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First aid

Hay fever - nasal allergies

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Does this describe your symptoms?

  • Nasal allergies, allergic rhinitis or hay fever
  • Clear nasal discharge with sneezing, sniffing, and nasal itching
  • Eye allergies (itchy, red and watery) are commonly associated
  • No fever
  • This is also called seasonal allergic rhinitis

General Information

  • Allergic rhinitis is an allergic reaction of the nose and sinuses to an inhaled substance (e.g., pollen, mold, or dust).
  • Many patients correctly self-diagnose this condition. Confirmation of this diagnosis by a physician is helpful, and becomes essential if symptoms are more than mild.
  • Many patients with allergic rhinitis also have symptoms of allergic conjunctivitis (watery itchy eyes).

Did you know that there are two types of allergic rhinitis?

  • Seasonal allergic rhinitis - Hay fever is the non-medical term people use to describe seasonal allergic rhinitis due to pollens. Patients who suffer from hay fever note that their symptoms are worse during certain seasons of the year. Such individuals usually have an allergy to pollen, grasses, or trees. Depending on the specific allergy, the symptoms may be worse in the spring, summer or fall. A few unfortunate individuals may experience allergic symptoms in all three seasons. Hay fever is not specifically an allergy to hay nor do sufferers have a fever.
  • Perennial allergic rhinitis - Patients with this type of allergic rhinitis may report nasal symptoms all year long. Alternatively they may complain of sporadic symptoms throughout the year, not confined to any particular season. Such individuals often have an allergy to dust mites, mold, mildew, feathers, or animal dander.

CAUTION - There are other illnesses that have nasal symptoms similar to hay fever:

  • Viral rhinitis - Also known as the common cold. Runny or stuffy nose is the main symptom. The nasal discharge may be clear, cloudy, yellow or green. The patient usually has other symptoms of a cold: fever, muscle aches, sore throat and headache.
  • Bacterial and viral sinusitis - Yellow or green nasal secretions suggest the possibility of bacterial sinus infection (sinusitis) if they occur in combination with [1] sinus pain OR [2] the return of a fever after it has been gone for over 24 hours OR [3] secretions lasting longer than 10 days without improvement.
  • Rhinitis medicamentosa - Prolonged continuous use (longer than 5 days) of over-the-counter decongestant nose drops can lead to "rebound" congestion where the nose becomes even stuffier.
  • Occupational exposure - Airborne irritants in the workplace can cause nasal problems.

If not, see these topics

When to Call Your Doctor

Call Your Doctor Now (night or day) If
  • You feel weak or very sick
Call Your Doctor Within 24 Hours (between 9 am and 4 pm) If
  • You think you need to be seen
  • Lots of coughing
  • Lots of yellow or green discharge from nose present more than 3 days
Call Your Doctor During Weekday Office Hours If
  • You have other questions or concerns
  • Your "Hay Fever" has never been diagnosed by a physician
  • Moderate-severe nasal allergy symptoms (i.e., symptoms interfere with sleep, school, or work) and you have been taking antihistamine medications for more than 2 days
  • Nasal discharge lasting more than 10 days
  • Nasal allergies occur year-round
  • Snoring most nights of the month
Self Care at Home If
  • Your nasal allergies occur only certain times of year, and you have been diagnosed by your physician, and you don't think you need to be seen

  1. Wash off Pollen Daily: Remove pollen from the body with hair washing and a shower, especially before bedtime.
  2. Avoiding Pollen:
    • Stay indoors on windy days
    • Keep windows closed in home, at least in bedroom; use air conditioner
    • Use a high efficiency house air filter (HEPA or electrostatic)
    • Keep windows closed in car, turn AC on recirculate
    • Avoid playing with outdoor dog
  3. For a Blocked Nose - Use Nasal Washes:
    • Step 1: Put 2-3 drops of warm water or saline in each nostril (Reason: To loosen up the dried mucus)
    • Step 2: Blow each nostril separately (Pinch one nostril shut while blowing your nose then repeat while pinching the other nostril).
    • Step 3. Repeat nose drops and blowing until discharge is clear.
    • Notes: Use a medicine dropper so you have control over how many drops you put in the nose. If you don't have one, you can use a dropper that came with ear drops, eye drops, or another medicine. You can purchase a dropper at a pharmacy. Do nasal washes four times a day or whenever you can't breathe through your nose. Another option instead of nasal washes is to take a hot shower. Breathe in the moist air through the nose and then blow each nostril.
    • How to Make Saline Nose Drops: Add 1/2 tsp of table salt to 8 oz (240 ml) of warm water.
  4. Antihistamine Medications for Hayfever:
    • Antihistamines help reduce sneezing, itching and runny nose.
    • You may need to take antihistamines continuously during pollen season (Reason: continuously is the key to control).
    • Loratadine is a newer (second generation) antihistamine. The dosage of loratadine (e.g., OTC Claritin, Alavert) is 10 mg once a day. Loratadine causes less sleepiness than diphenhydramine (Benadryl) or Chlorpheniramine (Chlortrimeton, Chlor-tripolon).
    • CAUTION: Antihistamines may cause sleepiness. Do not drink, drive or operate dangerous machinery while taking antihistamines.
    • Read the package instructions thoroughly on all medications that you take.
  5. Nasal Decongestant Nose Drops for Stuffy Nose:
    • Antihistamines do not help nasal congestion (stuffiness), but decongestant nose drops do. Decongestants shrink the swollen nasal mucosa and allow for easier breathing.
    • Phenylephrine nose drops (e.g., Neo-Synephrine) are available over-the-counter. Clean out the nose before using. Spray each nostril once, wait one minute for absorption, and then spray a second time.
    • CAUTION: Do not take this medication if you have high blood pressure, heart disease or prostate enlargement. Do not take these medications if you are pregnant. Do not take these medications if you have used a MAO inhibitor such as isocarboxazid (Marplan), phenelzine (Nardil), rasagiline (Azilect), selegiline (Eldepryl, Emsam), or tranylcypromine (Parnate) in the past 2 weeks. Life-threatening side effects can occur.
    • Do not use these medications for more than 3 days (Reason: rebound nasal congestion).
    • Read the package instructions thoroughly on all medications that you use.
  6. For Eye Allergies: For eye symptoms, wash pollen off the face and eyelids. Then apply cold wet compresses. Oral antihistamines will usually bring all eye symptoms under control.
  7. Call Your Doctor If:
    • Symptoms are not controlled in 2 days with continuous antihistamines
    • You become worse

And remember, contact your doctor if you develop any of the "Call Your Doctor" symptoms.

Disclaimer: This information is not intended be a substitute for professional medical advice. It is provided for educational purposes only. You assume full responsibility for how you choose to use this information.

Author and Senior Reviewer: David A. Thompson, M.D.

Last Reviewed: 1/19/2009

Last Revised: 4/7/2008

Content Set: Adult HouseCalls Online

Portions Copyright 2000-2009 Self Care Decisions LLC; Copyright LMS, Inc.

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