Allergic Rhinitis (Hay Fever)

Hay fever (allergic rhinitis) is a medical condition caused by an allergy to substances breathed in the air. Most people with allergic rhinitis are allergic to house dust mites, pollen, pets, moulds, or a combination of these. Allergic rhinitis is sometimes called ‘hay fever’ when it occurs during the times of year when there are a lot of pollens in the air. The allergic reaction makes the inside of the nose irritated, swollen and abnormally sensitive (inflamed). It also affects the back of the mouth and the throat. A person with rhinitis may have a blocked or a runny nose and may experience itching or soreness in the nose, throat and eyes. Allergic rhinitis can also disturb sleep and cause problems with concentration at work or school. Approximately 19% of Australians (almost one in 5) have allergic rhinitis. At least three out of four people with asthma also have allergic rhinitis. Asthma and allergic rhinitis are related health conditions. People with allergic rhinitis have a higher chance of going on to develop asthma than people without allergic rhinitis.

Can allergic rhinitis make asthma worse?

Hay fever (allergic rhinitis) can make asthma harder to control. People with asthma who also have allergic rhinitis have more visits to the hospital or emergency departments and more time off work or school than other people with asthma. Some people find that the things that trigger their asthma will also make their allergic rhinitis worse. These could include things they are allergic to (allergens) or cold air, cigarette smoke or other irritating fumes. Effective treatment for allergic rhinitis may reduce the chance of severe asthma attacks, and make the lungs work better. People with allergic rhinitis who are allergic to grass pollens (e.g. ryegrass) can have asthma attacks caused by springtime thunderstorms. These mainly occur in October-November, in places where there is a lot of grass pollen (e.g. most of south-eastern Australia). Very severe asthma attacks triggered by thunderstorms are more likely in people who have asthma as well as allergic rhinitis – especially if their asthma is not well controlled, or they are not taking regular preventer medication for their asthma.

What are the symptoms of allergic rhinitis?

Most people with allergic rhinitis have a blocked or a runny nose. Some also have sneezing and itching in the nose and back of the throat. Allergic rhinitis can also make the eyes itchy, red and teary. Not everyone with allergic rhinitis has all these symptoms. People with asthma may not recognise that they also have allergic rhinitis, because the symptoms can be mistaken for asthma. For this reason, Australian and international guidelines for doctors recommend that people with asthma should be checked for allergic rhinitis. Allergic rhinitis can occur all year round, or just at certain times of the year.

Allergic rhinitis symptoms

You don’t have to have all these symptoms to have allergic rhinitis:

• Itchy, runny or blocked nose
• Itchy or watery eyes
• Sneezing
• Always feeling like you have a head cold
• Frequent sore throats
• Hoarse voice
• Breathing through the mouth
• Snoring
• Facial pain or pressure
• Frequent headaches
• Repeatedly getting middle ear infections
• Constantly coughing to clear the throat or soon after lying down to sleep
• Bad breath
• Sleeping badly or being tired during the day
• Breathing problems even when your asthma is well controlled

Your doctor may:

• Measure how well your lungs are working, using a spirometer, or arrange for you to have this test. If you normally test your own lungs using a peak flow meter each day, bring your results.
• Offer allergy tests – either skin-prick tests or blood tests – or arrange for you to have these tests done by a specialist. Other methods that claim to test for allergy (e.g. cytotoxic food testing, kinesiology, Vega testing, pulse testing reflexology and hair analysis) are not useful tests and should not be used.
• Suggest that you try using a nasal spray for a few weeks and come back.

You may need to see a specialist if you have any symptoms that are not typical of allergic rhinitis, such as long-term sinus problems, polyps in the nose, pain, loss of hearing or sense of smell, persistent cough, or if only one nostril is always blocked or bleeding.

Corticosteroid nasal sprays

Nasal sprays that contain medicines that reduce inflammation in the lining of the nose (corticosteroids) are the most effective treatment for allergic rhinitis. Corticosteroid nasal sprays are effective for controlling itching and sneezing, runny nose, blocked nose, and eye symptoms (itching or wateriness). Most people with allergic rhinitis will benefit from using these medicines. Some corticosteroid nasal sprays are available from pharmacies without a prescription. Stronger versions are also available on prescription. For best results, these medications should be taken regularly and long term, just like preventers for asthma. Corticosteroid nasal sprays for allergic rhinitis have a good safety record in people of all ages, including children. It can take up to 2 weeks for the medicine to become fully effective. People who experience allergic rhinitis symptoms throughout the year may need to continue treatment indefinitely. Most people with allergic rhinitis will need to continue treatment for at least several months at a time.

Saline rinses: Your doctor may recommend that you use a salt water (saline) solution daily to help clear your nose and soothe the lining of the nose. Syringes and rinse bottles are available from pharmacies.

Avoid smoke: People with allergic rhinitis should not smoke and should avoid other people’s cigarette smoke. Smoking makes asthma and rhinitis worse and can prevent medicines from working properly. Bushfires and wood smoke may also worsen allergic rhinitis and asthma.

Avoid allergens: Your doctor can help you work out which allergens trigger your allergic rhinitis and asthma. Try to avoid your allergy triggers if you can. See Avoiding allergens for tips. If medication does not clear a badly blocked nose, doctors may occasionally recommend a surgical operation called turbinate reduction. Surgery is not a cure for rhinitis but may help with symptoms in severe cases.