What is hay fever?
Hay fever (allergic rhinitis) is an allergic reaction in the nose and eyes to airborne particles — usually pollen, but also dust mite, animal dander, mould, or other inhaled allergens. The immune system mistakenly identifies the particle as a threat and releases histamine and other inflammatory chemicals, causing the symptoms.
Hay fever can be:
- Seasonal — typically grass pollen (May-July in UK), tree pollen (February-May), or weed pollen (May-September)
- Perennial — year-round, usually from house dust mite, animal dander, or indoor moulds
- Mixed — year-round with seasonal worsening
~1 in 5
UK adults have hay fever. Around 1 in 3 say it significantly affects their daily life or work during the worst weeks of the season.
Symptoms
Classic hay fever symptoms:
- Sneezing, often in clusters
- Runny or blocked nose
- Itchy nose, throat, ears, or roof of mouth
- Watery, itchy, red eyes
- Postnasal drip (mucus running down the back of the throat)
- Cough, particularly at night or first thing
- Tiredness and "wiped out" feeling during peak season
- Difficulty concentrating, "brain fog"
- Disrupted sleep
- Headaches and facial pressure (from blocked sinuses)
- Reduced sense of smell and taste
Severe hay fever can have a major effect on:
- Work productivity and absenteeism
- School performance and exam outcomes (exam season coincides with grass pollen peak)
- Sleep quality
- Asthma control (many people with hay fever have or develop asthma)
- Mood — sustained tiredness and discomfort affect mental health
Common triggers
Pollens
- Tree pollens — February to May (birch, oak, plane tree, others)
- Grass pollens — May to July (most common UK hay fever trigger)
- Weed pollens — May to September (nettle, mugwort, plantain)
Indoor allergens (year-round)
- House dust mite — major year-round allergen, particularly affecting beds and soft furnishings
- Animal dander — cats, dogs, horses, others
- Mould spores — both outdoor (autumn) and indoor (damp homes)
- Cockroach — less common but relevant in some urban environments
Occupational triggers
Some people develop rhinitis from workplace exposures (flour, animal proteins, latex, wood dust, others). Worth discussing if symptoms cluster around work.
How we assess at MHW
1. Detailed history
Timing (when in year, time of day, in specific environments), pattern of symptoms, family history, asthma history, eczema, previous treatments tried, impact on daily life. The history often reveals the trigger pattern.
2. Examination
Nasal examination (using a small light or scope), looking for typical allergic changes (pale, swollen lining; clear mucus; "allergic salute" crease across the nose in some children). Check for nasal polyps, deviated septum, or signs of infection that mimic or complicate allergic rhinitis.
3. Allergy testing (specific IgE blood tests)
Where the trigger isn’t obvious or treatment isn’t controlling symptoms, allergy testing helps identify the specific allergens. At MHW we use specific IgE blood tests — a single blood sample sent to a UK accredited laboratory measuring antibodies to individual allergens (grass pollens, tree pollens, dust mite, animal danders, moulds, foods, and more).
Blood-based testing has several advantages:
- Suitable for patients on antihistamines (which can interfere with skin prick testing)
- Safe for patients with widespread skin conditions or history of severe reactions
- No risk of any allergic response from the test itself
- Multiple allergens tested from one sample
- Quantitative result — useful for tracking change over time
We don’t offer skin prick testing on site — if this is specifically needed (very rare), we refer to a specialist allergy centre. Allergy blood testing is particularly worth doing if symptoms aren’t well controlled or multiple potential triggers need clarifying. Results typically come back in 3–7 days and we discuss them with you at a follow-up.
4. Treatment plan
A written stepped plan covering avoidance, immediate treatment, and longer-term options if needed.
Treatment options
NICE CKS recommends a stepped approach, starting with simpler options and adding more as needed. Most people achieve good control without specialist intervention.
Avoidance and environmental measures
Where the trigger is identified, reducing exposure helps. See the lifestyle section below.
Antihistamines
A class of medications that block the histamine response. They reduce sneezing, itching, runny nose, and eye symptoms. Both over-the-counter and prescription options exist, in tablet, syrup, eye drop, and nasal spray forms. The specific choice depends on symptom pattern, age, and other factors discussed in consultation.
Nasal steroid sprays
A class of nasal sprays that reduce inflammation in the nasal lining. More effective than antihistamines for nasal blockage. Best used regularly during pollen season (ideally started 1–2 weeks before known triggers). Several options available, varying in potency and licensing — we discuss the appropriate choice for you.
Combination sprays
Nasal sprays combining different actions are available for more severe symptoms; require prescription.
Eye drops
For eye-predominant symptoms, specific eye drop treatments often provide rapid relief when oral medication alone isn’t enough.
Decongestants
Tablets or nasal sprays that reduce blockage. Nasal decongestant sprays should only be used short-term (a few days) to avoid rebound congestion. Oral options have other considerations discussed in consultation.
Step-up treatment
For severe or treatment-resistant rhinitis, additional options include oral steroids (short courses only), other oral medications, and immunotherapy. Specialist referral is sometimes appropriate.
UK law prevents naming specific prescription medications on this website — treatment options are discussed in clinic in the context of your individual symptoms, history, and preferences.
Immunotherapy — specialist referral
For severely affected patients, immunotherapy (also called desensitisation) is the only treatment that addresses the underlying allergy rather than just controlling symptoms. It involves gradually exposing the body to small, controlled amounts of the allergen so the immune system learns to tolerate it.
We don’t deliver immunotherapy at MHW. Immunotherapy is a multi-year specialist service that requires dedicated allergy clinics with capacity to manage potential serious reactions during initiation. If you’re a candidate, we discuss the options and refer to a specialist allergy centre (NHS or private) for delivery.
Forms of immunotherapy (delivered elsewhere)
- Sublingual immunotherapy (SLIT) — daily tablets or drops under the tongue, taken at home after initial supervised dose. Available in the UK for grass pollen, tree pollen, and dust mite. Treatment course is typically 3 years.
- Subcutaneous immunotherapy (SCIT) — injections given in clinic at intervals. More allergens covered but more clinic visits required.
Who’s suitable?
Immunotherapy is considered for patients with:
- Confirmed allergic rhinitis with significant symptoms
- Inadequate response to standard medications
- Identified specific allergen on testing
- Commitment to multi-year treatment
How we help
We can confirm the diagnosis with allergy blood testing, optimise your current medical treatment, and refer to an appropriate allergy specialist if immunotherapy is the right next step. We don’t initiate or maintain immunotherapy ourselves.
Lifestyle and avoidance measures
Pollen avoidance during season
- Keep windows closed, especially at peak pollen times (early morning, evening)
- Shower and change clothes after outdoor activity
- Don’t dry washing outside during pollen season
- Wraparound sunglasses outdoors
- Vaseline around the nostrils to trap pollen
- Pollen filter for car
- Check daily pollen forecasts; plan activities accordingly
Dust mite reduction
- Wash bedding weekly at 60°C
- Anti-allergy mattress and pillow covers
- Reduce soft furnishings, carpets where possible
- HEPA-filter vacuum
- Maintain low humidity
- Remove children’s soft toys to a wardrobe; freeze occasionally to kill mites
Pet dander
- Keep pets out of bedroom
- Bathe pets weekly
- HEPA air filtration
Allergic rhinitis often goes hand-in-hand with other conditions:
- Asthma — closely linked; many people with both. Treating one improves the other.
- Eczema — the "atopic triad" of eczema, asthma, and hay fever
- Food allergies — some pollen-related cross-reactions (oral allergy syndrome) with certain raw fruits and vegetables
- Nasal polyps — benign growths from inflamed nasal lining; need separate management
- Chronic sinusitis — sometimes complicates uncontrolled rhinitis
- Sleep problems — nasal blockage causes disrupted sleep and daytime tiredness
When to see us
Consider booking if:
- Over-the-counter treatments aren’t controlling your symptoms
- Symptoms are affecting work, study, sleep, or daily life
- You’re using nasal decongestant sprays for more than a few days
- You have year-round symptoms suggesting non-seasonal allergens
- You want to identify your specific allergens with testing
- You’re considering immunotherapy
- You have asthma made worse by hay fever season
- You have a child whose hay fever is affecting school or exams
- You want a plan ahead of pollen season
Frequently asked questions
When is the best time to see you?
Ideally before pollen season — February or March — so we have time to plan, test if needed, and start regular treatment before symptoms peak. But any time is fine; we treat in season too.
Do I need allergy testing?
Not always. If symptoms clearly match the timing of common allergens and respond to standard treatment, testing may not change management. Testing is most useful for unclear pictures, treatment failures, or if considering immunotherapy.
How long does the appointment take?
Initial consultation is 30–45 minutes. Skin prick testing adds about 30 minutes. Most patients leave with a clear plan within an hour.
Will insurance cover allergy testing?
Most UK PMI policies cover allergy testing when clinically indicated. Coverage for immunotherapy varies. We provide codes for your insurer.
Can children come for assessment?
Yes — we see children from age 5. Children must be accompanied by a parent or guardian.
Does eating local honey help?
This is a popular belief with limited evidence. Local honey rarely contains the wind-pollinated grass pollens that cause hay fever (those aren’t collected by bees). Reasonable to try; unlikely to help significantly.
Can hay fever go away on its own?
Hay fever can change over time — some children outgrow it; some adults develop new sensitivities. Immunotherapy is the only treatment that may produce long-term tolerance.
What about acupuncture / homeopathy?
Evidence is mixed to absent for these approaches. Some patients find acupuncture helpful for symptoms; we don’t recommend it as primary treatment but don’t discourage if you find it useful alongside standard treatment.