Allergic rhinitis, pollen exposure, asthma and respiratory health
Understanding Hay Fever in Respiratory Health
Hay fever is an allergic reaction affecting the nose and often the eyes. For people with asthma or another respiratory condition, pollen exposure may also worsen cough, wheeze, chest tightness and breathlessness. Understanding your triggers, using treatment correctly and keeping asthma well controlled can make pollen season considerably more manageable.
- Allergic rhinitis
- UK pollen seasons
- Hay fever symptoms
- Asthma triggers
- Pollen avoidance
- Nasal treatments
- Immunotherapy
- Respiratory assessment
Hay fever can affect the lower airways
In people with asthma, pollen-related inflammation may be associated with worsening cough, wheeze, chest tightness or breathlessness. Deteriorating asthma should not be treated as a nasal problem alone.
Prepare before your pollen season
Preventive treatments such as corticosteroid nasal sprays often work best when used regularly and correctly rather than only after symptoms have become severe.
What is hay fever?
Hay fever, also called seasonal allergic rhinitis, occurs when the immune system reacts to airborne pollen. Similar symptoms occurring throughout the year may be caused by house-dust mites, animal allergens, mould or another trigger and are more broadly described as allergic rhinitis.
When an allergic person encounters a relevant allergen, the immune system releases inflammatory chemicals including histamine. This can produce sneezing, itching, nasal discharge, blockage and watering or irritation of the eyes.
Hay fever is sometimes regarded as a minor seasonal inconvenience, but symptoms can disturb sleep, impair concentration, reduce productivity and limit outdoor activity. It can be particularly troublesome for people with asthma or another chronic respiratory condition.
Inflammation in the nose and sinuses can coexist with inflammation in the bronchial airways. Effective respiratory care therefore considers both allergic-rhinitis symptoms and asthma control.
Seasonal variability: the UK pollen calendar
Different plants release pollen at different times. The precise beginning, peak and end of each season varies according to weather, geography and annual growing conditions.
Tree pollen
Birch, alder and hazel are important spring allergens. Individual tree species pollinate at different points within the season.
Grass pollen
Grass pollen is the most frequent seasonal trigger in the UK and commonly peaks during late spring and early summer.
Weed pollen
Nettle, dock, mugwort and other weed pollens can prolong symptoms into late summer.
Fungal spores
Outdoor mould spores can become more prominent during warm, humid or damp conditions and may affect some people outside the main pollen peaks.
Your personal season may offer a diagnostic clue
Symptoms recurring at the same time each year can suggest the likely allergen. Allergy testing may help when the trigger is unclear, symptoms are severe or allergen immunotherapy is being considered.
Symptoms of hay fever
Sneezing
Repeated bouts of sneezing are common after exposure to pollen or another airborne allergen.
Runny nose
Nasal discharge is usually clear and watery rather than thick or purulent.
Nasal blockage
Swelling of the nasal lining can make breathing through the nose difficult and disturb sleep.
Itchy or watery eyes
Allergic conjunctivitis can cause redness, watering, itching and eyelid swelling.
Itchy nose, mouth or throat
Irritation may produce throat clearing and an uncomfortable tickling sensation.
Cough
Cough may result from upper-airway irritation, asthma, cough hypersensitivity or more than one mechanism.
Tiredness
Poor sleep, persistent symptoms and sedating medicines can all reduce daytime energy and concentration.
Head or facial pressure
Nasal congestion can produce pressure, although severe, persistent or one-sided pain requires medical review.
Not every seasonal cough is caused by hay fever
Persistent cough, breathlessness, wheeze, fever, discoloured sputum, chest pain or coughing blood may require a respiratory assessment rather than repeated allergy treatment alone. Read about specialist assessment for chronic cough .
Understanding the connection between hay fever and asthma
Asthma causes variable inflammation and narrowing of the lower airways. In someone who is sensitised to pollen, allergen exposure can worsen bronchial inflammation as well as nasal and eye symptoms.
Increasing cough
A cough that becomes more frequent during pollen exposure may represent asthma deterioration rather than hay fever alone.
Wheeze
A whistling sound when breathing can indicate lower-airway narrowing and should be addressed using the asthma plan.
Chest tightness
Tightness or difficulty taking a full breath may indicate worsening asthma control.
Breathlessness
Reduced exercise tolerance or breathlessness at rest requires assessment according to severity.
Night waking
Coughing or wheezing at night suggests that asthma may not be adequately controlled.
Increased reliever use
Needing a reliever inhaler more frequently should prompt review of the action plan and preventive treatment.
Continue prescribed asthma treatment, check inhaler technique and follow your written action plan. A preventer inhaler should not be stopped simply because symptoms improve between pollen peaks.
Where asthma is suspected or control is uncertain, spirometry, bronchodilator testing and airway-inflammation tests may contribute to a specialist assessment.
Hay fever and other respiratory conditions
People with COPD, bronchiectasis or another chronic lung condition may notice increased cough or breathing discomfort during periods of high pollen, although symptoms should not automatically be attributed to allergy.
COPD
New wheeze, breathlessness or sputum change may represent a COPD exacerbation, infection or another problem rather than simple hay fever.
Bronchiectasis
Increased purulent sputum, fever or haemoptysis should prompt consideration of infection and bronchiectasis deterioration.
Cough hypersensitivity
Pollen, scent and airborne particles can trigger coughing when the cough reflex has become overly sensitive.
Sinus and laryngeal symptoms
Nasal obstruction, postnasal sensations and throat irritation may contribute to cough and voice symptoms.
Reducing exposure to pollen
Complete avoidance is rarely possible, but reducing exposure during high-pollen periods may lessen symptoms and complement medical treatment.
- Monitor the pollen forecast Check a reliable local forecast and identify the pollen types that tend to trigger your symptoms.
- Plan outdoor activity Consider reducing prolonged outdoor exposure when your relevant pollen level is high, especially when symptoms or asthma are unstable.
- Keep pollen outside Close windows when pollen levels are high and avoid drying clothes or bedding outdoors during peak exposure.
- Change after outdoor exposure Remove outdoor clothing, shower and wash your hair when practical to reduce pollen carried into bedrooms and living areas.
- Protect the eyes Wraparound sunglasses may reduce direct contact between pollen and the eye surface.
- Clean living areas regularly Damp dusting and a vacuum cleaner with suitable filtration may help reduce allergens brought indoors.
- Review indoor filtration realistically A correctly sized HEPA air cleaner may reduce some airborne particles in a room, but it does not replace medication or asthma treatment.
- Avoid smoke and irritants Tobacco smoke, vaping aerosols, perfume and air pollution may compound nasal or bronchial irritation.
Maintain normal activity where possible
Pollen avoidance should not lead to complete inactivity. Adjusting timing, location and treatment may allow exercise to continue safely. People with asthma should carry the inhaler recommended in their action plan.
Medicines and treatments for hay fever
Treatment choice depends on which symptoms are most troublesome, their severity, other medical conditions, pregnancy, age and medicines already being taken.
Antihistamines
What they treat
Oral or nasal antihistamines can reduce sneezing, itching, nasal discharge and eye symptoms.
Daytime use
Less-sedating preparations are generally preferred when driving, working or studying.
Important caution
Some antihistamines cause drowsiness and may interact with alcohol or other sedating medicines.
Corticosteroid nasal sprays
What they treat
These sprays reduce nasal inflammation and can improve blockage, discharge, sneezing and itching.
Regular use
They usually work best when used consistently, with the correct technique, throughout the relevant season.
Technique matters
Aim slightly outwards away from the nasal septum and avoid forceful sniffing that draws medicine directly into the throat.
Eye drops and saline treatment
Allergy eye drops
Antihistamine or mast-cell-stabilising drops may reduce itching and watering.
Saline nasal sprays
Saline can help rinse allergens and secretions from the nose and may be used alongside other treatment.
Safe rinse water
Larger-volume nasal rinses should use sterile or distilled water, or water that has been boiled and allowed to cool.
Decongestants
Short-term relief
Nasal decongestants may temporarily reduce blockage but are not a long-term treatment for allergic inflammation.
Rebound congestion
Prolonged use of decongestant nasal sprays can make blockage worse when the medicine wears off.
Medical cautions
Oral decongestants may be unsuitable with hypertension, heart disease, glaucoma, prostate symptoms or some other medicines.
Ask a pharmacist or clinician before combining treatments
Multi-symptom cold and allergy products may duplicate antihistamines, painkillers or decongestants. Children, pregnant patients and people with chronic medical conditions need treatment selected for their circumstances.
Managing asthma during hay fever season
- Use your prescribed preventer treatment Continue regular inhaled anti-inflammatory treatment as advised, even when asthma feels controlled.
- Check inhaler technique Incorrect technique can substantially reduce the amount of medicine reaching the airways.
- Follow your written asthma action plan The plan should explain what to do when symptoms, reliever use or peak-flow readings deteriorate.
- Monitor symptoms and peak flow where advised Record patterns during pollen exposure so that changes can be discussed at review.
- Treat allergic-rhinitis symptoms Controlling nasal inflammation may improve overall comfort and reduce one contributor to respiratory symptoms.
- Seek review when control worsens Night waking, activity limitation or increasing reliever use may indicate inadequate asthma control.
Seek urgent help for a severe asthma attack
Urgent assessment is needed for severe breathlessness, difficulty speaking in full sentences, rapidly worsening wheeze, blue or grey lips, exhaustion, confusion or poor response to the reliever treatment specified in the asthma action plan.
Call 999 for severe breathing difficulty, collapse or another immediately life-threatening symptom.
Desensitisation and allergen immunotherapy
Allergen immunotherapy aims to reduce sensitivity by repeatedly exposing the immune system to a carefully controlled dose of the relevant allergen. It is considered for selected patients with a confirmed allergy and significant symptoms despite appropriate standard treatment.
Sublingual immunotherapy
A tablet or preparation is placed under the tongue according to a specialist protocol. The first dose may require supervised administration.
Subcutaneous immunotherapy
Allergy injections are administered in a specialist setting with observation because systemic allergic reactions can occur.
Confirming the allergen
The clinical history and allergy testing should identify an allergen that is clearly relevant to the symptom pattern.
Long treatment course
Immunotherapy commonly requires treatment over several years and depends on consistent adherence.
Asthma must be controlled
Poorly controlled or severe unstable asthma can increase risk and may make immunotherapy unsuitable until control improves.
Specialist selection
Immunotherapy is not required for most people with hay fever and should follow allergy-specialist assessment.
Immunotherapy is allergen-specific
Treatment for one confirmed pollen allergy does not automatically treat symptoms caused by every tree, grass, weed, animal or indoor allergen.
Lifestyle, exercise and general respiratory health
Stay physically active
Exercise supports general and respiratory health. On difficult pollen days, consider a lower-exposure location or indoor activity rather than stopping exercise completely.
Protect sleep
Treating nasal blockage and keeping pollen out of the bedroom may reduce disrupted sleep and daytime fatigue.
Avoid tobacco smoke
Smoking and second-hand smoke irritate the respiratory tract and may make allergy and asthma symptoms harder to control.
Review alcohol effects
Alcohol may worsen nasal symptoms in some people and can add to drowsiness from sedating antihistamines.
When to seek medical advice
Arrange a routine clinical review when:
- symptoms remain troublesome despite pharmacy treatment;
- hay fever is disrupting sleep, work, study or daily activity;
- you are unsure which allergen is causing symptoms;
- you have recurrent wheeze, breathlessness or chest tightness;
- your asthma reliever is needed more often than usual;
- you are considering allergen immunotherapy;
- nasal blockage is persistent, severe or one-sided;
- you develop repeated sinus or ear problems.
Seek urgent assessment for:
- severe or rapidly worsening breathlessness;
- difficulty speaking because of breathing problems;
- blue or grey lips, collapse or confusion;
- swelling of the tongue or throat;
- difficulty swallowing or signs of anaphylaxis;
- severe eye pain, light sensitivity or visual loss;
- chest pain or coughing blood.
Call 999 for severe breathing difficulty, collapse, suspected anaphylaxis or another immediately life-threatening symptom.
Conclusion
Hay fever is an allergic reaction to pollen that commonly causes sneezing, nasal blockage, watery discharge and itchy eyes. Similar allergic-rhinitis symptoms can also be caused by year-round allergens such as house-dust mites, animals and mould.
UK pollen exposure changes through the year, with tree pollen predominating in spring, grass pollen in late spring and summer, and weed pollen extending into late summer. Weather and geography can alter the precise timing.
People with asthma should treat worsening cough, wheeze, chest tightness or breathlessness as possible lower-airway symptoms. Prescribed preventer treatment, good inhaler technique and a written asthma action plan remain important throughout allergy season.
Monitoring pollen, reducing exposure, using antihistamines or nasal treatment appropriately and protecting the home environment can improve control. Allergen immunotherapy may be considered for carefully selected patients with a confirmed allergy and persistent symptoms despite standard care.
Persistent or severe respiratory symptoms deserve proper assessment. A specialist asthma and respiratory review can help distinguish allergic-rhinitis symptoms from worsening asthma or another cause of cough and breathlessness.
Frequently asked questions
Is hay fever the same as allergic rhinitis?
Hay fever usually refers to seasonal allergic rhinitis caused by pollen. Allergic rhinitis also includes symptoms caused by year-round allergens such as house-dust mites or animals.
Can hay fever make asthma worse?
Yes. Pollen can worsen lower-airway inflammation in people with allergic asthma, leading to cough, wheeze, chest tightness, breathlessness or increased reliever use.
When does hay fever season start in the UK?
Tree pollen commonly begins during spring, grass pollen usually becomes prominent from mid-May into July, and weed pollen can continue into September. Timing varies each year.
Which pollen causes the most hay fever in the UK?
Grass pollen is the most common seasonal trigger, although tree and weed pollens are important for many individuals.
Should I use a nasal spray every day?
Corticosteroid nasal sprays generally work best when used regularly during the relevant season. Follow the product instructions and advice from your pharmacist or clinician.
Can nasal decongestant sprays be used throughout summer?
No. Prolonged use can cause rebound nasal congestion. Decongestant sprays should only be used for the short period specified in their instructions or by a clinician.
Does an air purifier cure hay fever?
No. A correctly sized HEPA air cleaner may reduce some airborne particles indoors, but it does not remove all exposure or replace appropriate medical treatment.
Can I exercise outside when the pollen count is high?
Many people can remain active by adjusting timing, location and treatment. Those with asthma should follow their action plan and avoid outdoor exercise when asthma is unstable.
Is allergen immunotherapy a cure?
It can produce sustained improvement in selected patients, but it is not guaranteed to remove every symptom and only targets the allergens included in the treatment.
Can hay fever cause a persistent cough?
Allergy may contribute to cough, but persistent cough can also result from asthma, infection, reflux, cough hypersensitivity or another respiratory condition and may require assessment.
References and further information
- NHS. Hay fever. View NHS information
- UK Health Security Agency. Hay fever and airborne allergens. View UKHSA guidance
- Met Office. Pollen forecast and pollen information. View the UK pollen forecast
- British Society for Allergy and Clinical Immunology. Rhinitis management guidance. View BSACI guidelines
- London Chest Specialist. Asthma diagnosis and treatment. Read about specialist asthma care
- London Chest Specialist. Lung-function tests. Read about respiratory testing
