The main symptoms of allergic rhinitis are rhinorrhea (increase in nasal secretion), pruritus, sneezing fits, obstruction and congestion of the nasal pathway [7]. Other characteristic physical findings include conjuctival swelling and erythema, eyelid swelling, lower eyelid venous stasis and effusion from the middle ear.

• Cervical Lymphadenopathy

  This was accompanied by painful anterior cervical lymphadenopathy. The condition responded well to an oral cephalosporin and increased fluid intake along with an analgesic agent. The patient recovered without sequelae. [ncbi.nlm.nih.gov]

• Fever

  […] asthma only (without hay fever) did. [ncbi.nlm.nih.gov]

  Read More on This Topic respiratory disease: Hay fever Hay fever is a common seasonal condition caused by allergy to grasses and pollens. [britannica.com]

• Fatigue

  Symptoms include itchy eyes, runny nose, sneezing, and fatigue. These symptoms can be accompanied by cough and wheezing. The name “Hay fever” originates from symptoms that occur during the time of year when farmers harvest and bale hay. [pmaonline.com]

  Prolonged, sometime violent sneezing Itchy, painful nose, throat, and roof of mouth-breathing Stuffy, runny nose Postnasal drip, resulting in coughing Watery, itchy eyes Head and nasal congestion Ear pressure or fullness Fatigue Hay fever symptoms could [ohioallergyclinic.com]

  However, common signs of hay fever include: • Nasal congestion • Cough • Postnasal Drip • Fatigue • Sneezing How is hay fever diagnosed? If you think you may be suffering from hay fever, contact an allergist. [carolinaasthma.com]

  […] blocked nose itchy, red or watery eyes (also known as 'allergic conjunctivitis') an itchy throat, roof of mouth, nose or ears a postnasal drip (mucus dripping down the back of the throat) cough swollen, blue-coloured skin under the eyes (allergic shiners) fatigue [healthdirect.gov.au]

• Lymphadenopathy

  This was accompanied by painful anterior cervical lymphadenopathy. The condition responded well to an oral cephalosporin and increased fluid intake along with an analgesic agent. The patient recovered without sequelae. [ncbi.nlm.nih.gov]

• Sneezing

  Conjunctival infection and edema of the nasal mucosa lead to attacks of sneezing. [britannica.com]

  RESULTS: Significant reductions in severity of symptom scores were found for sneezing, running nose, running eyes and itchy mouth/palate (p or 0.05). [ncbi.nlm.nih.gov]

  Hay fever or allergic rhinitis is an allergic inflammation of the nasal membranes that is characterized by rhinorrhea, sneezing, nasal congestion and pruritus. [symptoma.com]

  “It’s like a grenade going off in your nose; within 30 seconds you’re sneezing” Advertisement In most people, these harmless proteins are ignored, but those with allergies are not so lucky. [newscientist.com]

• Rhinitis

  Perennial/diagnosis Rhinitis, Allergic, Seasonal/complications* Rhinitis, Allergic, Seasonal/diagnosis Risk Factors Sweden/epidemiology [ncbi.nlm.nih.gov]

  Pollens of insect pollinated plants cannot cause allergic rhinitis because they are not able to remain airborne for long and do not carry any risks. Below are some plants that have been implicated as etiologic factors for allergic rhinitis. [symptoma.com]

• Cough

  Indicators of home dampness were strongly and significantly associated with dry cough, wheeze, and rhinitis symptoms. [ncbi.nlm.nih.gov]

  Cough/wheeze 8. Exhaustion 9. Puffy and watery eyes 10. Reduced taste and smell 11. Reduced hearing 12. Itch along roof of mouth 13. Extreme exhaustion 14. [dailymail.co.uk]

  Symptoms of cough and wheezing are more concerning and should be addressed by a doctor. Patients whose symptoms are not relieved by medications may benefit from allergen immunotherapy or “allergy shots”. [pmaonline.com]

  How you tell the difference Both hay fever and the common cold causes sneezing, runny or stuffy nose and coughing. [theconversation.com]

• Nasal Congestion

  It is characterised by cold-like symptoms that may include a runny nose, itchy eyes, sneezing and nasal congestion or blockage. [ncbi.nlm.nih.gov]

  Hay fever, also called allergic rhinitis, seasonally recurrent bouts of sneezing, nasal congestion, and tearing and itching of the eyes caused by allergy to the pollen of certain plants, chiefly those depending upon the wind for cross-fertilization, such [britannica.com]

• Sore Throat

  Hay fever can cause runny noses, streaming eyes and sore throats. Sadly, many treatments for this distressing condition are not recommended during pregnancy because of fears surrounding the effect on the unborn child. [ncbi.nlm.nih.gov]

  A sore throat, on the other hand, is generally a precursor to cold. If you have cold-like symptoms and a sore throat or have had one in the last few days, your condition is more likely to be the common cold. [theconversation.com]

  These options can also reduce postnasal drip, which contributes to sore throats. [healthline.com]

  Sore throat or coughing. Snoring. How can you help prevent seasonal allergies? Seasonal allergies, such as hay fever, are often caused by exposure to pollen. You can reduce your exposure to pollen by: Keeping your house and car windows closed. [healthlinkbc.ca]

• Abdominal Pain

  “These could include swelling, breathing difficulties, itchy skin or skin rashes and abdominal pain, amongst others. [express.co.uk]

  "We have a lot of people who come in with nonspecific abdominal pain, diarrhea, cramps or incapacitating gastrointestinal problems," Tobin says. [rush.edu]

• Nausea

  Symptoms include: Stuffy or running nose Frequent sneezing Itchy eyes, nose, roof of mouth, or throat Coughing Watery eyes Blocked nose Pressure in the nose and cheeks Ear fullness and popping Dizziness and/or nausea Dark circles under the eyes Headache [southerncross.co.nz]

  Known disadvantages of the use of current non‐sedating second‐generation antihistamines include the side effects of mild drowsiness, fatigue, headache, nausea and dry mouth ( Rossi 2004 ). [doi.org]

• Excessive Tearing

  tear production; Dennie-Morgan lines (prominent creases below the inferior eyelid); and dark circles around the eyes (“allergic shiners”), which are related to vasodilation or nasal congestion Oropharynx: "Cobblestoning," that is, streaks of lymphoid [emedicine.medscape.com]

• Lacrimation

  Seasonal variety of allergic rhinitis, marked by acute conjunctivitis with lacrimation and itching; regarded as an allergic condition triggered by specific allergens. [icd9data.com]

• Urticaria

  Rhinoconjunctival syndrome was diagnosed in 180 (97.8%) patients, pollen induced bronchial asthma in 76 (41.3%) and pollen induced urticaria in 35 (19.0%) patients. [ncbi.nlm.nih.gov]

  […] pustules rarely reaction resemble scalp scaly scarlatiniform scars scleroderma scratch seborrheic dermatitis sensitization serum skin sometimes subcutaneous surface symptoms syndrome Syph syphilis therapy thickening tion toxic treatment tumors ulcers urticaria [books.google.com]

  Claratyne Tablets provide non-drowsy, rapid 24 hour relief from the symptoms of hayfever, year round allergies and chronic urticaria (hives). One daily dose provides relief from: - Sneezing - Runny nose - Watery, itchy eyes - Itchy rash [bayer.com.au]

  "Urticaria, Angioedema, and Allergic Rhinitis." 'Harrison's Principles of Internal Medicine, 20e' Eds. NY: McGraw-Hill. pp. Chapter 345. ISBN 978-1-259-64403-0. a b c d "American Academy of Allergy Asthma and Immunology". "Allergy Tests". [en.wikipedia.org]

  Martin Metz and Marcus Maurer, Rupatadine for the treatment of allergic rhinitis and urticaria, Expert Review of Clinical Immunology, 7, 1, (15), (2011). Z. A. Randriamanantany, I. Annesi‐Maesano, D. Moreau, C. Raherison, D. Charpin, C. [doi.org]

• Psychiatric Symptoms

  Increased occurrence of psychiatric symptoms was seen both in individuals with O-RCSS and CSS. [ncbi.nlm.nih.gov]

• Epistaxis

  headache, nasal irritation, sedation 50 ( 145) for 1 nasal spray Olopatadine (Patanol) [corrected] C 6 years Block H 1 receptors; onset of action is 30 minutes Bitter aftertaste, epistaxis, headache, nasal irritation, sedation 50 ( 250) for 1 nasal [aafp.org]

  APARATO RESPIRATORIO R01 Dolor atribuido al aparato respiratorio R02 Fatiga respiratoria/disnea R03 Respiración jadeante/sibilante R04 Otros problemas de la respiración R05 Tos R06 Epistaxis/hemorragia nasal R07 Estornudos/congestión nasal R08 Otros signos [iqb.es]

  Significant local adverse effects: epistaxis. [doi.org]

  leading to release of various inflammatory mediators that cause the symptoms we recognize as AR, including sneezing; nasal congestion; stuffiness; rhinorrhea (runny nose); cough; itching of the nose, eyes, and throat; sinus pressure; headache; and epistaxis [emedicine.com]

• Onset in Adolescence

  Abstract Allergic rhinitis is a common disorder occurring in about one in four people in Britain with a peak onset during adolescence.1-3 Although not necessarily a serious illness, it can adversely affect quality of life and disrupt normal activities [ncbi.nlm.nih.gov]

• Headache

  Headache frequency seems to have a greater impact on the association with respiratory or allergic conditions than headache diagnoses. [ncbi.nlm.nih.gov]

  In addition to allergies, ENT specialists treat deviated septum, rhinitis, sinusitis, sinus headaches and migraines, nasal obstruction and surgery, and more. Dr. Spencer C. [entnet.org]

  Usually you’ll experience: Scratchy or sore throat Runny nose (discharge can be yellow or green in colour) Sneezing Sensitive or watery eyes Nasal congestion Lethargy or sleep disturbance Cough Headaches Mild fever Body aches and pains Give yourself more [healthpartners.com.au]

  Antihistamines sometimes cause dry mouth, headaches, and drowsiness, but a bigger drawback is that they tend to become less effective with long-term use. [consumerreports.org]

Allergy testing often shows what allergens an individual is sensitive to. The most common form of allergy testing is skin testing [8]. This often involves a patch test to see what particular substances are causing the condition. In less common situations, the suspected allergen is dissolved and dropped onto the lower eyelid as a means of testing for allergies. The lower eyelid test may be harmful when done improperly. When it is established that an individual cannot undergo skin testing, the RAST blood test is helpful in determining specific allergen sensitivity. In a differential leukocyte count, peripheral eosinophilia is seen.

The main goal of treatment is to prevent or reduce the symptoms that are brought about with the inflammation of the affected tissues [9]. Measures that have been proven effective include avoiding the allergen. When medications are required, intranasal corticosteroids are the preferred treatment. Other options can be used when these turn out to be ineffective. Antihistamines and steroids are also effective.

Prognosis is very positive because in many cases, hay fever is successfully managed by minimising exposure to the allergens and treatment with one or more medications [6]. Without medical treatment, many people with hay fever find their symptoms diminish as they get older.

Allergic rhinitis is triggered by the pollens of specific seasonal plants. It is known as hay fever because its prevalence is highest during the haying season. The condition however, can affect people round the year [2]. The causative pollen agent varies amongst individuals and also from region to region but in general, the pollens of wind-pollinated plants are the main cause. Pollens of insect pollinated plants cannot cause allergic rhinitis because they are not able to remain airborne for long and do not carry any risks [3]. Below are some plants that have been implicated as etiologic factors for allergic rhinitis.

• Trees: Olive, linden/lime, plane, poplar, willow, horse chestnut, horn beam, hazel, cedar, alder, birch and pine.
• Grasses: Family Poaceae (mostly ryegrass (Lolium sp.) and timothy (Phelum pratense)). An estimated 90% of hay fever sufferers are allergic to grass pollen. 
• Weeds: Ragweed, plantain, nettle, mugwort, fat hen and sorrel/dock. 

The Balsam of Peru, which is seen in fragrances and other products, may also cause allergic rhinitis.

In the United States, allergic rhinitis affects an estimated 40 million people. Recent figures also suggest a cumulative prevalence rate of 20% [4].

Internationally, the prevalence may vary within and among different countries. In Scandinavia, studies points to a 15% prevalence rate in men and 14% prevalence rate in women. This may be due to geographic differences in the types as well as potency of the overall aeroallergen burden.

Allergic rhinitis is basically an inflammation of the mucous membranes of the nose, eyes, sinuses, pharynx, middle ear and Eustachian tubes [5]. Inflammation of the mucous membranes is characterized by a complex interaction of inflammatory mediators but it is chiefly triggered by a response to an extrinsic protein triggered by an immunoglobulin E (IgE).

The ability to develop allergic or IgE mediated reactions following exposure to extrinsic allergens has a genetic composition. In individuals who are susceptible, exposure to any of the foreign proteins brings about allergic sensitisation. This is characterized by the production of specific IgE directed against these proteins.

This specific IgE coats the surface of the mast cell seen in the nasal mucosa. Following inhalation of a specific pollen grain, it binds to IgE on the mast cells and this leads to the immediate or delayed release some mediators such as histamine, tryptase, chymase, kinins, and heparin. These mediators following various interactions bring about the symptoms consistent with allergic rhinitis.

There is no clear prevention path to avoid getting hay fever. A few suggestions point to the avoidance of exposure to allergy inducing substances such as dust mites and animal dander but there is no clear evidence on this yet as susceptible people still develops hay fever even with careful avoidance.

For people with hay fever, the best thing to do is to take steps to lessen the exposure to the allergens that cause the symptoms [10] and taking allergy medications before exposure to allergens as directed by medical personnel.

Hay fever is a condition more correctly known as allergic rhinitis. It is seen when an allergen like pollen, dust or particles off an animal such as hair or shed skin gets inhaled by an individual who has a susceptible immune system [1]. In these individuals, the allergen triggers the production of the immunoglobin E (IgE) which binds to mast cells and basophils containing histamine.

When allergic rhinitis is caused by pollens from plants, it is known as pollinosis and when it is caused by grass pollens, it is known as hay fever.

Although symptoms resembling a cold or flu can be produced following hay fever, it doesn’t bring about a fever. The disease was erroneously linked with hay because it was believed at the time that symptoms were triggered by coumarin (smell of new hay).

Hay fever or allergic rhinitis is a condition that causes symptoms that bear close resemblance to cold-like signs and symptoms such as runny nose, itchy eyes, congestion and sneezing. Unlike a cold though, hay fever is not caused by a virus. It is instead caused by an allergic response to outdoor or indoor pollens like pollen and dust mites.

Hay fever is a troublesome condition as it can affect performance at work or school and also interfere with leisure activities. In most cases, avoiding triggers and taken the right medication is the best way to manage the condition.

1. May JR, Smith PH. (2008). Allergic Rhinitis. In DiPiro JT, Talbert RL, Yee GC, Matzke G, Wells B, Posey LM. Pharmacotherapy: A Pathophysiologic Approach (7th ed.). New York: McGraw-Hill. pp. 1565–75.
2. Yamamoto T, Asakura K, Shirasaki H, Himi T, Ogasawara H, Narita S, Kataura A. [Relationship between pollen allergy and oral allergy syndrome]. Nippon Jibiinkoka Gakkai Kaiho 2005 108 (10): 971–9.
3. Baroody FM, Brown D, Gavanescu L, Detineo M, Naclerio RM. Oxymetazoline adds to the effectiveness of fluticasone furoate in the treatment of perennial allergic rhinitis. The Journal of Allergy and Clinical Immunology 2011 127 (4): 927–34.
4. Passalacqua G, Bousquet PJ, Carlsen KH, Kemp J, Lockey RF, Niggemann B, Pawankar R, Price D, Bousquet J. ARIA update: I—Systematic review of complementary and alternative medicine for rhinitis and asthma. The Journal of Allergy and Clinical Immunology 2006 117 (5): 1054–62.
5. Rondón C, Fernandez J, Canto G, Blanca M. Local allergic rhinitis: Concept, clinical manifestations, and diagnostic approach. Journal of investigational allergology & clinical immunology 2010 20 (5): 364–71;
6. Dykewicz MS, Fineman S, Skoner DP, et al. Diagnosis and management of rhinitis: complete guidelines of the Joint Task Force on Practice Parameters in Allergy, Asthma and Immunology. American Academy of Allergy, Asthma, and Immunology. Ann Allergy Asthma Immunol 1998; 81:478.
7. Wallace DV, Dykewicz MS, Bernstein DI, et al. The diagnosis and management of rhinitis: an updated practice parameter. J Allergy Clin Immunol 2008; 122:S1.
8. van Cauwenberge P, Bachert C, Passalacqua G, et al. Consensus statement on the treatment of allergic rhinitis. European Academy of Allergology and Clinical Immunology. Allergy 2000; 55:116.
9. Bousquet J, Khaltaev N, Cruz AA, et al. Allergic Rhinitis and its Impact on Asthma (ARIA) 2008 update (in collaboration with the World Health Organization, GA(2)LEN and AllerGen). Allergy 2008; 63 Suppl 86:8.
10. Bousquet J, van Cauwenberge P, Aït Khaled N, et al. Pharmacologic and anti-IgE treatment of allergic rhinitis ARIA update (in collaboration with GA2LEN). Allergy 2006; 61:1086.