Hay Fever (Allergic Rhinitis)


What Is It?




Symptoms of hay fever usually begin before age 30. They typically include some of the following: sneezing, itchy and runny nose; stuffy nose; red, itchy or watery eyes; itchy or sore throat. The congested nose can lead to mouth breathing, and the dripping mucus can cause persistent cough and sore throat. Because hay fever also causes swelling in the sinuses and near the opening of the Eustachian tube (passage that connects the throat to the middle ear), sufferers can develop additional symptoms of secondary sinus infections or ear infections.


Your doctor will ask you about your symptoms, especially about when and where (outdoors or indoors) they occur. Your doctor also will ask about your family history of allergies and your personal history of allergy-related conditions, including eczema, hives and asthma.

Your doctor will make the diagnosis of hay fever based on your allergy history, the timing and appearance of your symptoms and the results of your physical examination. During your physical examination, your doctor will check for signs of inflammation in your eyes, nose and throat. Typically, the lining of the nose is swollen and pale pink or bluish, though it can be red. The doctor often looks for other signs of allergic rhinitis, such as dark circles under the eyes (called allergic shiners)resulting from chronic sinus congestion, wrinkles under the eyes as a result of chronic puffiness around the eyes, and a crease across the nose from frequently wiping it and pushing it upward.

To identify the specific allergen (allergy-triggering substance) that is triggering your hay fever, your doctor may refer you to an allergist, who can perform skin testing. In skin testing, a small amount of a specific allergen is scratched, pricked or injected into the skin. Results are available in 10 to 20 minutes. Blood tests also can be done to measure eosinophils (a type of white blood cell that increases in number during allergy seasons) or levels of IgE, an allergy-inducing antibody. Blood tests are more expensive and generally less accurate than skin tests, and it can take several days to get results. However, blood tests often are used when skin testing cannot be performed, such as when someone has severe eczema.

Expected Duration

Although hay fever symptoms can reappear each year when the offending plant begins to bloom, they tend to diminish as you get older. Alternatively, some people don’t develop hay fever until adulthood.


You can help prevent attacks of hay fever by reducing your exposure to the suspected allergens. It helps to:

  • Stay indoors as much as possible during months when you know that your hay-fever symptoms will flare. Remember that pollen counts tend to be highest before 10 a.m. and after sunset, so schedule any outdoor activities for low-pollen hours. Early afternoon usually is best.


  • Because some pollen grains can enter your house even when windows are shut, you can cut down your exposure to this indoor contamination by using a HEPA filter (high-efficiency particulate air filter).

  • While traveling in your car, you should drive with your external vents closed and air conditioning on. Some newer vehicles can be equipped with a high-efficiency air filtration system.


  • When planning your garden, choose flowers that are bright and colorful, because these colors usually signal that the plant is pollinated by insects rather than by wind.

  • Take a shower or wash your hair before going to bed at night to remove pollen that accumulated during the day.





If antihistamines don’t work, the next step might be steroid medication, such as beclomethasone (Beconase, Vancenase), budesonide (Nasonex) or flunisolide (Rhinolar), given as a nasal spray. These medications are effective and currently are the most potent forms of drug therapy available for both hay fever and perennial allergic rhinitis.

If steroid sprays and antihistamines fail, or if you have perennial symptoms, your doctor may recommend trying immunotherapy (allergy shots), a treatment aimed at desensitizing your body’s immune reaction to a particular allergen. In immunotherapy, increasing concentrations of the allergen are injected under your skin either weekly or biweekly. If immunotherapy is effective, allergy symptoms usually subside within six months to a year. Treatment often is continued for three to five years.

When To Call A Professional

Call your doctor if you think you might have hay fever and the symptoms interfere with your normal everyday activities or make you feel generally miserable, or if you have hay fever and your symptoms are not controlled by your current medications.


In most cases, hay fever can be managed successfully by minimizing exposure to the allergens and treating with one or more medications. Without medical treatment, most people with hay fever find that their symptoms gradually diminish as they grow older.

Johns Hopkins patient information

Last revised:

Diseases and Conditions Center

