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Seasonal Allergy / Hey Fever

Definition :
Hay fever, also known as allergic rhinitis, can cause cold-like symptoms such as a runny nose, congestion, sneezing or sinus pressure. But unlike a cold, hay fever isn't caused by a virus — it's caused by an allergic response to specific substances in your environment. Allergy signs and symptoms start whenever you're exposed to those substances.

You may have seasonal allergy symptoms that start or get worse at a particular time of year, triggered by tree pollen, grasses or weeds. If you're sensitive to indoor allergens such as dust mites, cockroaches, mold or pet dander, you may have year-round symptoms.

While hay fever can make you miserable, you are not alone — it's one of the most common allergic conditions, affecting about one in five people in the United States. You may never be able to completely avoid hay fever symptoms — but treatment and prevention can help a lot.

Over-the-counter medications may be enough to manage your mild hay fever symptoms. But if your symptoms are more severe — or if hay fever is a year-round nuisance — see an allergy specialist for evaluation and treatment. Without proper treatment, hay fever can impair your quality of life and cause sleeplessness, fatigue and irritability that affect your performance at work or school. It may increase your risk of developing more serious allergic conditions such as asthma or eczema.

If you have hay fever, you may react to one or more common inhaled allergens. No matter what you're allergic to, the underlying cause of your misery is the same. During a process called sensitization, your immune system mistakenly identifies the allergen as an invader and produces an antibody against it called immunoglobulin E (IgE).

The next time you're exposed to the allergen, your immune system launches an allergic reaction. The IgE antibodies trigger the release of inflammatory chemicals, including histamine, which swells the mucous membranes in your nose, sinuses and eyes, causing a runny nose, watery eyes and sneezing.

Hay fever doesn't mean that you're necessarily allergic to hay. Despite its name, hay fever is almost never triggered by hay, and it doesn't cause a fever. It got its name in the early 1800s when British doctors noticed that some rural residents experienced sneezing, itchy eyes and coughing after exposure to cut hay or grass. At the time, doctors didn't realize that the probable culprit was an allergic reaction to pollen or mold. They called the condition a "fever" because it caused nervousness, one of the old English definitions of fever. Most hay fever reactions are triggered by seasonal allergens or by environmental allergens that are present year-round.

Seasonal hay fever symptoms can be caused by :

  • Tree pollen, common in the spring
  • Grass pollen, common in the late spring and summer
  • Weed pollen, common in the fall
  • Spores from fungi and molds, which can be worse during warm weather months

Year-round (perennial) signs and symptoms can be caused by :

  • Dust mites
  • Animal dander (dried skin flakes and saliva)
  • Cockroaches
  • Spores from indoor and outdoor fungi and molds

Heredity plays a key role in determining who gets allergies, including hay fever. You may be more likely to develop hay fever if allergies or asthma runs in your family.

Although hay fever can begin at any age, you're most likely to develop it during childhood or early adulthood. As you get older, your symptoms may worsen or improve. The severity of hay fever tends to diminish slowly, often over decades.

Risk Factor :
The following risk factors may increase your risk of developing hay fever :

  • Family history of allergies
  • Male gender
  • Birth during pollen season
  • Being a firstborn child
  • Exposure to cigarette smoke during your first year of life
  • Exposure to dust mites

When to seek medical advice :
If you have occasional symptoms of hay fever and haven't found relief from using over-the-counter medications, see your doctor to design a treatment program. You may need an allergy specialist for an accurate and complete diagnosis. See your doctor if :

  • Your problems are persistent
  • You have side effects from medications or your medications haven't worked
  • You have another condition along with hay fever, such as nasal polyps, asthma or frequent sinus infections
  • Your child has hay fever — early allergen immunotherapy may help prevent your child from developing asthma
Signs and symptoms of hay fever can range from mild to severe. If your condition is mild, you may have brief, infrequent episodes of a runny nose and itchy, watery eyes. At the other extreme, you may have persistent, severe symptoms that last more than four days a week or longer than four weeks at a time. Chronic congestion may cause facial pressure and pain, alter your sense of taste and smell, and affect your appearance. The skin under your eyes may swell and turn bluish as you develop what are sometimes called "allergic shiners."

Hay fever symptoms usually develop immediately after you're exposed to specific allergy-causing substances (allergens). Common allergens include pollen, dust mites, cockroaches, mold and pet dander. Sometimes, exposure to irritants such as perfume and tobacco smoke can trigger or worsen symptoms.

Signs and symptoms of hay fever may include :

  • Runny nose
  • Watery eyes
  • Congestion
  • Frequent sneezing
  • Itchy eyes, nose, roof of mouth or throat
  • Swollen, blue-colored skin under the eyes (allergic shiners)
  • Cough
  • Facial pressure and pain

Hay fever can also cause :

  • Sleeplessness
  • Fatigue
  • Irritability

It may be difficult to distinguish hay fever from a cold. Here's how to tell the difference :

Hay fever Colds
Signs and symptoms Runny nose with thin, watery discharge; no fever Runny nose with watery to thick yellow discharge; low-grade fever
Onset Immediately after exposure to allergens One to three days after exposure to cold virus
Duration As long as you're exposed to allergens Five

Your doctor will ask detailed questions about your personal and family medical history, your signs and symptoms, and your usual way of treating them. Your doctor will also perform a physical examination to look for additional clues about the causes of your signs and symptoms.

Your medical history and physical exam may provide enough information for your doctor to discuss your diagnosis and treatment. But if your doctor is uncertain that you have allergies or suspects that you have allergies and needs more information about the possible causes, he or she may recommend that you have skin tests. During skin testing, small amounts of purified allergen extracts are pricked into the skin of your arm or upper back and observed for signs of an allergic reaction. A blood test is also sometimes used to identify possible allergens.

Complication :
Hay fever can affect your quality of life. Constant nose blowing, sneezing, and other signs or symptoms can be inconvenient, uncomfortable or embarrassing. Hay fever can cause sleeplessness, fatigue and irritability and can affect your performance at work or school.

Hay fever often occurs with more serious allergic conditions such as asthma — a chronic condition that occurs when the main air passages of your lungs, the bronchial tubes, become inflamed. If you have asthma, you may have signs and symptoms such as difficulty breathing, shortness of breath, a tight feeling in the chest, coughing and wheezing.

People with hay fever may also have eczema (also called dermatitis) — an inflammation that can cause swollen, red or itchy skin. In particular, atopic dermatitis often occurs with allergies and frequently runs in families in which family members have asthma, hay fever or both.

Prolonged sinus congestion due to hay fever may increase your susceptibility to sinusitis — an infection or inflammation of the membrane that lines the sinuses. Sinusitis causes pain, tenderness and swelling around your eyes, cheeks, nose or forehead. Some people have sinusitis that keeps recurring or never goes away (chronic sinusitis).

In children, hay fever often is a contributing factor to middle ear infection (otitis media), which causes pain, fever and fluid buildup in the middle ear.

After your doctor has identified what allergy triggers your symptoms, you'll work together to develop a plan to avoid these substances. Sometimes, avoidance alone can effectively control hay fever problems.

Your doctor may also prescribe an oral medication, a nasal spray or eyedrops — alone or in combination — to decrease your signs and symptoms. If you are taking any medications or have a chronic health condition, talk to your doctor or pharmacist before starting any treatment for hay fever, to be sure you're not at risk of a drug interaction or other adverse effect.

Treatments for hay fever include :

  • Nasal corticosteroids. Because corticosteroid nasal sprays are the most effective hay fever medications, they're often prescribed first, especially for more troublesome symptoms. Examples include beclomethasone (Beconase), fluticasone (Flonase), triamcinolone (Nasacort), budesonide (Rhinocort), flunisolide (Nasarel) and mometasone (Nasonex). Although these medications can be effective after a few days of treatment, you may not notice any improvement until after you've used them for a week or so. Nasal corticosteroids are generally safe for extended use.

    Mild side effects of nasal corticosteroids may include an unpleasant smell or taste. They can also occasionally cause irritation, crusting and nosebleeds, which may be especially noticeable during the winter. These side effects can be minimized by applying a small amount of petroleum jelly (such as Vaseline) inside your nose before using a nasal steroid or using a saline nasal spray to restore moisture. It may also help to switch from one nasal steroid to another, since you may find a different corticosteroid spray less irritating.

  • Antihistamines. These oral medications and nasal sprays help relieve itching, sneezing and runny nose, but have less effect on congestion. They work by blocking histamine, an inflammatory chemical released by your immune system during an allergic reaction. Over-the-counter oral antihistamines include diphenhydramine (Benadryl), chlorpheniramine (Chlor-Trimeton) and clemastine (Tavist). Because these older antihistamines may make you sleepy, avoid using them before driving or operating heavy machinery. Newer oral antihistamines — such as loratadine (Claritin), which is available over-the-counter — are less likely to cause sedation. Less-sedating oral antihistamines available by prescription include cetirizine (Zyrtec) and fexofenadine (Allegra). The prescription antihistamine nasal spray azelastine (Astelin) is effective for hay fever, but may cause drowsiness.
  • Decongestants. These medications, often used in combination with antihistamines, are available in over-the-counter and prescription liquids, tablets and nasal sprays. Oral decongestants include medications containing pseudoephedrine (Sudafed, Actifed, others). Nasal decongestants include phenylephrine (Neo-Synephrine) and oxymetazoline (Afrin). Because oral decongestants can elevate blood pressure, avoid them if you have high blood pressure (hypertension). Oral decongestants also can worsen the symptoms of prostate enlargement, making urination more difficult. Don't use a decongestant nasal spray for more than two or three days at a time because it can cause rebound signs of congestion when used longer.
  • Cromolyn sodium. This medication (NasalCrom, others) is available as an over-the-counter nasal spray that must be used several times a day. It helps relieve hay fever symptoms by preventing the release of histamine. Although cromolyn sodium isn't associated with any serious side effects, it's most effective when started before signs and symptoms develop.
  • Leukotriene modifier. Montelukast (Singulair) is a prescription tablet taken to block the action of leukotrienes — immune system chemicals that cause allergy symptoms such as excess mucus production. It has proved effective in treating allergic asthma, and it's also effective in treating hay fever. Possible side effects include headache. Less common side effects include abdominal pain, cough, dental pain and dizziness. This medication is not as effective as inhaled corticosteroids. It's often used when nasal sprays cannot be tolerated, or when mild asthma is present.
  • Nasal atropine. Available in a prescription nasal spray, ipratropium bromide (Atrovent) helps relieve a severe runny nose by preventing the glands in your nose from producing excess fluid. It's not effective for treating congestion, sneezing or postnasal drip. Mild side effects include nasal dryness, nosebleeds and sore throat. Rarely, it can cause more severe side effects such as blurred vision, dizziness and difficult urination. The drug is not recommended for people with glaucoma or men with an enlarged prostate.
  • Immunotherapy. If medications don't relieve your hay fever symptoms, your doctor may recommend allergy shots (immunotherapy or desensitization therapy). Over a period of two to five years, you receive regular injections containing purified allergen extracts. The goal is to desensitize you to specific allergens, reduce your signs and symptoms, and decrease your need for medications.

    Immunotherapy may be especially effective if you're allergic to cat dander, dust mites, or pollen produced by trees, grass and weeds. In children, immunotherapy may help prevent the development of asthma. Rarely, immunotherapy injections can cause a severe allergic reaction (anaphylaxis).

Reducing a child's exposure to allergy-causing substances such as dust mites may help delay or prevent the onset of hay fever. This may be especially true in children with a family history of allergies.

For reasons that aren't completely understood, allergic conditions such as hay fever have become increasingly common in Western countries. Under normal circumstances, the immune system produces antibodies to defend your body against harmful organisms such as bacteria, viruses and parasites. In fact, some exposure to these organisms may be necessary to stimulate the immune system's proper development. But in an environment where disinfectants and antibiotics are commonly used, such organisms may be in short supply. Your immune system may instead produce antibodies against usually harmless substances such as pollen, mold and pet dander, resulting in the development of allergies.

Researchers have found that children may be less likely to develop allergies if they attend child care centers, live in homes with older siblings or are raised on farms. In such environments, children are exposed to more germs and, as a consequence may be less likely to develop allergies.

Please be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.
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