Overview
Hay fever (allergic rhinitis) is a common allergic disease characterized by nasal inflammation and symptoms due to the immune system's overreaction to allergens such as pollen, dust mites, mold, or animal dander.
It affects about 20% of the population. It is not related to "hay"; it got its name because it was first described during hay-cutting season. It is often accompanied by asthma and eczema.
Types
- Seasonal: Pollen allergies (spring-summer)
- Year-round: Dust mites, animal dander, mold
Symptoms
Symptoms start within minutes of contact with the allergen:
- Sneezing (especially in succession)
- Runny nose (watery, clear)
- Nasal congestion
- Itchy nose
- Itchy, red, watery eyes
- Itchy palate, throat
- Postnasal drip
- Cough (due to postnasal drip)
- Dark circles under the eyes ("allergic shiners")
- Horizontal line across the nose tip ("allergic salute" - in children)
- Fatigue, weakness
- Difficulty concentrating
- Sleep disturbances
- Headache
- Decreased sense of smell
Symptoms are similar to a cold but:
- No fever
- Clear discharge (not yellow-green)
- Severe itching is present
- Lasts weeks-months
Causes
The immune system perceiving allergens as harmful and releasing substances such as histamine.
Common allergens:
Pollen (seasonal):
- Spring: tree pollens (birch, oak)
- Summer: grass pollens
- Fall: weed pollens (ragweed, nettle)
Year-round allergens:
- House dust mites
- Animal dander (cat, dog)
- Mold spores
- Cockroaches
- Chemicals at work
Risk Factors
- Family history (strongest)
- Other allergies (eczema, food allergy)
- Asthma
- Early antibiotic use
- Air pollution
- Cigarette smoke exposure (infancy)
- Birth season (born during pollen season)
- Only child
- Urban life
Complications
- Decreased quality of life
- Sleep disturbances, daytime fatigue
- Asthma attacks
- Sinusitis (can become chronic)
- Middle ear infection
- Adenoid enlargement (in children)
- Concentration and school performance problems
- Nasal polyps
When to See a Doctor
- If symptoms are affecting daily life
- If it does not respond to over-the-counter medications
- If side effects occur
- If asthma symptoms have been added
- If sinus pain, fever has been added
- If symptoms have become severe
- Persistent nasal, eye complaints in your child
Diagnosis and Treatment
Diagnosis:
- Detailed history (season, trigger)
- Physical examination
- Skin prick test (allergen identification)
- Specific IgE blood test
- Endoscopic nasal examination
- CT in some cases
Treatment:
1. Avoidance of allergens (first step)
2. Medications:
Oral antihistamines:
- New generation: cetirizine, loratadine, fexofenadine, desloratadine, bilastine
- Less drowsiness
- As needed or regularly
Nasal corticosteroids (most effective):
- Mometasone, fluticasone, budesonide
- Used regularly
- Mainstay treatment in chronic allergic rhinitis
- Takes 1-2 weeks to work
Antihistamine eye drops:
- Olopatadine, ketotifen
- For eye complaints
Antihistamine nasal sprays:
- Azelastine
Leukotriene receptor antagonists:
- Montelukast
- Especially with asthma
Decongestants:
- Nasal decongestant sprays (short-term, no more than 3-5 days)
- Oral decongestants (caution in heart, blood pressure patients)
Other:
- Nasal saline irrigation
- Mast cell stabilizers
3. Immunotherapy (allergy shots):
- Subcutaneous or sublingual
- Lasts 3-5 years
- Permanent solution
- Does not require continuous medication
- May prevent asthma development
4. Biological treatments:
- Omalizumab (anti-IgE)
- For severe, resistant cases
Prevention and Lifestyle
Pollen protection:
- Do not go outside during peak pollen hours (early morning, evening)
- Keep windows closed
- Use air conditioning (with HEPA filter)
- Shower and change clothes when returning home
- Do not hang laundry outdoors (pollen sticks)
- Track the pollen calendar
- Wear sunglasses
Dust mites:
- Wash bedding at 60 °C weekly
- Anti-mite mattress and pillow covers
- Hard flooring instead of carpet
- Keep humidity below 50%
- Wash or freeze stuffed animals weekly
- Use damp cloth and vacuum (with HEPA filter) when dusting
Animal dander:
- Keep pets out of the bedroom
- Bathe pets regularly
- Use HEPA air purifier
Mold:
- Keep bathroom dry
- Control humidity
- Clean moldy areas
General:
- Do not smoke, avoid smoke
- Pay attention to your nutrition
- Exercise (for general health)
- Get enough sleep
- Manage stress