Hay Fever (Allergic Rhinitis): Symptoms, Triggers, and When to See a Doctor

What Is Hay Fever?

Allergic rhinitis ("hay fever") is an IgE-mediated immune response to airborne allergens (pollen, dust mites, mold, pet dander). It affects 10–30% of adults and up to 40% of children globally.

Core Nasal & Ocular Symptoms

• Sneezing (often in paroxysms)
• Runny nose (clear, watery discharge)
• Nasal congestion/stuffiness
• Itchy nose, palate, throat, ears
• Itchy, watery, red eyes (allergic conjunctivitis)
• Postnasal drip → cough, throat clearing

Systemic & Secondary Symptoms

• Fatigue (poor sleep from congestion)
• Headache / sinus pressure
• Reduced sense of smell/taste
• Irritability, difficulty concentrating
• Dark circles under eyes ("allergic shiners")
• Worsening asthma (cough, wheeze, chest tightness)

Less Common but Possible

• Skin reactions (hives, eczema flare)
• Ear fullness/popping (Eustachian tube dysfunction)
• Nosebleeds (from rubbing/blowing)

Seasonal vs. Perennial

Seasonal	Perennial
Tree pollen (spring)	Dust mites (year-round)
Grass pollen (late spring/summer)	Pet dander
Weed pollen/ragweed (fall)	Mold spores (indoor/outdoor)

When to See a Doctor

• Symptoms disrupt sleep, work, or school
• OTC medications ineffective or cause side effects
• Asthma symptoms worsen
• Sinus pain, fever, green/yellow discharge (possible bacterial sinusitis)
• Uncertain diagnosis (vs. non-allergic rhinitis, nasal polyps, deviated septum)

Management Overview

• Avoidance: Pollen forecasts, HEPA filters, encasings for bedding.
• Intranasal corticosteroids: First-line (fluticasone, mometasone).
• Antihistamines: 2nd-gen (cetirizine, loratadine, fexofenadine) – less sedation.
• Leukotriene modifiers: Montelukast (especially if asthma).
• Immunotherapy: Sublingual tablets or allergy shots for long-term modification.

An allergist can confirm triggers via skin prick or blood testing and personalize a treatment plan.