Allergic rhinitis (hay fever): symptoms, medications & hyposensitization

At a glance

FrequencyOne of the most common chronic diseases — in Germany, by estimates, a relevant proportion of the population is affected
Other namesHay fever (with a pollen allergy), allergic cold
TriggersPollen (grasses, birch, alder, hazel and others), house dust mites, animal hair, mould
TreatmentAllergen avoidance, antihistamines, corticosteroid nasal spray, allergen immunotherapy (hyposensitization)
ConnectionClosely linked to allergic asthma — early treatment may possibly lower the asthma risk
ICD-10J30 (allergic rhinitis)

Table of contents

  1. What is allergic rhinitis?
  2. Forms
  3. Symptoms
  4. Diagnosis
  5. Medication-based treatment
  6. Hyposensitization (allergen immunotherapy)
  7. Allergen avoidance — practical tips
  8. Everyday life with allergic rhinitis
  9. How brite helps you
  10. FAQ
  11. Related topics

1. What is allergic rhinitis?

In allergic rhinitis, the immune system overreacts to substances in the air that are actually harmless — for example pollen, house dust mites, animal hair or mould. The result is an inflammation of the nasal mucosa with typical symptoms such as sneezing, a runny nose, a blocked nose and itchy eyes.¹

Allergic rhinitis is often dismissed as trivial. In reality, it can considerably impair quality of life: sleep quality, concentration, performance at work and social activities can be markedly restricted.¹˒²

Allergic rhinitis and asthma are closely linked A relevant proportion of people with allergic rhinitis develop allergic asthma over time. Conversely, a large proportion of people with asthma also have allergic rhinitis. Early treatment — especially hyposensitization — may possibly lower the asthma risk.¹

2. Forms

Seasonal allergic rhinitis (hay fever)
Triggered by pollen from trees (above all birch, alder, hazel), grasses or herbs. Symptoms occur seasonally — typically in spring and summer.
Perennial allergic rhinitis
Triggered by house dust mites, animal hair (above all cat, dog) or mould. Symptoms persist throughout the year — often with a blocked nose as the key symptom.
Intermittent vs. persistent (ARIA classification)
The ARIA classification distinguishes by duration (intermittent: fewer than four days per week or fewer than four weeks; persistent: more) and by severity (mild vs. moderate-to-severe).¹

3. Symptoms

Nasal symptoms

  • Bouts of sneezing — often in series
  • A watery nasal discharge (rhinorrhoea)
  • A blocked nose (nasal obstruction) — with perennial rhinitis often the leading symptom
  • An itchy nose

Eye symptoms (allergic conjunctivitis)

  • Itchy, watery, reddened eyes — often occur together with the nasal symptoms (rhinoconjunctivitis)

Other complaints

  • Tiredness and exhaustion — often underestimated; impairs concentration and performance
  • Headache
  • Sleep disorders — due to a blocked nose
  • Mouth breathing, snoring
  • A reduced sense of smell
  • In children: mouth breathing, the allergic salute (rubbing the nose upwards), a nasal crease

4. Diagnosis

  • Medical history: when do the symptoms occur? Seasonal or year-round? Pets? Occupational exposure? Family history?
  • Skin test (prick test): allergen extracts are applied to the skin and lightly scratched in. A wheal indicates a sensitization. The result usually appears after a few minutes. Important: antihistamines have to be stopped a few days beforehand, because they can falsify the result.
  • Blood test (specific IgE): can be used as an alternative or in addition to the prick test. Advantage: no influence from medications. With molecular allergy diagnostics, individual allergen components can also be determined.
  • Nasal provocation: in unclear cases — the suspected allergen is introduced directly into the nose and the reaction is measured.

More: Preparing for a doctor's appointment.

5. Medication-based treatment

The choice of medication depends on the severity and the level of distress. Many of the following medications are usually available over the counter at the pharmacy — but medical advice is recommended with more severe symptoms.

Basis Antihistamines
Oral (tablets)
Active ingredients: cetirizine, loratadine, bilastine, desloratadine, fexofenadine
The newer generations usually barely cause tiredness anymore. They work against sneezing, a runny nose and itchy eyes — less well against a blocked nose. More: Cetirizine or loratadine?
Nasal (nasal spray)
Active ingredient: azelastine
Works quickly and locally. Can be combined with a corticosteroid nasal spray.
Eye drops
Active ingredients: azelastine, ketotifen
For allergic conjunctivitis (eye involvement).
Highly effective Corticosteroid nasal spray
Intranasal corticosteroids — the most effective option
Active ingredients: mometasone, fluticasone, budesonide
Regarded as the most effective medications for allergic rhinitis — especially against a blocked nose. They act in an anti-inflammatory way.
Important: the full effect usually only sets in after several days of regular use. With proper use, the side effects are usually minor (local irritation, nosebleeds possible). Not systemic cortisone — it acts only locally in the nose.¹
Further Further options
Cromones (e.g. cromoglicic acid)
Mast cell stabilizers as a nasal spray or eye drops. Less effective than antihistamines and corticosteroids, but very well tolerated.
Decongestant nasal sprays (e.g. xylometazoline)
Work quickly against a blocked nose but should usually not be used for longer than a few days — habituation and a rebound effect are possible. They are not allergy medications in the narrower sense.
Leukotriene receptor antagonist (montelukast)
Prescription only. Can be useful with allergic rhinitis with accompanying asthma.

6. Hyposensitization (allergen immunotherapy)

Allergen immunotherapy (AIT, formerly hyposensitization or desensitization) is the only therapy that addresses the cause of the allergy — not just the symptoms. It can change the course of the disease in the long term and may possibly lower the risk of developing asthma.¹˒³

Principle
Over months to years, the body is given increasing amounts of the allergen to get the immune system used to the trigger. The aim: a lasting tolerance.
Subcutaneous immunotherapy (SCIT) — the injection therapy
The allergen is regularly injected under the skin (usually at the medical practice). A build-up phase with an increasing dose, then a maintenance phase over three to five years.
Sublingual immunotherapy (SLIT) — the tablet/drop therapy
The allergen is placed as a tablet or drops under the tongue. Can be carried out at home. The first intake usually takes place under medical supervision.

Effectiveness and suitability

  • The effectiveness is well documented in studies for grass and birch pollen as well as house dust mites.
  • The choice of preparation is important — not all preparations have equivalent evidence of effectiveness. The guideline recommends preparations with documented evidence of effectiveness.³
  • Suitable with a proven IgE-mediated allergy, when the medication-based therapy is not enough or the course of the disease is to be influenced.
  • Can be used from childhood onwards.

7. Allergen avoidance — practical tips

Pollen allergy

  • Pay attention to the pollen forecast (e.g. the pollen app of the Deutscher Wetterdienst, the German Weather Service)
  • On days with heavy pollen, keep the windows closed, use a pollen filter in the car
  • Wash your hair in the evening and don't put clothes in the bedroom
  • Ventilation: in the countryside in the morning, in the city in the evening (pollen patterns)

House dust mite allergy

  • Encasings (mite-proof covers) for the mattress, pillow and duvet
  • Wash the bed linen hot regularly
  • Keep the bedroom cool and dry
  • Avoid carpets and dust traps in the bedroom as far as possible

Animal hair allergy

  • Keep the animal out of the bedroom as far as possible
  • Vacuum regularly (HEPA filter) and ventilate
  • With a severe allergy, giving up the animal may be necessary — a difficult decision that has to be weighed up individually

8. Everyday life with allergic rhinitis

  • Medications: the regular use of the corticosteroid nasal spray is more effective than taking it only as needed — the full effect builds up over days. More: Taking medications correctly.
  • Cross-allergies: many people with a pollen allergy also react to certain foods (oral allergy syndrome, e.g. birch → apple, hazelnut, cherry). If a tingling in the mouth or swellings occur after eating, an assessment can be useful.
  • Driving: older antihistamines (e.g. diphenhydramine) can cause tiredness and impair fitness to drive. The newer generations (cetirizine, loratadine) usually barely have this effect anymore. More: Medications and driving.
  • Children: allergic rhinitis often appears as early as childhood. Mouth breathing, snoring and problems with concentration at school can be clues. An early assessment and, where appropriate, hyposensitization are recommended.

How brite helps you with hay fever & co.

A corticosteroid nasal spray every morning, plus an antihistamine as needed, perhaps a SLIT tablet for hyposensitization — allergy treatment only works with a routine. brite holds the plan together.

  • Medication reminder — a mometasone nasal spray daily (even when things are going well right now), cetirizine in the evening, a SLIT tablet on an empty stomach: brite reminds you on time. Set up a reminder
  • Interaction check — an antihistamine combined with other medications? Stop it before the prick test? brite checks for free. Check now
  • Health history — document the symptom intensity, the pollen season, your medication use and side effects. Helps at your next appointment in allergology. Track your history
  • Digital medication plan — all your allergy medications clearly laid out for ENT, allergology, your family doctor and the pharmacy. Go to medication plan
Get started for free
brite App

FAQ: Common questions about hay fever & allergic rhinitis

Hay fever is the colloquial term for seasonal allergic rhinitis that is triggered by pollen. Allergic rhinitis is the medical umbrella term and also includes the perennial form (e.g. from house dust mites or animal hair).
Yes — allergen immunotherapy is the only causal therapy for allergic rhinitis. It can considerably reduce the symptoms in the long term and may possibly lower the risk of asthma. The effectiveness is well documented for grass and birch pollen and house dust mites. The treatment usually lasts three to five years.¹˒³
Corticosteroid nasal sprays (e.g. mometasone, fluticasone) are regarded as the most effective medications for allergic rhinitis — especially against a blocked nose. They usually have to be used daily, and the full effect sets in after a few days. Decongestant nasal sprays (xylometazoline) should be used only for a short time.¹
Yes — allergic rhinitis and asthma are closely linked. A relevant proportion of those affected develop allergic asthma over time. Early treatment — especially hyposensitization — may possibly lower this risk.¹
Older antihistamines (e.g. diphenhydramine) can cause considerable tiredness. The newer generations (cetirizine, loratadine, desloratadine, fexofenadine, bilastine) usually barely have this effect anymore. Nevertheless, individual sensitivity is possible.
Many people with a pollen allergy also react to certain foods, because the allergens are similarly structured (e.g. birch and apple, hazelnut, cherry). Typical symptoms: a tingling or swelling in the mouth after eating. This is called oral allergy syndrome.
Usually three to five years. A shorter time is mostly not enough for a lasting effect. The therapy can be carried out as injections (SCIT, at the practice) or as tablets/drops under the tongue (SLIT, at home).³
Many allergy medications are available over the counter (antihistamines such as cetirizine and loratadine, corticosteroid nasal sprays such as mometasone). With more severe symptoms or a treatment need beyond OTC (hyposensitization, montelukast), medical advice is recommended.

11. Related topics

Asthma Cetirizine Loratadine Cetirizine or loratadine? Medications and driving Drug interactions

Sources

  1. ARIA Guidelines: Allergic Rhinitis and its Impact on Asthma (Update 2023). aria.who.int
  2. gesundheitsinformation.de (IQWiG): Heuschnupfen. gesundheitsinformation.de
  3. S2k-Leitlinie Allergen-Immuntherapie (DGAKI, AWMF Reg-Nr. 061-004, 2022). awmf.org
  4. Deutsche Gesellschaft für Allergologie und klinische Immunologie (DGAKI). dgaki.de
Medical disclaimer: This article is for general information and does not replace medical advice, diagnosis or treatment. With severe or persistent symptoms, an allergological assessment should take place. Hyposensitization requires a careful indication by a specialist experienced in allergology. With any unclear or severe symptom — especially shortness of breath — medical help should be sought without delay. Last updated: April 2026.