HAY FEVER: A nosey affair

Itchy, runny nose, watery eyes, sneezing, or cough? It could be due to pollution-induced allergy

Child wiping noseHay fever is neither due to hay – as was previously thought – nor does it always present with fever.

Termed allergic rhinitis, hay fever represents irritation and inflammation of nose and eyes. It is caused by allergic reaction to a variety of air-borne substances and affects as many as one-fifth of the population. What’s more, the problem is on the rise the world over, thanks to increase in pollution and shifting lifestyles.

Hay fever generally starts in childhood. It can, however, occur at any age following exposure to allergens over a prolonged period of time. Among the common allergy-causing substances in the air are pollen, moulds, animal dander, smoke, dust and fumes. The time of onset and duration of symptoms depend largely on the type of the causative allergen.

Pollen particles are tiny, male sex cells produced by trees, grass, weeds and flowers. Pollen from garden flowers are large and waxy; they are less likely to cause allergy, while those of trees, grass and weeds are extremely small and easily spread by the wind. These get inhaled with the air we breathe; they trigger allergic response and cause inflammation of the airways.

Blame it on pollen

The pollinating season usually heralds allergic symptoms. Most cases of allergic rhinitis are caused by weeds and grasses and these plants pollinate between May and September, while trees pollinate in spring. The distribution of pollen particles also depends on the weather. The pollen is released early in the morning and as the day gets warmer, more pollen is released and the pollen count peaks by the evening. The amount of sunshine, rainfall, humidity and the speed and direction of the wind can all influence the spread of pollen.

Moulds, on the other hand, are present throughout the year and can grow outdoors as well as indoors – especially in damp places. Pet dander, insects like cockroaches, fumes of mosquito repellents, perfumes, tobacco smoke and many others can also trigger allergic rhinitis.

Symptom picture

Symptoms of itchy, runny nose and watery eyes, with irritation, usually appear immediately after exposure to the causative allergen; they can vary from mild to severe. Mild cases may be brief, infrequent episodes of runny nose with sneezing and itchy, teary eyes. Many patients keep clearing their throats and rubbing their nose often. As the condition worsens, congestion and stuffiness of the nose increase. There may be loss of smell and altered taste. The blocked nose can also lead to sinusitis and headaches.

Dripping of mucous from the back of the nose into the throat may also cause frequent cough. Severe cases may even have bleeding from the nose.

With the symptoms lasting weeks or months, the ability to concentrate gets affected, while physical and social activities are hampered and sleep may be disturbed.

Allergic rhinitis is also sometimes accompanied by other allergic disorders like asthma and eczema of the skin.


The diagnosis of allergic rhinitis is apparent when someone presents with typical nasal and eye symptoms. A viral infection of the upper airways, however, can also result in stuffy and runny nose, but in such cases, fever is common and the condition is self-limiting [3-5 days]. In some of these cases, the secretion may turn yellowish, suggesting pus [infection].

The real challenge in hay fever lies in identifying the causative allergen. While seasonal allergic rhinitis is likely due to pollen, a perennial problem may be triggered by house dust, fumes and so on. A skin test, by pricking the suspected allergens into the skin, may be of value in some cases. Estimation of blood levels of the antibody [immune system-related proteins], Immunoglobulin-E [IgE], responsible for allergic reactions, can also be done.

Managing hay fever

The most important measure in the treatment of hay fever is avoidance of the causative allergen. But, this is easier said than done. Most patients need anti-histamines or anti-allergy medications for controlling symptoms. These drugs block the action of histamine, the mediator released in the process of an allergic reaction. Many anti-histamines are now available, some of them over-the-counter [OTC]. The newer, less sedating anti-histamines act a bit slowly and are more expensive.

New anti-histamine nasal sprays are also available; they minimise certain side-effects. Decongestant nasal drops reduce the swelling of the nasal passages, but their effect is temporary. Besides, they may cause return of symptoms on withdrawal. For chronic and more severe cases, corticosteroid nasal sprays may be needed. Corticosteroids stop the allergic reaction and reduce the inflammation and swelling, thereby providing effective relief from symptoms. Being locally effective, these sprays do not have any significant adverse effects on the body and can be used for a long time, if required. There are certain blocking agents and sprays of ipratropium, a drug that dries up the secretion, that can provide relief from symptoms.

Some cases of severe, long-lasting hay fever may be treated by immunotherapy, or desensitisation by using minute amounts of the causative allergen for a certain duration. However, this treatment consumes time as well as money, and the results are not predictable. Consult your physician for the best result. Also, do not self-medicate when symptoms persist, or become chronic.

Some alternative approaches like ayurveda, acupuncture, homoeopathy, and herbal remedies, are suggested to relieve, or prevent, hay fever symptoms. Speak to a therapist, in the given field, to find out what suits your individual needs best.

Prevention Holds the Key

  • Minimise exposure to pollen
  • Avoid going out when pollen counts are high
  • Keep windows closed during mid-day, when pollen count starts rising
  • Wear sunglasses to protect the eyes from pollen
  • Have a shower before going to bed to clear the pollen caught on the body and hair
  • Avoid hanging clothes for drying in the garden as the pollen can get trapped in the linen/clothes
  • Wipe pets after they run around in the garden as the pollen may rub off onto the fur
  • Those who are allergic to animal dander should not keep pets at least in the bedroom
  • Your garden should be devoid of “high-risk” grass and weeds. Pollen in the air can be put down by a fine spray from a hose sprinkler. Avoid sitting, playing, or walking on the grass and cutting grass, if you are prone to allergies
  • Keep the house free of dust and dampness and avoid flowers within the house
  • Avoid carpets in the bedroom
  • Dehumidifiers, or air-conditioners, may help in reducing humidity indoors, and in your car
  • Prevent cockroaches through proper sealing, by not spilling the food, and keeping food containers tightly closed
  • Do not smoke and do not allow others to smoke near you.
Srinivas Bevinje
Dr Srinivas Kakkilaya Bevinje, MD, is a Mangalore-based consultant physician. His areas of interest include metabolic medicine, infectious diseases, and community health.

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