Hay fever: symptoms, treatment, and how to manage the pollen season
Hay fever — medically known as seasonal allergic rhinitis — affects at least one in four people in the UK. Despite being so common, it is frequently undertreated, with many patients managing inadequately and suffering unnecessarily during the pollen season. The good news is that with the right treatment approach, symptoms can be very well controlled.
What is hay fever?
Hay fever is an allergic reaction to airborne allergens, most commonly pollen from trees, grasses, and weeds. When you are exposed to these allergens, the immune system overreacts, releasing histamine and other chemicals that trigger the characteristic symptoms of the condition.
The most common symptoms are a blocked or runny nose (nasal congestion and rhinorrhoea), frequent sneezing, and itchy, watery eyes — a condition known as allergic conjunctivitis. Many people also experience itching of the nose, throat, mouth, or ears. These core symptoms are driven directly by histamine release in the mucous membranes and conjunctiva.
Beyond these familiar signs, hay fever can also cause a range of secondary symptoms that are sometimes overlooked. Coughing due to postnasal drip — where mucus drains from the nose down the back of the throat — is particularly common. Fatigue is frequently reported, often as a consequence of disturbed or unrefreshing sleep during periods of high symptoms. Headaches arising from sinus pressure are another complaint. Some patients also notice a temporary loss of smell and taste during the worst periods of the season. Taken together, these effects can significantly impair concentration, mood, and overall quality of life, particularly during the summer months.
When is the pollen season?
The pollen season in the UK runs roughly from February to October, but the peaks vary considerably depending on pollen type. Understanding which pollens trigger your symptoms can help you prepare treatment in advance, even without formal allergy testing.
Tree pollen is the first to arrive each year, typically from February to June. Hazel and alder peak in late winter; birch, ash, and oak follow in spring, usually from March to May. Birch pollen in particular is a common and potent allergen for many people in the UK. Grass pollen, which runs from May to August and peaks in June and July, is the single most common cause of hay fever symptoms in this country. Weed pollen extends the season into autumn — nettles, plantain, dock, and mugwort can all cause symptoms from June through to October. For some patients, fungal spores round out the calendar: Alternaria and Cladosporium spores are present in summer and early autumn and can cause significant symptoms in sensitised individuals.
If your symptoms appear to begin in late winter, tree pollen is the likely culprit. If they are at their worst in June and July, grass pollen is the most probable cause. Keeping a diary of your symptoms in relation to pollen forecasts over one or two seasons can be a useful and inexpensive way of identifying your triggers.
Practical tips to reduce pollen exposure
Reducing your exposure to pollen does not eliminate symptoms entirely, but it can meaningfully reduce the burden of allergen that drives them. A combination of indoor and outdoor measures tends to be most effective.
Indoors, the priority is to keep pollen out and reduce its accumulation in the home. Keeping windows and doors closed during periods of high pollen — particularly in the morning and early evening when counts are typically highest — makes a significant difference. Using an air purifier with a HEPA filter helps to remove airborne pollen that does enter the home. Vacuuming regularly with a HEPA-filtered vacuum cleaner prevents pollen from recirculating. Washing bedding and curtains frequently during the season is worthwhile, as pollen accumulates on fabric surfaces. Avoid drying laundry outdoors during high pollen days, as clothes and bedding act as very effective pollen traps.
Outdoors, checking the daily pollen forecast — the Met Office provides this free of charge — allows you to plan activities around lower-risk windows. Wearing wraparound sunglasses provides meaningful protection for the eyes. Showering and changing clothes after spending time outside prevents pollen from being carried into the home and bedroom. Avoid grassy areas, especially freshly mown grass, which releases large quantities of pollen. Planning outdoor exercise or activities for after rainfall is also sensible, as rain effectively washes pollen from the air and temporarily reduces counts.
Treatment options
Effective treatments for hay fever are well established, and most patients can achieve very good symptom control with the right combination. The key is choosing the appropriate treatment for your symptom pattern and using it consistently rather than reactively.
Antihistamines
Antihistamines are the first-line treatment for most people with hay fever. Non-drowsy antihistamines — cetirizine, loratadine, and fexofenadine — are preferred for daytime use and are safe for most adults. They work by blocking histamine receptors, preventing the cascade of symptoms that histamine triggers. Antihistamines are most effective when taken consistently throughout the season rather than only when symptoms are at their worst. If you know which pollen triggers your symptoms, starting antihistamines a week or two before the season begins can significantly improve control. Older antihistamines such as chlorphenamine (Piriton) are effective but cause drowsiness and impair driving — they are generally best reserved for nighttime use if needed.
Nasal corticosteroid sprays
Nasal corticosteroid sprays are now considered the most important treatment for moderate to severe hay fever, and the evidence clearly supports their use as a cornerstone of management. They work by reducing inflammation in the nasal lining, addressing the underlying allergic process rather than merely blocking one chemical mediator. Examples include beclomethasone (available over the counter as Beconase) and fluticasone or mometasone, which are available on prescription. These sprays take several days to reach their full effect — ideally they should be started at least a week before the season begins. Used correctly, with the nozzle directed away from the nasal septum towards the outer wall of the nostril, they are extremely safe and have minimal systemic absorption.
Antihistamine eye drops
For patients with significant eye symptoms — itching, redness, and watering that is not adequately controlled by oral antihistamines — topical antihistamine eye drops can provide quick and targeted relief. Azelastine and ketotifen eye drops are both available and work well. They can be used alongside oral antihistamines and nasal sprays without concern.
Decongestants
Nasal decongestants such as xylometazoline can help during periods of severe nasal congestion when other treatments are not providing sufficient relief. However, they should not be used for more than five to seven consecutive days. Prolonged use leads to rebound congestion — a condition called rhinitis medicamentosa — where the nasal lining becomes dependent on the decongestant and swells more severely when it is not used.
Combination therapy
For patients with more severe or poorly controlled symptoms, combining a nasal corticosteroid spray with a non-drowsy oral antihistamine is often substantially more effective than either treatment alone. This combination addresses both the local nasal inflammation and the systemic histamine-mediated symptoms. For patients with co-existing asthma that worsens during pollen season, leukotriene receptor antagonists — such as montelukast — may occasionally be added, as they address both airway and nasal symptoms through a complementary mechanism.
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When should I see a doctor about hay fever?
Many cases of mild to moderate hay fever can be self-managed with over-the-counter treatments, particularly if the diagnosis is clear. However, there are several situations where a consultation with a GP is appropriate and worthwhile.
If your symptoms are severe and are significantly affecting your sleep, concentration, ability to work, or quality of life, a doctor can review your current treatment and optimise it — there are prescription options that may work better than what is available without a prescription. If you have tried several over-the-counter treatments and they are not providing adequate relief, that is a good reason to seek a review. If you have asthma and it worsens during the pollen season, this needs to be properly assessed, as the two conditions interact and poorly controlled hay fever can worsen asthma control. If you are uncertain whether your symptoms are due to hay fever or another condition — such as perennial (year-round) allergic rhinitis, non-allergic rhinitis, or a structural nasal problem — a GP can help clarify this. Finally, if you are interested in allergen immunotherapy (desensitisation), this must be initiated through a specialist and requires a referral.
Immunotherapy for hay fever
Allergen immunotherapy is the only currently available treatment that can modify the underlying allergic response, rather than simply managing its symptoms. It involves gradually exposing the immune system to increasing doses of the relevant allergen — most commonly grass pollen — in order to reduce the immune system's sensitivity to it over time. This can be delivered by injection (subcutaneous immunotherapy, administered in a clinic) or by dissolving a tablet under the tongue daily at home (sublingual immunotherapy). Sublingual grass pollen tablets are the most commonly used form for hay fever and are taken daily for several months before and throughout the grass pollen season.
Immunotherapy typically requires a commitment of three years to achieve lasting benefit, and it is most appropriate for patients with moderate to severe grass pollen allergy that is not adequately controlled by standard pharmacological treatment. On the NHS it is generally reserved for the most severe cases; it can be accessed more readily through private allergy services. It should be discussed with an allergist or immunologist who can perform specific allergy testing, confirm the relevant allergen, and determine whether you are a suitable candidate. For the right patient, the long-term benefits can be substantial — including continued symptom reduction after the course is complete.