Hay Fever

What is hay fever?

The terms "hay fever" and “nasal allergies” refer to a common allergic condition characterized by an itchy, often runny, nose and nasal congestion generally not associated with a cold or other viral infection. The eyes are frequently affected as well, with intense itching and tearing. Even the ears and the throat may feel itchy or irritated. This condition results from inflammation in the nasal passages (as well as in the linings of the eyelids and throat) caused by exposure to one or more triggers in the air like pollens or dust, termed allergens. The medical term for this condition is allergic “rhinitis” (‘rhin-’ = of or about the nose; and ‘-itis’ = inflamed).

Allergic rhinitis is one of the most common chronic conditions in the U.S., affecting about 20% of the population (10-30% of adults and up to 40% of children in some areas). Though sniffles and sneezing are well-recognized effects of this condition, less commonly recognized are the very important systemic effects, which can include profound fatigue, somnolence, difficulty concentrating on a task (and for children, impaired learning performance).

What causes allergies?

Contrary to a popular misconception, allergies do not result from a weak immune system. In fact, both the nasal symptoms and the systemic effects of hay fever are due to a powerful immune response that focuses in the nose, but, like most immune responses, overflows into the circulation, affecting the whole body. The disorder in this immune response is simply that it is inappropriate. Similar nasal stuffiness and fatigue can accompany our body’s immune response to a virus, but at least in this case the immune system is fighting off a microbe (the virus) that otherwise would do us harm. In the case of allergies, the immune system sets up a war against a trigger that is generally quite benign, like tree pollen, or cat dander. Unlike the case of the virus, however, where the immune system goes to work and clears out the trigger (the virus) after a few days of fighting, in the case of allergies, the trigger can remain in the nose for long periods – about 8 weeks for tree pollen season and many years if one lives with a cat. The ensuing battle between our immune system and the “harmless” trigger results in the symptoms we experience.

When do allergies occur?

Classically, the term “hay fever” referred to seasonal allergic rhinitis symptoms, those that recur regularly at the same time of year generally due to the appearance in the air of pollen. In the Northeast United States, seasonal allergic rhinitis may occur in the spring (due to tree pollen), mid-summer (due to grass pollen), or in the late summer/fall (due to ragweed and other summer weed pollens). In contrast to seasonal rhinitis, perennial allergic rhinitis occurs year-round. This is fundamentally the same condition, but is generally caused by one or more indoor allergens present year-round such as dust mite, cat dander, or in many cities, cockroaches. In fact, many individuals find they have perennial allergic rhinitis with a seasonal overlay – symptoms that last year round, but peak during a particular pollen season.

What can I do if I think I have allergies?

What can you do if you think you have allergic rhinitis? In this condition, knowledge is definitely power. Seek out a physician – generally an allergist – who can help you evaluate what your allergic triggers may be. The gold standard for this evaluation is the allergy skin test, a very easy in-office procedure that provides a sensitive test of the airborne agents that cause your allergies, all within 15 minutes. Often, those with allergic conditions will discover multiple potential triggers on skin testing. Your allergist will help you to interpret which of these possible triggers is most relevant to the symptoms you are experiencing, and provide expert advice on anticipating and minimizing exposure to these triggers. Simple allergen avoidance measures can make a big difference, even in the case of seemingly ubiquitous allergens like pollens. Finally, your allergist can present you with a variety of options for interventions you can undertake to provide symptom relief. These include rapid-acting easy-to-use medications, and the more long-term approach of immunotherapy (also called “shot therapy”), the only approach aimed at correcting the underlying cause of the allergic rhinitis, that inappropriate immune response that kicked off the condition to begin with.

Additional Resources

For more information about allergic rhinitis, see the link below at the American Academy of Allergy, Asthma, and Immunology:


For a customizable view of the rhinitis treatment options available to you, take a look at the American Lung Association’s “Asthma Profiler Tool” via the link below. It’s free, easy to use, and provides expert advice without commercial bias.