Hay fever

Many people are affected by hay fever as soon as plants and trees bloom in the spring. The symptoms are caused by an allergic reaction to pollen in the air, affecting the upper airways. Sneezing and itchy eyes can be a real problem, especially on days that are warm and dry.

At a glance

  • Allergic rhinitis affects about 1 out of 4 people in industrialized countries like Germany.
  • Sometimes a higher risk of allergies runs in families.
  • It’s nearly impossible for people to protect themselves from pollen, unless they travel to areas of the world where there is currently no pollen in the air.
  • The symptoms can be treated with various medications.
  • Some people with allergic rhinitis develop allergic asthma after a few years.

Note: The information in this article cannot and should not replace a medical consultation and must not be used for self-diagnosis or treatment.

Hay fever: a man sneezing into a handkerchief

What is hay fever?

Many people are affected by hay fever as soon as plants and trees bloom in the spring. The symptoms are caused by an allergic reaction to pollen in the air, affecting the upper airways.

A forest with pollen flying through it. There are rays of sunshine between trees.

Sneezing and itchy eyes can be a real problem, especially on days that are warm and dry. People with allergies and asthma have more asthma attacks than usual around this time of year too.

Hay fever is also often known as allergic rhinitis.

What are the signs of hay fever?

People who have allergic rhinitis sneeze a lot and have a runny or stuffy nose. Some people have watery and itchy eyes too, and their eyelids become swollen. The term for this is allergic rhinoconjunctivitis (allergic rhinitis combined with conjunctivitis).

Other possible hay fever symptoms include itching and asthma-like symptoms such as coughing, wheezing, and shortness of breath. If their symptoms are more severe, they might also feel weak and tired.

These symptoms only occur during the pollen season. They are usually much more noticeable than the symptoms of a dust mite allergy. The symptoms of the latter can last the whole year.

What causes hay fever?

Allergy symptoms arise when the body overreacts. The body overreacts to substances that are actually harmless, such as pollen (allergens).

These allergens trigger a chain reaction in the immune system. First, antibodies to the allergen are made, and they bind to specific cells. If these cells come into contact with the allergen again, they are then able to “respond” by releasing chemical substances such as histamine. These substances then lead to allergic reactions such as sneezing or itchy eyes.

What is an allergy?

The video below explains what can trigger an allergy and what symptoms can occur.

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What are the risk factors for hay fever?

Some environmental conditions such as air pollution or cigarette smoke can make allergies more likely. But a higher risk of allergies can also run in families.

Experts believe that the immune system in many people is less well trained than it used to be. It is thus believed that higher standards of hygiene and fewer infections in childhood have also contributed to allergies being more widely spread these days.

How common is hay fever?

1 in 4 people have rhinitis (sneezing, itchiness and a blocked or runny nose) when they come into contact with pollen and other allergens.

Allergic rhinitis affects about 1 out of 4 people in industrialized countries like Germany. Symptoms usually first arise before the age of 20.

How does hay fever go on to develop?

Some people with allergic rhinitis develop allergic asthma after a few years. People who have an allergic reaction to pollen can also become allergic to certain foods after a while (a phenomenon known as cross-reactivity).

Severe symptoms may increase the likelihood of developing other medical conditions such as sinusitis (inflammation of the sinuses). In many people, the allergy makes the mucous membranes lining the airways overly sensitive too. As a result, they may also react more strongly than other people to irritants like dry air or cigarette smoke.

How can hay fever be prevented?

It’s nearly impossible for people to protect themselves from pollen, unless they travel to areas of the world where there is currently no pollen in the air. The German weather service, among others, provides up-to-the-minute information and pollen count forecasts. 

People can minimize the effects of pollen by keeping windows closed when there is a high pollen count and washing their hair before going to bed. 

How is hay fever diagnosed?

Doctors treating people with hay fever will first ask about their symptoms, their everyday life circumstances, and medical history. The doctor can then do a skin prick test to find out whether they are allergic to particular substances. This involves placing potential allergens on the forearm, and then pricking the surface of the skin where the allergens are, so the substances go into the skin. If the skin becomes red and swollen, like a mosquito bite, they have had an allergic reaction to that substance.

In some cases, doctors prescribe a blood test or something known as a nasal provocation test during which the membranes lining the nose are exposed to extracts of the potential allergen. If the lining of the patient’s nose becomes swollen, they sneeze and their nose starts running, they are likely to have allergic rhinitis.

How can hay fever be treated?

Hay fever can be treated with various medications:

  • decongestant nasal drops and nasal sprays
  • antihistamines
  • corticosteroids
  • leukotriene receptor antagonists

There are also non-drug alternatives such as saline (salt water) nasal sprays and nasal washes (nasal irrigation).

Sometimes desensitization, also known as hyposensitization (allergen-specific immunotherapy) can be helpful. It aims to reduce people’s sensitivity to allergens over the long term. The treatment takes about three years to complete. Similar to vaccines, this treatment approach involves regularly injecting people with small amounts of the allergen under the skin or placing it under the tongue.

Hay fever is treated by antihistamines, decongestant nasal drops, corticosteroids, saline nasal sprays and nasal douches, leukotriene receptor antagonists

People with seasonal hay fever often have very severe symptoms, but they only occur in phases – for example when the pollen count for grasses or grains is high. Others have an allergic reaction to dust mites or animal hair and have symptoms all year round. Medication can relieve symptoms, regardless of what triggered the allergy.

For more detailed information, for example about drug treatment for hay fever, visit gesundheitsinformation.de.

What else should I know?

Further information about the hay fever condition can also be found at allergieinformationsdienst.de.

  • Biedermann T, Heppt W, Renz H, Röcken M (Ed). Allergologie. Berlin 2016.
  • Brozek JL, Bousquet J, Baena-Cagnani CE, Bonini S, Canonica GW, Casale TB et al. Allergic Rhinitis and Its Impact on Asthma (ARIA) Guidelines: 2010 Revision. J Allergy Clin Immunol 2010; 126(3): 466-476. Aufgerufen am 01.06.2020.
  • Greiner AN, Hellings PW, Rotiroti G, Scadding GK. Allergic rhinitis. Lancet 2011; 378(9809): 2112-2122. Aufgerufen am 01.06.2020.
  • Trautmann A, Kleine-Tebbe J. Allergologie in Klinik und Praxis. Stuttgart 2013.

In cooperation with the Institute for Quality and Efficiency in Health Care (Institut für Qualität und Wirtschaftlichkeit im Gesundheitswesen) (IQWiG). As at:

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