Hay fever is a common nasal condition that affects some 40 million Americans. It is estimated that 20% of the US population has hay fever but not all cases are diagnosed or appropriately managed by a medical professional. Some cases are worse than others and with the convenience of over-the-counter allergy medication, many people choose to treat mild hay fever on their own. But you may not know as much as you think you do about hay fever. There is a lot more to the condition than just a runny nose and sneezing during spring, summer and the fall.
Some of the symptoms that you may be experiencing may not seem like typical hay fever symptoms. Or these symptoms only arise when your hay fever is poorly managed as a result of complications developing. Similarly you may be surprised to learn about some of the lesser known triggers of hay fever. For these reasons it is always important to consult with a medical doctor and have your condition professionally managed particularly if you suffer with severe and/or chronic hay fever.
About hay fever
Hay fever is the common name for a condition known as allergic rhinitis. Allergic because it is related to your immune system’s hypersensitivity to otherwise harmless substances like dust and pollen. Rhinitis means inflammation of the nose that often presents with nasal congestion, a runny nose and sneezing. There are two types of allergic rhinitis:
- Seasonal rhinitis which varies by season and worsens with pollen exposure (tree, grass or weed pollens).
- Perennial rhinitis which persists throughout the year.
It is actually seasonal rhinitis that is hay fever per se. But these days the term is also used to describe perennial rhinitis. While seasonal rhinitis is almost entirely allergic in nature, about 1 out of 4 cases of perennial rhinitis are non-allergic.
Hay fever headaches
One of the common complications of hay fever is sinusitis. Remember that the inner lining of the nasal cavity is continuous with the paranasal sinuses. What affects the nose will affect the sinuses. Obstruction of the sinus resulting in congestion can cause frontal headaches. This means that the pain is felt in the forehead, just above the eyes. Severely congested sinuses and an acute bacterial sinus infection can worsen the headache. Coupled with the drowsiness and ‘sickly feeling’ (malaise), the headaches may be mistaken for other conditions.
Ear itching in hay fever
Nasal symptoms are expected but many people do not realize that hay fever can cause ear symptoms as well. One of the main reasons for ear symptoms is due to the communication channel between the middle ear and nasal cavity. This is known as the Eustachian tube and its purpose is to balance the air pressure in the middle ear. Symptoms involving the ear in hay fever and can vary from ear itching to earache. The latter is more likely to occur with otitis media, a complication of severe or chronic hay fever.
Eye swelling in hay fever
Eye symptoms are known to accompany hay fever. Typically there is watery eyes, redness and itching as the conjunctiva surrounding the eyeball is just as hypersensitive as the inner nasal lining. In fact, an eye allergy of this sort is known as allergic conjunctivitis and can occur on its own without hay fever. In severe cases there may be swelling of the eye. It is actually the eyelid that becomes swollen (eyelid edema) which gives the appearance of eye swelling.
Dental problems with hay fever
People with chronic hay fever may develop several orodental problems. This is mainly due to prolonged mouth breathing as nasal breathing makes it difficult to breathe through the nose. It is also exacerbated by sleep apnea which is a complication that may develop with chronic hay fever. The main dental problem is overbite (malocclusion) and a high-arched palate. Mouth breathing is further exacerbated by nasal polyps which is another complication associated with chronic hay fever.
Indoor and outdoor molds
Molds are fungi that thrive in damp conditions. While it is known that mold on the ceiling, walls and floors of a house or other building can be a problem for asthmatics, it is also a problem for people with hay fever. Remember that allergic rhinitis is closely related to asthma, which is often allergic in nature as well. Therefore many of the triggers of hay fever is also a problem in asthma. It is not only indoor molds that can be a problem. Outdoor molds which may grow on grass and grains can also be a trigger for hay fever. And some molds can exist both indoors and outdoors. Therefore the lack of visible molds in your house does not mean that you are not being exposed to it.
Cockroaches and rodents
Animal dander and house dust mite are two well known triggers in allergic rhinitis. These inhaled allergens are commonplace in the home. Animal dander is more of a problem for people who have indoor pets. Just as commonplace within the home are cockroaches and rodents, both of which are major triggers of allergic rhinitis. However, these pests are often not seen despite living in the home. People living in the inner city in particular who have tried to eliminate other allergens from the environment should consider cockroaches and rodents as a possible problem.
Food allergies in hay fever
Most triggers of hay fever are inhaled. That means it is airborne and enters the nose where it makes contact with the nasal lining. This triggers inflammation in a person who is allergic to these substances. However, hay fever is just one of the three allergic conditions commonly referred to as the allergic triad. The other two is atopic dermatitis and allergic asthma. It is known that ingested allergens (food or drink) can be a problem in atopic dermatitis and allergic asthma, particularly in children. Therefore the risk with food allergies also exists for hay fever although less commonly so.
However, it is rare for hay fever to be solely triggered by problem foods. Furthermore it is unlikely that allergic rhinitis triggered by foods will occur without causing respiratory and skin symptoms as well. In a person with chronic hay fever where lifestyle measures are important, a food diary should be kept. Any foods noted to be a problem or identified as part of an elimination diet should be avoided altogether. Even more important though is that food needs to be kept in air tight containers as it could be contaminated by rodents, cockroaches or molds which are known triggers for hay fever.