Important things you need to know about hay fever

Hay fever

If you sneeze a lot, if your nose is often runny or stuffy, or if your eyes, mouth or skin often feels itchy, you may have allergic rhinitis, a condition that affects 40 million to 60 million Americans.
Allergic rhinitis, like skin rashes and other allergies, develops when the body’s immune system becomes sensitized and overreacts to something in the environment that typically causes no problem in most people.
Allergic rhinitis is commonly known as hay fever. But you don’t have to be exposed to hay to have symptoms. And contrary to what the name suggests, you don’t have to have a fever to have hay fever.
Allergic rhinitis takes two different forms:
Seasonal: Symptoms of seasonal allergic rhinitis can occur in spring, summer and early fall. They are usually caused by allergic sensitivity to airborne mold spores or to pollens from grass, trees and weeds.
Perennial: People with perennial allergic rhinitis experience symptoms year-round. It is generally caused by dust mites, pet hair or dander, cockroaches or mold. Underlying or hidden food allergies rarely cause perennial nasal symptoms.
Some people may experience both types of rhinitis, with perennial symptoms getting worse during specific pollen seasons. There are also nonallergic causes for rhinitis
Hay fever affects up to 30% of all people worldwide, including up to 10% of U.S. children under 17 years of age and 7.8% of U.S. adults. The medical cost of allergic rhinitis is approximately $3.4 billion, mostly due to the cost of prescription medications. These figures are probably an underestimate because many of those affected may attribute their discomfort to a chronic cold . Although childhood hay fever tends to be more common, this condition can occur at any age and usually occurs after years of repeated inhalation of allergic substances. The incidence of allergic disease has dramatically increased in the U.S. and other developed countries over recent decades.
"Hay fever" is a misnomer. Hay is not a usual cause of this problem, and it does not cause fever. Early descriptions of sneezing, nasal congestion, and eye irritation while harvesting field hay promoted this popular term. Allergic rhinitis is the correct term used to describe this allergic reaction  , and many different substances cause the allergic symptoms noted in hay fever. Rhinitis means "inflammation of the nose" and is a derivative of rhino , meaning nose. Allergic rhinitis that occurs during a specific season is called "seasonal allergic rhinitis." When it occurs throughout the year, it is called "perennial allergic rhinitis."
Rhinosinusitis is the medical term that refers to inflammation of the nasal lining as well as the lining tissues of the sinuses. This term is sometimes used because the two conditions frequently occur together.
Hay Fever Symptoms
Runny nose
Itchy eyes, mouth or skin
Sneezing
Stuffy nose due to blockage or congestion
Fatigue (often reported due to poor quality sleep as a result of nasal obstruction)
Why does an allergic reaction occur?
An allergic reaction occurs when the immune system attacks a usually harmless substance called an allergen  that gains access to the body. The immune system calls upon a protective substance called immunoglobulin E (IgE) antibodies to fight these invading allergic substances or allergens. Even though everyone has some IgE, an allergic person has an unusually large amount of IgE. This army of IgE antibodies attacks and engages the invading army of allergic substances of allergens.
Specialized cells called mast cells also participate in the allergic reaction. Mast cells release a variety of chemicals into the tissues and blood, one of which is known as histamine. These chemicals frequently cause allergic reactions. These chemicals are very irritating and cause itching, swelling, and fluid leaking from cells. Through various mechanisms, these allergic chemicals can cause muscle spasm and can lead to lung and throat tightening as is found in asthma and loss of voice (laryngitis ).
Hay Fever Triggers
Outdoor allergens, such as pollens from grass, trees and weeds
Indoor allergens, such as pet hair or dander, dust mites and mold
Irritants, such as cigarette smoke, perfume and diesel exhaust
Hay Fever Management and Treatment
Avoid triggers by making changes to your home and to your behavior.
Keep windows closed during high pollen periods; use air conditioning in your home and car.
Wear glasses or sunglasses when outdoors to keep pollen out of your eyes.
Use “mite-proof” bedding covers to limit exposure to dust mites and a dehumidifier to control mold (if you smell mildew, you likely have mold).
Wash your hands after petting any animal and have a nonallergic person help with pet grooming, preferably in a well-ventilated area or outside.
Control some symptoms with over-the-counter medication.
Decongestants
Antihistamines (eyedrops, nasal spray and oral medication)
See an allergist for prescription medications, which may be more effective.
Antihistamines (eyedrops, nasal spray and oral medication)
Allergy shots (immunotherapy)

Symptoms
Allergic rhinitis — commonly known as hay fever — is a group of symptoms affecting the nose. But don’t be misled by the name — you don’t have to be exposed to hay to have symptoms. And despite the name, it’s not usually accompanied by fever.
People with allergic rhinitis generally experience symptoms after breathing in an allergy-causing substance such as pollen or dust. In the fall, a common allergen is ragweed. In the spring, the most common triggers are grasses and pollen.
When a sensitive person inhales an allergen, the body’s immune system may react with the following symptoms (listed in order of frequency):
Stuffy nose due to blockage or congestion
Itching, usually in the nose, mouth, eyes, throat or skin
Puffy, swollen eyelids
Sneezing
Cough
Symptoms also may be triggered by common irritants such as:
Cigarette smoke
Strong odors, such as perfume, or hair spray and fumes
Cosmetics
Laundry detergents
Cleaning solutions, pool chlorine, car exhaust and other air pollutants (i.e., ozone)
There are two types of allergic rhinitis:
Seasonal: Symptoms can occur in spring, summer and early fall. They are usually caused by sensitivity to airborne mold spores or to pollens from trees, grasses or weeds.
Perennial: Symptoms occur year-round and are generally caused by sensitivity to dust mites , pet hair or dander,
cockroaches or mold .
Allergic rhinitis can be associated with:
Decreased concentration and focus
Limited activities
Decreased decision-making capacity
Impaired hand-eye coordination
Problems remembering things
Irritability
Sleep disorders
Fatigue
Missed days of work or school
More motor vehicle accidents
More school or work injuries
Many parents of children with allergic rhinitis have said that their children are more moody and irritable during allergy season. Since children cannot always express their symptoms verbally, they may express their discomfort by acting up at school and at home. In addition, some children feel that having an allergy is a stigma that separates them from others.
It is important that the irritability or other symptoms caused by ear, nose or throat trouble are not mistaken for attention deficit disorder. With proper treatment , symptoms can be kept under control and disruptions in learning and behavior can be avoided.
Symptoms of allergic rhinitis have other causes as well, the most customary being the common cold — an example of infectious rhinitis. Most infections are relatively short-lived, with symptoms improving in three to seven days.
Many people have recurrent or chronic nasal congestion, excess mucus production, itching and other nasal symptoms similar to those of allergic rhinitis. In those cases, an allergy is not the cause.
Diagnosing
To find the most effective way to treat allergic rhinitis symptoms, see an allergist
Your allergist may start by taking a detailed history, looking for clues in your lifestyle that will help pinpoint the cause of your symptoms. You’ll be asked, among other things, about your work and home environments (including whether you have a pet), your eating habits, your family’s medical history and the frequency and severity of your symptoms.
Sometimes allergic rhinitis can be complicated by several medical conditions, such as a deviated septum (curvature of the bone and cartilage that separate the nostrils) or nasal polyps (abnormal growths inside the nose and sinuses). Any of these conditions will be made worse by catching a cold. Nasal symptoms caused by more than one problem can be difficult to treat, often requiring the cooperation of an allergist and another specialist, such as an otolaryngologist (ear, nose and throat specialist).
Your allergist may recommend a skin test , in which small amounts of suspected allergens are introduced into your skin. Skin testing is the easiest, most sensitive and generally least expensive way of identifying allergens.
Types of skin tests
Prick or scratch test: In this test, a tiny drop of a possible allergen is pricked or scratched into the skin. Also known as a percutaneous test, this is the most common type of skin test. The results are known within 10 to 20 minutes.
Intradermal test: A small amount of a possible allergen is injected under the skin using a thin needle. The site is checked for a reaction after about 20 minutes. This test is typically more sensitive than the prick or scratch test.
Management and Treatment
The first approach in managing seasonal or perennial forms of hay fever should be to avoid the allergens that trigger symptoms.
Outdoor exposure
Stay indoors as much as possible when pollen counts are at their peak, usually during the midmorning and early evening (this may vary according to plant pollen), and when wind is blowing pollens around.
Avoid using window fans that can draw pollens and molds into the house.
Wear glasses or sunglasses when outdoors to minimize the amount of pollen getting into your eyes.
Wear a pollen mask (such as a NIOSH-rated 95 filter mask) when mowing the lawn, raking leaves or gardening, and take
appropriate medication beforehand.
Don’t hang clothing outdoors to dry; pollen may cling to towels and sheets.
Try not to rub your eyes; doing so will irritate them and could make your symptoms worse.
Indoor exposure
Keep windows closed, and use air conditioning in your car and home. Make sure to keep your air conditioning unit clean.
Reduce exposure to dust mites, especially in the bedroom. Use “mite-proof” covers for pillows, comforters and duvets, and mattresses and box springs. Wash your bedding frequently, using hot water (at least 130 degrees Fahrenheit).
To limit exposure to mold, keep the humidity in your home low (between 30 and 50 percent) and clean your bathrooms, kitchen and basement regularly. Use a dehumidifier, especially in the basement and in other damp, humid places, and empty and clean it often. If mold is visible, clean it with mild detergent and a 5 percent bleach solution as directed by an allergist.
Clean floors with a damp rag or mop, rather than dry-dusting or sweeping.
Exposure to pets
Wash your hands immediately after petting any animals; wash your clothes after visiting friends with pets.
If you are allergic to a household pet , keep the animal out of your home as much as possible. If the pet must be inside, keep it out of the bedroom so you are not exposed to animal allergens while you sleep.
Close the air ducts to your bedroom if you have forced-air or central heating or cooling. Replace carpeting with hardwood, tile or linoleum, all of which are easier to keep dander-free.
Many allergens that trigger allergic rhinitis are airborne, so you can’t always avoid them. If your symptoms can’t be well-controlled by simply avoiding triggers, your allergist may recommend medications that reduce nasal congestion, runny nose, sneezing and itching. They are available in many forms — oral tablets, liquid medication, nasal sprays and eyedrops. Some medications may have side effects, so discuss these treatments with your allergist.
Intranasal corticosteroids are the single most effective drug class for treating allergic rhinitis. They can significantly reduce nasal congestion as well as sneezing, itching and a runny nose.
Talk with your allergist about whether these medications are appropriate and safe for you. These sprays are designed to avoid the side effects that may occur from steroids that are taken by mouth or injection. Take care not to spray the medication against the center portion of the nose (the nasal septum). The most common side effects are local irritation and nasal bleeding. Some older preparations have been shown to have some effect on children’s growth; data about some newer steroids don’t indicate an effect on growth
Antihistamines are commonly used to treat allergic rhinitis. These medications counter the effects of histamine, the irritating chemical released within your body when an allergic reaction takes place. Although other chemicals are involved, histamine is primarily responsible for causing the symptoms. Antihistamines are found in eyedrops, nasal sprays and, most commonly, oral tablets and syrup.
Antihistamines help to relieve nasal allergy symptoms such as:
Sneezing and an itchy, runny nose
Eye itching, burning, tearing and redness
Itchy skin, hives and eczema
There are dozens of antihistamines; some are available over the counter, while others require a prescription. Patients respond to them in a wide variety of ways.
Generally, the newer (second-generation) products work well and produce only minor side effects. Some people find that an antihistamine becomes less effective as the allergy season worsens or as their allergies change over time. If you find that an antihistamine is becoming less effective, tell your allergist, who may recommend a different type or strength of antihistamine. If you have excessive nasal dryness or thick nasal mucus, consult an allergist before taking antihistamines. Contact your allergist for advice if an antihistamine causes drowsiness or other side effects.
Proper use: Short-acting antihistamines can be taken every four to six hours, while timed-release antihistamines are taken every 12 to 24 hours. The short-acting antihistamines are often most helpful if taken 30 minutes before an anticipated exposure to an allergen (such as at a picnic during ragweed season). Timed-release antihistamines are better suited to long-term use for those who need daily medications. Proper use of these drugs is just as important as their selection. The most effective way to use them is before symptoms develop. A dose taken early can eliminate the need for many later doses to reduce established symptoms. Many times a patient will say that he
Proper use of these drugs is just as important as their selection. The most effective way to use them is before symptoms develop. A dose taken early can eliminate the need for many later doses to reduce established symptoms. Many times a patient will say that he or she “took one, and it didn’t work.” If the patient had taken the antihistamine regularly for three to four days to build up blood levels of the medication, it might have been effective.
Side effects: Older (first-generation) antihistamines may cause drowsiness or performance impairment, which can lead to accidents and personal injury. Even when these medications are taken only at bedtime, they can still cause considerable impairment the following day, even in people who do not feel drowsy. For this reason, it is important that you do not drive a car or work with dangerous machinery when you take a potentially sedating antihistamine. Some of the newer antihistamines do not cause drowsiness.
A frequent side effect is excessive dryness of the mouth, nose and eyes. Less common side effects include restlessness, nervousness, overexcitability, insomnia, dizziness, headaches, euphoria, fainting, visual disturbances, decreased appetite, nausea, vomiting, abdominal distress, constipation, diarrhea, increased or decreased urination, urinary retention, high or low blood pressure, nightmares (especially in children), sore throat, unusual bleeding or bruising, chest tightness or palpitations. Men with prostate enlargement may encounter urinary problems while on antihistamines. Consult your allergist if these reactions occur.
Important precautions:
Follow your allergist’s instructions.
Alcohol and tranquilizers increase the sedation side effects of antihistamines.
Do not use more than one antihistamine at a time, unless prescribed.
Keep these medications out of the reach of children.
Know how the medication affects you before working with heavy machinery, driving or doing other performance-intensive tasks; some products can slow your reaction time.
Some antihistamines appear to be safe to take during pregnancy, but there have not been enough studies to determine the absolute safety of antihistamines in pregnancy. Again, consult your allergist or your obstetrician if you must take antihistamines.
While antihistamines have been taken safely by millions of people in the last 50 years, don’t take antihistamines before telling your allergist if you are allergic to, or intolerant of, any medicine; are pregnant or intend to become pregnant while using this medication; are breast-feeding; have glaucoma or an enlarged prostate; or are ill.
Never take anyone else’s medication.
Decongestants help relieve the stuffiness and pressure caused by swollen nasal tissue. They do not contain antihistamines, so they do not cause antihistaminic side effects. They do not relieve other symptoms of allergic rhinitis. Decongestants are available as prescription and nonprescription medications and are often found in combination with antihistamines or other medications. It is not uncommon for patients using decongestants to experience insomnia if they take the medication in the afternoon or evening. If this occurs, a dose reduction may be needed. At times, men with prostate enlargement may encounter urinary problems while on decongestants. Patients using medications to manage emotional or behavioral problems should discuss this with their allergist before using decongestants. Pregnant patients should also check with their allergist before starting decongestants.
Nonprescription decongestant nasal sprays work within minutes and last for hours, but you should not use them for more than a few days at a time unless instructed by your allergist. Prolonged use can cause rhinitis medicamentosa, or rebound swelling of the nasal tissue. Stopping the use of the decongestant nasal spray will cure that swelling, provided that there is no underlying disorder.
Oral decongestants are found in many over-the-counter (OTC) and prescription medications, and may be the treatment of choice for nasal congestion. They don’t cause rhinitis medicamentosa but need to be avoided by some patients with high blood pressure. If you have high blood pressure, check with your allergist before using them.
Nonprescription saline nasal sprays will help counteract symptoms such as dry nasal passages or thick nasal mucus. Unlike decongestant nasal sprays, a saline nasal spray can be used as often as it is needed. Sometimes an allergist may recommend washing (douching) the nasal passage. There are many OTC delivery systems for saline rinses, including neti pots and saline rinse bottles.
Nasal cromolyn blocks the body’s release of allergy-causing substances. It does not work in all patients. The full dose is four times daily, and improvement of symptoms may take several weeks. Nasal cromolyn can help prevent allergic nasal reactions if taken prior to an allergen exposure.
Nasal ipratropium bromide spray can help reduce nasal drainage from allergic rhinitis or some forms of nonallergic rhinitis.
Leukatriene pathway inhibitors (montelukast and zafirlukast) block the action of leukotriene, a substance in the body that can cause symptoms of allergic
rhinitis. These drugs are also used to treat asthma.
Immunotherapy may be recommended for people who don’t respond well to treatment with medications or who experience side effects from medications, who have allergen exposure that is unavoidable or who desire a more permanent solution to their allergies. Immunotherapy can be very effective in controlling allergic symptoms, but it doesn’t help the symptoms produced by nonallergic rhinitis.
Two types of immunotherapy are available: allergy shots and sublingual (under-the-tongue) tablets.
Allergy shots: A treatment program, which can take three to five years, consists of injections of a diluted allergy extract, administered frequently in increasing doses until a maintenance dose is reached. Then the injection schedule is changed so that the same dose is given with longer intervals between injections. Immunotherapy helps the body build resistance to the effects of the allergen, reduces the intensity of symptoms caused by allergen exposure and sometimes can actually make skin test reactions disappear. As resistance develops over several months, symptoms should improve.
Sublingual tablets: This type of immunotherapy was approved by the Food and Drug Administration in 2014. Starting several months before allergy season begins, patients dissolve a tablet under the tongue daily. Treatment can continue for as long as three years. Only a few allergens (certain grass and ragweed pollens) can be treated now with this method, but it is a promising therapy for the future.
Eye allergy preparations may be helpful when the eyes are affected by the same allergens that trigger rhinitis, causing redness, watery eyes and itching. OTC eyedrops and oral medications are commonly used for short-term relief of some eye allergy symptoms. They may not relieve all symptoms, though, and prolonged use of some of these drops may actually cause your condition to worsen.
Prescription eyedrops and oral medications also are used to treat eye allergies. Prescription eyedrops provide both short- and long-term targeted relief of eye allergy symptoms, and can be used to manage them.
Check with your allergist or pharmacist if you are unsure about a specific drug or formula.

Symptoms of hay fever mimic those of chronic colds and include
stuffy or runny nose,
itchy and watering eyes, and
sneezing .
The best way to treat an allergy condition is to identify the allergic trigger and avoid it.
Allergists are medical specialists trained in the diagnosis and treatment of allergies, including hay fever.
Histamine is a key chemical cause of allergic rhinitis and other allergic reactions.
Effective treatment is available in many forms, including medications and desensitization therapy (immunotherapy).
Antihistamines are the drugs most commonly used to treat allergic rhinitis.
What is hay fever? What are hay fever symptoms and signs?
Hay fever affects up to 30% of all people worldwide, including up to 10% of U.S. children under 17 years of age and 7.8% of U.S. adults. The medical cost of allergic rhinitis is approximately $3.4 billion, mostly due to the cost of prescription medications. These figures are probably an underestimate because many of those affected may attribute their discomfort to a chronic cold . Although childhood hay fever tends to be more common, this condition can occur at any age and usually occurs after years of repeated inhalation of allergic substances. The incidence of allergic disease has dramatically increased in the U.S. and other developed countries over recent decades.
"Hay fever" is a misnomer. Hay is not a usual cause of this problem, and it does not cause fever. Early descriptions of sneezing, nasal congestion, and eye irritation while harvesting field hay promoted this popular term. Allergic rhinitis is the correct term used to describe this allergic reaction  , and many different substances cause the allergic symptoms noted in hay fever. Rhinitis means "inflammation of the nose" and is a derivative of rhino , meaning nose. Allergic rhinitis that occurs during a specific season is called "seasonal allergic rhinitis." When it occurs throughout the year, it is called "perennial allergic rhinitis."
Rhinosinusitis is the medical term that refers to inflammation of the nasal lining as well as the lining tissues of the sinuses. This term is sometimes used because the two conditions frequently occur together.
Symptoms of allergic rhinitis, or hay fever, frequently include
nasal congestion,
a runny nose with clear mucus,
sneezing,
nose, eye itching, and
excess tear production in the eyes.
Postnasal dripping of clear mucus frequently causes a cough . Loss of the sense of smell is common, and loss of taste sense occurs occasionally. Nose bleeding may occur if the condition is severe. Eye itching , redness, and excess tears in the eyes frequently accompany the nasal symptoms. The eye symptoms are referred to as " allergic conjunctivitis" (inflammation of the whites of the eyes). These allergic symptoms often interfere with one's quality of life and overall health.
Many people with allergies  have difficulty with social and physical activities. For example, concentration  is often difficult while experiencing allergic rhinitis symptoms.
Hay Fever Symptoms
Allergies are exaggerated immune responses to environmental triggers known as allergens. Allergies are very common, and about 50 million people in North America suffer from allergies. One of the most common forms of allergy is allergic rhinitis ("hay fever"), which produces symptoms like
nasal congestion,
itchy and watery eyes,
sneezing,
stuffy or runny nose,
scratchy or sore throat,
throat clearing,
cough from postnasal drip.
The symptoms of hay fever can, in turn, lead to fatigue and lethargy.
Learn more about hay fever symptoms »
Why does an allergic reaction occur?
An allergic reaction occurs when the immune system attacks a usually harmless substance called an allergen  that gains access to the body. The immune system calls upon a protective substance called immunoglobulin E (IgE) antibodies to fight these invading allergic substances or allergens. Even though everyone has some IgE, an allergic person has an unusually large amount of IgE. This army of IgE antibodies attacks and engages the invading army of allergic substances of allergens.
Specialized cells called mast cells also participate in the allergic reaction. Mast cells release a variety of chemicals into the tissues and blood, one of which is known as histamine. These chemicals frequently cause allergic reactions. These chemicals are very irritating and cause itching, swelling, and fluid leaking from cells. Through various mechanisms, these allergic chemicals can cause muscle spasm and can lead to lung and throat tightening as is found in asthma and loss of voice (laryngitis ).
What causes allergic rhinitis?
Any substance can cause an allergy  if exposed to an allergic person in the right way. But for all practical purposes and with few exceptions, allergic rhinitis is caused by proteins. Commonly, allergic rhinitis is a result of an allergic person coming in contact several times with protein from plants. Many trees, grasses, and weeds produce extremely small, light, dry protein particles called pollen. This pollen is spread by the wind and is inhaled. These pollen particles are usually the male sex cells of the plant and are smaller than the tip of a pin or less than 40 microns in diameter.
Even though pollen is usually invisible in the air, pollen is a potent stimulator of allergy  . Pollen lodges in the nasal lining tissues (mucus membranes) and other parts of the respiratory tract, where it initiates the allergic response. Up to 7.8% of American adults suffer from allergic rhinitis. Approximately one in four people with allergic rhinitis also has asthma  .
What are risk factors for allergic rhinitis?
A person is programmed to be allergic by his/her genetic makeup and is destined to be allergic from birth. People of all races are affected, and the condition affects both males and females equally. Symptoms commonly begin in childhood. Having frequent exposure to the particular allergic substance is a risk factor for frequent attacks.
When and where does allergic rhinitis occur?
Since allergic rhinitis is frequently caused by pollen, symptoms occur when pollen is in the air. Trees primarily pollinate in the spring, while grasses pollinate in the spring and summer. Weeds usually pollinate in the late summer and fall. Of allergy sufferers in the United States, many are allergic to ragweed, about half are allergic to grasses, and fewer are allergic to trees. Of course, many people are allergic to other substances such as mold spores, animal dander protein, and dust mites, to name a few. If you wish to know the pollen count in your area, this information can often be found in the newspaper in the weather section or you can access the National Allergy Bureau's pollen count information at their web site (http://www.aaaai.org/nab/index.cfm).
Food is an uncommon cause of allergic rhinitis.
Is allergic rhinitis contagious?
Allergic rhinitis, like other allergic reactions, is not
contagious  . However, the symptoms of allergic rhinitis can be confused with those of a common cold , which can be spread from person to person.
What specialists treat allergic rhinitis?
Allergists are medical specialists trained in the diagnosis and treatment of allergies  , including hay fever. People with hay fever also often seek care from a primary-care physician, including internists, pediatricians, and family practitioners.
How do health-care professionals diagnose allergic rhinitis? How do health-care professionals identify allergies?
Typically, allergies are initially diagnosed by a combination of characteristic symptoms coupled with exam findings that correspond with allergies.
If a person is experiencing the typical symptoms of hay fever, a consultation with an allergy specialist can help identify the offending substances. Since the ideal way to manage an allergy is to avoid the substances that cause allergic reaction, it is important to first identify these substances (allergens). Many allergens can be suspected from information obtained in a patient's history. For example, if symptoms usually worsen with exposure to cats, then cat dander protein is a probable allergen causing the symptoms. If cutting grass is associated with the onset of symptoms, then grass allergy is probable. A patient's history of reactions is important in determining his/her unique allergies. Allergy testing is only done when allergies are debilitating enough that patients desire allergy immunotherapy  .
Because the identification of allergens is important and often difficult to pinpoint, skin testing is often needed to identify exactly the specific substance causing the allergy. Skin testing is done with minimal discomfort and is performed as follows:
A small amount of the suspected allergy substance is placed on the skin.
The skin is then gently scratched through the small drop with a special sterile needle. This is known as the prick-puncture method and is typically used for initial evaluations. A second method, known as the intradermal method, involves injection of a small amount of the test substance into the skin. Intradermal testing is more sensitive but also tends to lead to more false-positive results.
If the skin reddens and, more importantly, swells, then an individual is said to be "sensitized" to the particular allergen. If typical symptoms occur when a sensitized individual is exposed to the suspected substance, then allergy to that substance is probable.
The skin testing described is tolerated by the youngest of patients and should be the standard of testing.
Skin testing is not indicated for people who are at risk of a severe (anaphylactic) allergic reaction, who have certain
skin conditions  , or who are taking certain medications.
A number of blood tests are also available to aid in the diagnosis of allergy. These blood tests may be useful in people who cannot be skin tested due to skin diseases, who are taking medications that interfere with skin testing, or who are at a high risk of having an anaphylactic reaction to skin testing. These blood tests typically use various techniques to look for IgE antibodies in the blood and by inference suggest allergy in the tissues. If the allergy testing agrees with the history of symptoms upon exposure to the substance, then a diagnosis of allergic rhinitis is likely.
What is the treatment for allergies?

Avoidance of identified allergens is the most helpful factor in controlling allergy symptoms . Attempts to control the environment and avoidance measures often significantly aid in resolving symptoms. However, allergy avoidance is often not easy. A thorough discussion with your physician is needed, and control measures may be required daily.
If avoidance is not possible or does not relieve symptoms, additional treatment is needed. Many patients respond to medications that combat the effects of histamine, known as antihistamines. Antihistamines do not stop the formation of histamine, nor do they stop the conflict between the IgE and antigen. Therefore, antihistamines do not stop the allergic reaction but rather protect tissues from the effects of the allergic response.
The first-generation antihistamines, such as
diphenhydramine (Benadryl ), chlorpheniramine (Chlor-Trimeton), dimenhydrinate (Dramamine), brompheniramine (Dimetapp and others), clemastine fumarate (Tavist , Allerhist), and dexbrompheniramine (Drixoral) frequently cause mouth dryness and sleepiness as side effects.
Newer, so-called "non-sedating" or second-generation antihistamines are also available. These include loratadine (Claritin), fexofenadine (Allegra ), cetirizine (Zyrtec ), and
azelastine (Astelin Nasal Spray). In general, this group of antihistamines is slightly more expensive, has a slower onset of action, is longer acting, and induces less sleepiness. Many of these medications are available over the counter.
Discuss with a physician other antihistamine side effects that occasionally occur (for example, urine retention in males, fast heart rate, and others). Always discuss the potential side effects of any medication with a physician and/or pharmacist.
Decongestants help control allergy symptoms but not their causes. Decongestants shrink the swollen membranes in the nose and make it easier to breathe. Decongestants can be taken orally or by nasal spray. Decongestant  nasal sprays should not be used for more than five days without a doctor's advice, and if so, usually only when accompanied by a nasal steroid. Decongestant nasal sprays often cause a so-called "rebound effect" if taken for too long. A rebound effect is the worsening of symptoms when a drug is discontinued. This is a result of a tissue dependence on the medication.
Some people with allergies need specialized prescription medications such as corticosteroids , cromolyn , and ipratropium (Atrovent ) nasal sprays. These nasal sprays do not cause the rebound effect noticed with decongestant nasal sprays. Cortisone nasal sprays are very effective in reducing the inflammation that causes swelling, sneezing, and a runny nose. Cortisone can also decrease the formation of many chemicals involved in the allergic response. Many cortisone nasal sprays are on the market through prescription only. Intranasal steroids are typically the first-line medications for patients suffering from persistent allergies. Fluticasone (Flonase) is one medication available over the counter.
Cromolyn is also an anti-inflammatory medication available over the counter. Although cromolyn is not as potent as cortisone, it is very safe. Cromolyn must be used well in advance of anticipated allergy symptoms to be useful. Ipratropium (Atrovent) nasal spray is available for drying a wet runny nose. It will not prevent allergic reactions. This is an atropine derivative and although usually very safe, a person sensitive to atropine should be cautious when taking this drug.
Montelukast (Singulair) is an inhibitor of leukotriene action, another chemical involved in the allergic reaction. This medication is used for therapy of asthma  and has also been approved for treatment of allergic rhinitis, but it is not a first-line therapy. It has been shown to be most effective in those for whom significant congestion is a primary complaint. It may also be used in some cases together with antihistamines.
If antihistamines and nasal sprays are not effective or not tolerated by the patient, other types of therapy are available.
Allergy desensitization  or immunotherapy may be needed. Allergy immunotherapy stimulates the immune system with gradually increasing doses of the substances to which a person is allergic. Because the patient is being exposed to the allergy-inducing substance, an allergic reaction can occur and this treatment should be supervised by a physician. Although the exact way allergy desensitization works is not completely known, allergy injections appear to modify or stop the allergic reaction by reducing the strength of the IgE and its effect on the mast cells. This form of treatment is very effective for allergies to pollen, mites, cats, and especially stinging insects (for example, bees). Allergy immunotherapy usually requires a series of injections (allergy shots ) and takes three months to one year to become effective. The required length of treatment may vary, but three to five years is a typical course. Frequent office visits are necessary.
The duration of the effect of allergy immunotherapy should last many years, if not a lifetime. Although rare, serious allergy reactions can occur while receiving allergy injections. One cannot predict who will have a severe reaction. Even after years of receiving allergy shots, a patient can experience a reaction.
Are there home remedies for hay fever?
A number of herbal or alternative treatments have been used for symptoms of hay fever. Scientific review of the use of these preparations has been limited, although there are some reports that suggest potential benefit for a number of different herbal remedies, at least in certain patients. These include the following:
Certain Ayurvedic herbal mixes
Butterbur (Petasites hybridus )
Timofend (from Tinospora cordifolia )
Cinnamon bark
Benifuuki green tea
Many herbal formulations contain a number of different ingredients, each with potentially varying effects and properties. People who wish to try one of these treatments should learn about potential side effects. These kinds of products are not evaluated for safety, like over-the-counter and prescription medications.
Treatments that are not recommended for allergic rhinitis
Antibiotics: Effective for the treatment of bacterial infections, antibiotics do not affect the course of uncomplicated common colds (a viral infection) and are of no benefit for noninfectious rhinitis, including allergic rhinitis.
Nasal surgery: Surgery is not a treatment for allergic rhinitis, but it may help if patients have nasal polyps or chronic sinusitis that is not responsive to antibiotics or nasal steroid sprays.

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