What Is Allergic Rhinitis/Hay Fever?
Allergic rhinitis, often called hay fever, is a common condition affecting the nose and eyes. It occurs when the immune system abnormally reacts, or mounts, an allergic reaction to airborne substances that are usually harmless.
During allergen exposure, the body releases inflammatory chemicals that affect the delicate mucous membranes lining the nose and eyes. This leads to a range of allergy symptoms that can be short-lived or persistent, depending on the trigger.
Allergic rhinitis may be seasonal or year-round. With appropriate care, symptoms can be managed effectively, and quality of life significantly improved.
Seasonal and Perennial Allergic Rhinitis
Seasonal allergic rhinitis occurs at particular times of the year, often when the allergy season begins, and outdoor pollen levels rise. This is commonly known as seasonal hay fever and is frequently triggered by grass pollen and other seasonal allergens.
By contrast, perennial allergic rhinitis causes symptoms throughout the year and is usually related to indoor triggers such as dust mites, mould or animal dander. These indoor allergens often include dead skin cells, which dust mites feed on.
There is often a lot of overlap between these patient groups. Both forms fall under the broader category of nasal allergies, and symptoms may worsen with repeated or prolonged exposure.
Causes and Risk Factors
Allergic rhinitis develops when the immune system becomes sensitised and begins to develop symptoms after repeated contact with specific allergens. While anyone can be affected, certain risk factors increase susceptibility, including a personal or family history of allergies, asthma or eczema.
Repeated allergen exposure can lead to ongoing inflammation of the nasal tissue, increasing sensitivity over time. Some people notice their symptoms worsen during high-pollen days, thunderstorms or environmental changes, a phenomenon linked to thunderstorm asthma in susceptible individuals.
Allergic Rhinitis Symptoms
Early hay fever symptoms often include:
- Sneezing
- Itchy nose
- Watery eyes
- Eye allergy symptoms
As inflammation progresses, people may experience additional nasal allergy symptoms, including:
- Runny nose
- Chronic nasal congestion
- Nasal obstruction
- Postnasal drip
- A persistent cough
- Sore throat from throat irritation
These allergic symptoms can range from mild to severe symptoms that interfere with sleep, concentration, work, or school. Some people also report other nasal symptoms such as facial pressure or a reduced sense of smell.
Allergic Rhinitis vs Other Forms of Rhinitis
Symptoms of allergic rhinitis are sometimes confused with infectious rhinitis, which is caused by viruses or bacterial infections. This overlap explains why many people struggle to tell the difference between a cold and hay fever.
There are also non-allergic causes of nasal inflammation, such as non-allergic rhinitis, which does not involve the immune system and does not respond to standard allergy treatments.
Structural factors, including deviation of the nasal septum or the presence of nasal polyps, may worsen congestion and complicate symptom control.
How Is Hay Fever Diagnosed?
If symptoms are mild and respond well to treatment, formal testing may not be required. However, when symptoms persist, affect daily life, or are difficult to control, further assessment is recommended.
Hay fever diagnosed accurately allows for more targeted treatment. Diagnostic options include:
- Skin testing, where small amounts of allergens are applied to the skin
- Blood tests to detect allergen-specific antibodies
Referral to an allergy specialist or services in clinical immunology may be helpful in complex or treatment-resistant cases.
How To Manage Allergic Rhinitis
Medications
The cornerstone of treatment for nasal symptoms is corticosteroid nasal sprays, which reduce inflammation within the nasal passages and help relieve symptoms over time. These sprays are safe for long-term use when used correctly.
Oral antihistamines may be added for itching, sneezing and eye symptoms. Decongestants (spray or tablets) should be used for just a few days, and only if symptoms are hard to tolerate.
Overuse of decongestants can lead to rhinitis medicamentosa, a condition where rebound congestion occurs.
Immunotherapy and Long-Term Treatment
For people with ongoing symptoms despite medication, allergen immunotherapy may be considered. This treatment aims to reduce the immune system’s sensitivity to specific allergens.
Options include:
- Allergy shots, also known as subcutaneous immunotherapy
- Oral desensitisation via a daily tablet.
This approach generally requires 3 years of treatment but can provide long-term improvement and reduce reliance on medication for selected patients.
Managing Allergic Rhinitis Day to Day
Practical steps can help reduce symptom burden:
- Minimise exposure when trigger symptoms are known
- Stay indoors during peak pollen times
- Wash face and hands after outdoor exposure
- Keep indoor environments clean and well-ventilated
These measures are especially helpful during periods when seasonal allergies are at their worst.
Surgical Options for Allergic Rhinitis
For most people, allergic rhinitis is effectively managed with medications and lifestyle adjustments. However, in some cases, surgery may be considered to improve symptoms and quality of life when nasal obstruction or structural issues contribute to persistent problems.
Common Surgical Procedures
1. Turbinate Reduction (Turbinoplasty).
- In allergic rhinitis, they can become swollen, causing chronic nasal obstruction and nasal congestion
- The turbinates are structures inside the nose that help filter and humidify air.
- Reducing the size of the turbinates can improve airflow and reduce nasal irritation.
2. Septoplasty
- This procedure corrects a deviated nasal septum, which can worsen nasal blockage and make allergy symptoms harder to manage.
- It is often combined with turbinate reduction for better symptom relief.
- Reserved for individuals with chronic sinusitis or structural blockages that do not respond to medical therapy.
- Surgery can help restore normal sinus drainage and reduce recurrent symptoms.
When Surgery Is Considered
Surgery is generally considered when:
- Severe symptoms persist despite medical therapy
- Structural abnormalities, such as a deviated septum or nasal polyps, contribute to ongoing discomfort
- Quality of life is significantly affected by chronic nasal obstruction, postnasal drip or other nasal symptoms
An ENT specialist can assess whether surgical intervention is appropriate and discuss expected outcomes, recovery and ongoing care. Surgery does not cure the allergic response itself, but can make living with allergic rhinitis more manageable and improve the effectiveness of medications.
Possible Complications
If left poorly controlled, allergic rhinitis may contribute to:
- Chronic sinusitis
- Sleep disturbance or obstructive sleep apnoea
- Ear symptoms
- Asthma worsening in people with co-existing asthma
Some individuals also experience throat symptoms related to nasal irritation and ongoing postnasal drainage.
When To See An ENT Specialist
You should consider specialist assessment if:
- Symptoms are persistent or worsening
- Nasal blockage does not respond to treatment
- There is concern about structural issues or complications
An ENT specialist can assess the nasal tissue, airway anatomy and overall nasal health to guide appropriate care. You can discuss what is the best treatment for the allergic rhinitis symptoms you display.
Allergic rhinitis is a common condition that can significantly affect daily life, particularly during periods of high allergen exposure. Whether symptoms are seasonal or year-round, accurate diagnosis and tailored treatment can lead to meaningful improvement.
With the right combination of medical therapy, lifestyle adjustments and specialist input, most people can achieve good symptom control and long-term relief.
Contact an ENT Specialist at Complete ENT to discuss your treatment options.
