Kevin Lutz, MD, FACP
May 1 2021

Hay fever is actually not a very accurate name. Hay fever symptoms are not typically triggered by hay, nor does hay fever cause a fever. The more descriptive term is seasonal allergic rhinitis.


We’ve all heard the old saying: April showers bring May flowers. And May flowers bring…hay fever! Let’s talk about hay fever and what you can do about it.

Hay fever is actually not a very accurate name. Hay fever symptoms are not typically triggered by hay, nor does hay fever cause a fever. The more descriptive term is seasonal allergic rhinitis. If you have an allergy, your immune system mistakes an otherwise harmless substance (most commonly pollen) as an invader. This substance is called an allergen. Your immune system overreacts to the allergen by producing a particular type of antibodies called Immunoglobulin E (IgE). These antibodies travel to a kind of white blood cells that release histamine and other chemicals, causing an allergic reaction. The resulting symptoms include:

  • an itchy, sneezing, runny nose
  • itchy, swollen throat and roof of the mouth
  • itching and sense of fullness in the ears
  • red, watery eyes with a gritty sensation

Seasonal allergic rhinitis occurs most commonly in the spring and autumn. Some people experience allergy symptoms all year long. This is called perennial allergic rhinitis and is triggered by indoor allergens like dust, pet dander, mold, and residue from dust mites and cockroaches.

It is interesting to note that at least 1 out of 3 people with nasal symptoms do not have allergies. Viruses such as a head cold, bacterial infections, or irritants such as smoke, strong odors and cleaning solutions can lead to the same nasal symptoms. But these are not allergic responses.

You have heard me say many times prevention is a better trick than treatment. Avoidance is the idea way to prevent allergy symptoms from occurring, but avoiding allergens such as pollen or pet dander is not always possible.

Antihistamines purchased over the counter often help for short-term relief of symptoms. Benadryl is very effective but is notorious for causing sedation. It is the active ingredient in many sleep aids and can cause more side effects than benefits. Newer antihistamines include Allegra, Claritin and Zyrtec. All are available in generic form. In my experience, Allegra causes the least amount of sedation and Zyrtec causes the most sedation. Antihistamines kick in quickly but only last a day or so.

Nasal corticosteroid sprays are more effective than antihistamines to temporarily treat symptoms. This type of medication is different from the “steroids” connected with those misused in sports. Nasal corticosteroids have been proven to be safe and effective for use in allergic rhinitis. They do not take effect as quickly as antihistamines but last longer. They provide better symptom control and are better at preventing the onset of symptoms. Over the counter varieties include Nasacort, Rhinocort and Flonase.

Immunotherapy, also known as allergy shots, is a long-term treatment approach that decreases symptoms for many people with allergic rhinitis as well as allergic asthma, conjunctivitis (eye allergy) and insect sting allergies. Allergy shots often lead to lasting relief of allergy symptoms even after treatment is stopped.

Special recognition goes to NeilMed sinus rinse. It is my favorite over the counter treatment and I encourage anyone with any nasal and sinus symptoms to try it. It works for allergies, head colds and sinus infections. It washes the offending dust, pollen and germs out of the nose and sinuses without any side effects or potential medication interactions. It is a great combination with nasal steroids. Just remember to use NeilMed first to wash out all the allergens then use the nasal steroids.

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