Hay fever
The old name misleads on both counts: hay has nothing to do with it and there is no fever. This is an allergy to pollen.
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Medicines commonly prescribed for Hay fever
For informational purposes only. Always consult a doctor before using any medicine.
Dosage form: TABLET, 10 mgActive substance: cetirizineManufacturer: Mabo Farma S.A.Prescription requiredDosage form: TABLET, 10 mg cetirizine dihydrochlorideActive substance: cetirizineManufacturer: Laboratorios Cinfa S.A.Prescription not requiredDosage form: TABLET, 10 mg cetirizine dihydrochlorideActive substance: cetirizineManufacturer: Viatris LimitedPrescription required
The old name misleads on both counts: hay has nothing to do with it and there is no fever. This is an allergy to pollen. It arrives in the same weeks every year, lasts a month or longer rather than a couple of days, and is far harder to live with than it looks from the outside. People with hay fever sleep badly, work at half strength through the whole season and are worn out by the evening, while everyone else simply sees somebody sneezing. It also rarely travels alone: in some people it drags asthma along behind it, and spotting that early matters more than anything else on this page.
How it differs from a cold
The most reliable clue is itching. The eyes itch, so do the roof of the mouth, the ear canals and the tip of the nose; a cold never does that. From there the picture is easy to recognise:
- sneezing not once or twice but in runs of five or ten, especially first thing in the morning;
- a streaming, watery nose that somehow still feels blocked;
- red, watering eyes with puffy lids by the end of the day;
- loss of smell and flattened taste;
- pressure across the forehead and cheekbones, and a headache as the day goes on;
- a heavy tiredness that bears no relation to how much you have done.
What allergy does not cause: a raised temperature, shivering, aching muscles or thick discoloured catarrh. A cold clears within a week or ten days; this drags on for weeks and returns the following year at almost the same time. It worsens outdoors and in dry, breezy weather, and eases in the rain and indoors. In children two things show from the outside: the repeated upward swipe of the palm across the nose, and dark shadows under the eyes that have nothing to do with late nights.
Why it comes back in the same weeks
Pollen arrives in waves, and the time of year when symptoms start usually gives away the culprit.
- Trees come first: hazel and alder, then birch further north, while in southern Europe cypress and olive can start the season in late winter.
- Grasses run from late spring into early summer. They are the commonest cause of hay fever across Europe and release by far the greatest quantity of pollen.
- Weeds take the second half of summer and the autumn: mugwort, ragweed and, around the Mediterranean, pellitory, which can shed pollen almost all year.
Exact dates shift from one region and one year to the next with the weather, so it is worth following local pollen counts rather than a generic calendar. One habit repays the effort: over two seasons, jot down when symptoms began and when they let go. That note tells a doctor more than the most detailed description of how you feel.
A chapter of its own is the reaction to certain foods. Pollen proteins resemble those in some fruits and vegetables, and the body confuses the two. With a birch allergy, a raw apple, pear, cherry, carrot, nut or kiwi brings tingling in the mouth and a scratchy throat. It normally settles within minutes and carries no danger, and the same foods cooked are tolerated perfectly well. But if the lips or tongue swell after eating, the voice changes or swallowing becomes difficult, that is no longer tingling and needs proper medical assessment.
Meeting less pollen
Hiding from it completely is impossible, but cutting the dose is well within reach and the difference is noticeable.
- Keep windows shut on dry, windy days and at peak hours, early morning and evening; air the rooms after rain.
- When you get home, wash your face, rinse your nose with saline and change your clothes; wash your hair at night, or the pollen spends eight hours on your pillow.
- Do not dry washing outdoors or on the balcony.
- Wear glasses outside, ideally wraparound ones: they cut eye irritation considerably.
- In the car keep the windows up and fit a pollen filter; indoors a vacuum cleaner with a fine filter and damp dusting both help.
- Hand the mowing and any work with long grass to somebody else during the season.
- Do not smoke and stay out of smoky rooms: smoke irritates the lining in its own right and makes everything above worse.
What eases the symptoms
These are groups of medicines; the particular product and the dose are for your doctor or pharmacist to settle, since much depends on age, pregnancy and other conditions.
- Steroid nasal sprays are the mainstay once the nose is blocked. They have one quirk that trips up almost everybody: they do not work straight away, the effect builds over several days. So the spray is started a week or two before the season usually begins and used every day, not only when things are bad. Aim the nozzle outwards, away from the septum, and do not sniff hard afterwards.
- Antihistamine tablets deal with itching, sneezing and the runny nose. The modern ones cause little drowsiness; older ones cause a great deal, and you should not drive or do work needing concentration while taking them. If what you bought over the counter makes you sleepy, ask for a different one.
- Antihistamine eye drops, when sore, streaming eyes are the main complaint.
- Saline nasal rinses: a simple measure that physically washes the pollen out, and one that sits well alongside everything else.
- Decongestant drops and sprays unblock the nose quickly, but must not be used for more than a few days in a row; the lining becomes dependent on them and the nose ends up blocked with no pollen involved at all.
If two weeks of careful treatment leave your nose shut and your eyes streaming, do not increase doses on your own — the plan needs reviewing with a doctor.
The only thing that changes the course of the illness
The familiar line that hay fever cannot be cured is out of date. Medicines do only relieve symptoms, but there is a treatment aimed at the allergy itself: allergen immunotherapy. The allergen is given slowly and in gradually rising amounts, as drops or tablets under the tongue or as injections; the course runs for three to five years and starts several months ahead of the season.
Its value lies in the benefit persisting after the course has finished, and in children it also lowers the chance of developing asthma or becoming allergic to new substances. In return it demands persistence and an accurate diagnosis: before starting, the trigger must be confirmed by skin testing or a blood test. The first doses are given under supervision, because strong reactions are possible. It is not available everywhere, and an allergy specialist decides whether it is appropriate.
When the trouble is no longer only in the nose
Do not put off seeing a doctor if the season brings a night-time cough, wheeze, breathlessness on ordinary exertion or a feeling of tightness in the chest. This is how asthma announces itself, and it is common in people with pollen allergy; the sooner it is controlled, the quieter the following years will be.
Arrange to be seen the same day if the discharge turns thick and yellow-green, your temperature rises, one side of the face aches, or a single nostril blocks and blood appears in the mucus — none of that fits an allergy. The same goes for eyes: pain inside the eye, dislike of light and falling vision do not belong to allergic conjunctivitis.
Call an ambulance at once (112 across European countries) if after a food, a sting or a medicine the lips, tongue or throat swell, the voice changes, breathing becomes difficult, a rash spreads over the body or you feel faint. That is anaphylaxis and it is measured in minutes. If you have already been prescribed an adrenaline auto-injector, use it immediately and still call for an ambulance.
Online consultation
A remote appointment handles the usual questions of the season well: whether this is allergy or a cold that will not shift, why the spray "does nothing" (nearly always the starting date and the technique), whether the products you have chosen can be combined with your regular medication, what is safe in pregnancy and what suits a child. The doctor can help you build the whole season's plan in advance, explain which tests are needed before immunotherapy can be discussed, and point you towards the right specialist. What cannot be assessed remotely is difficulty breathing or swelling of the face and throat — those need an ambulance straight away.
This material is for information only and does not replace medical advice.
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