Hay Fever & Allergic Rhinitis: Symptoms, Triggers and Treatments

What is hay fever (allergic rhinitis)?

Hay fever — medically termed allergic rhinitis — is an IgE-mediated inflammatory condition of the nasal mucosa triggered by inhaled allergens, most commonly grass, tree, or weed pollen. NICE Clinical Knowledge Summaries (CKS) defines it as a condition in which the nasal mucosa is sensitised to specific allergens, causing sneezing, rhinorrhoea, nasal obstruction, and itching.

NICE CKS distinguishes between seasonal allergic rhinitis (triggered by outdoor pollens — colloquially called hay fever) and perennial allergic rhinitis, which occurs year-round and is typically triggered by house dust mites, pet dander, or mould spores.

Symptoms to look out for

• Bilateral nasal obstruction, rhinorrhoea, sneezing, and nasal pruritus
• Itchy, red, or watery eyes (allergic conjunctivitis) — present in up to 75% of those with seasonal allergic rhinitis
• Itching of the palate, throat, or ears (due to cross-reactive allergens)
• Postnasal drip causing cough and throat-clearing
• Reduced or absent sense of smell
• Fatigue, sleep disturbance, and impaired concentration

Common triggers and pollen types

• Tree pollen — primarily birch, oak, and ash. Responsible for early-season symptoms (March–May)
• Grass pollen — the most prevalent trigger in the UK, affecting the majority of hay fever sufferers. Peak season: May–July
• Weed pollen — including nettles, dock, and mugwort. Can extend the season into September

UK pollen season calendar

Pollen counts are highest on warm, dry, and windy days and tend to peak in late morning and early evening. The Met Office provides daily pollen forecasts which can help patients plan outdoor activity and pre-treat accordingly.

Treatment options explained

NICE CKS recommends a stepwise approach to managing allergic rhinitis, based on symptom severity and the presence or absence of eye symptoms. Treatment should be tailored to the individual.

Antihistamines: sedating vs non-sedating

NICE CKS recommends non-sedating (second-generation) antihistamines as the preferred choice for most patients. The BNF lists cetirizine, loratadine, and fexofenadine among the non-sedating options licensed in the UK.

• Cetirizine 10 mg (once daily) — widely used, available OTC; NICE CKS notes a small risk of sedation in some individuals
• Loratadine 10 mg (once daily) — considered the least sedating of the oral antihistamines; suitable for those with safety-critical occupations
• Fexofenadine 120 mg (once daily) — non-sedating, prescription-only at this dose in the UK. Available through Medicinex following a clinical consultation

Nasal corticosteroid sprays

NICE CKS states that intranasal corticosteroids are more effective than oral antihistamines for nasal symptoms, particularly nasal obstruction, and should be offered to patients with moderate-to-severe or persistent symptoms.

• Use regularly — daily, not just when symptoms are bad — for maximum anti-inflammatory benefit
• Start 1–2 weeks before the expected pollen season for best effect
• Angle the nozzle toward the outer wall of the nasal passage to minimise the risk of epistaxis
• Symptom improvement typically occurs within 3–7 days of consistent use
• NICE CKS notes these have minimal systemic absorption at licensed doses and are safe for long-term use

Self-help and avoidance strategies

• Check the Met Office pollen forecast daily and plan outdoor activity accordingly
• Keep windows and doors closed on high pollen days, especially in the morning when counts peak
• Shower and change clothes after spending time outdoors to remove pollen
• Wear wrap-around sunglasses to reduce ocular pollen exposure
• Apply a thin layer of petroleum jelly or a licensed nasal barrier balm around the nostrils to trap pollen
• Avoid drying laundry outdoors during the pollen season
• Vacuum regularly using a HEPA-filter vacuum and damp-dust surfaces to reduce indoor allergen load