a variety of things such as allergies, air pollution and climate. There may be variations in these factors that can influence asthma control. For allergies caused by pollens there may be a short honeymoon from allergies when someone moves to a new place. However, within a few years people often become sensitized to new allergens.


Question: I recently moved to Denver from the West Coast, and my asthma is much better here. I travel a lot for business, usually to the West Coast, and my asthma is worse again. What is the difference?

Answer: Because of its dry air and high altitude, Denver has lower levels of the house dust mite. The house dust mite is a major allergen causing asthma flare-ups on the West Coast and in other humid areas of the country. This might explain why you do well in Denver and suffer relapses of asthma when you travel. Evaluation by your allergist will likely be helpful.


Question: Why is it that some children only get sick with asthma in the wintertime? Should I always start my child on inhaled steroids in August? And leave him on them until March?

Answer: The most likely explanation is that your child's asthma flare-ups are caused by viral infections. These tend to be most common in the wintertime. A less likely explanation is that your child is allergic to indoor allergens such as molds, animal dander and house dust mites. Because people often spend more time indoors during the winter, this may increase exposure to indoor allergens. It is very reasonable for your doctor to put your child on preventive therapy such as inhaled corticosteroids in the winter if you know from past experience that he is likely to have increased symptoms at that time.


Question: Can people with COPD take Allegra®? I know Sudafed and others are not recommended for COPD patients.

Answer: People who have allergies as well as COPD can take antihistamines, such as Allergra, for their allergies.


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