Allergic Rhinitis (Hay Fever):
Symptoms, Medication & Immunotherapy

At a glance

PrevalenceOne of the most common chronic conditions — affecting an estimated 10–30% of adults worldwide
Other namesHay fever (when triggered by pollen), allergic nasal symptoms
TriggersPollen (grass, birch, alder, hazel), dust mites, animal dander, mould
TreatmentAllergen avoidance, antihistamines, corticosteroid nasal spray, allergen immunotherapy
ConnectionClosely linked to allergic asthma — early treatment may possibly lower the risk of asthma
ICD-10J30 (Allergic rhinitis)

Table of contents

  1. What is allergic rhinitis?
  2. Forms
  3. Symptoms
  4. Diagnosis
  5. Medical treatment
  6. Allergen immunotherapy
  7. Allergen avoidance — practical tips
  8. Daily 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 otherwise harmless — such as pollen, dust mites, animal dander or mould. The result is inflammation of the nasal lining with typical symptoms: sneezing, runny nose, nasal congestion and itchy eyes.¹

Allergic rhinitis is often dismissed as a minor problem. In reality, it can significantly affect quality of life: sleep quality, concentration, work performance and social activities can be considerably impaired.¹˒²

Allergic rhinitis and asthma are closely connected A significant proportion of people with allergic rhinitis develop allergic asthma over time. Conversely, many people with asthma also have allergic rhinitis. Early treatment — particularly immunotherapy — may possibly lower the risk of asthma.¹

2. Forms

Seasonal allergic rhinitis (hay fever)
Triggered by pollen from trees (especially birch, alder, hazel), grasses or weeds. Symptoms occur seasonally — typically in spring and summer.
Perennial allergic rhinitis
Triggered by dust mites, animal dander (especially cat, dog) or mould. Symptoms persist year-round — often with nasal congestion as the leading 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-severe).¹

3. Symptoms

Nasal symptoms

  • Sneezing fits — often in series
  • Watery nasal discharge (rhinorrhoea)
  • Nasal congestion (nasal obstruction) — often the leading symptom in perennial rhinitis
  • Nasal itching

Eye symptoms (allergic conjunctivitis)

  • Itchy, watery, red eyes — often appear together with nasal symptoms (rhinoconjunctivitis)

Other complaints

  • Fatigue and exhaustion — often underestimated; impairs concentration and performance
  • Headaches
  • Sleep disturbance — caused by nasal congestion
  • Mouth breathing, snoring
  • Reduced sense of smell
  • In children: mouth breathing, allergic salute (rubbing the nose upwards), transverse nasal crease

4. Diagnosis

  • History: When do symptoms appear? Seasonal or year-round? Pets? Occupational exposure? Family history?
  • Skin prick test: Allergen extracts are applied to the skin and lightly pricked. A wheal indicates sensitisation. Result usually visible within minutes. Important: antihistamines must be discontinued several days beforehand, as they can affect the result.
  • Blood test (specific IgE): Can be used as an alternative or in addition to the skin prick test. Advantage: not affected by medication. Molecular allergy diagnostics can also identify individual allergen components.
  • Nasal provocation: In unclear cases — the suspected allergen is introduced directly into the nose and the reaction is measured.

5. Medical treatment

The choice of medication depends on the severity and the burden of symptoms. Many of the following medications are typically available over the counter — but a medical consultation is recommended for more severe symptoms.

Basic Antihistamines
Oral (tablets)
Active ingredients: cetirizine, loratadine, bilastine, desloratadine, fexofenadine
The newer generations are typically much less sedating. Effective against sneezing, runny nose and itchy eyes — less effective against nasal congestion.
Nasal (nasal spray)
Active ingredient: azelastine
Acts quickly and locally. Can be combined with a corticosteroid nasal spray.
Eye drops
Active ingredients: azelastine, ketotifen
For allergic conjunctivitis (eye involvement).
Most effective Corticosteroid nasal spray
Intranasal corticosteroids — the most effective option
Active ingredients: mometasone, fluticasone, budesonide
Considered the most effective medications for allergic rhinitis — particularly for nasal congestion. Anti-inflammatory action.
Important: The full effect typically only appears after several days of regular use. Side effects with proper use are typically mild (local irritation, occasional nosebleeds). Not systemic corticosteroids — acts only locally in the nose.¹
Other Other options
Cromones (e.g. cromoglicic acid)
Mast cell stabilisers as nasal spray or eye drops. Less effective than antihistamines and corticosteroids, but very well tolerated.
Decongestant nasal sprays (e.g. xylometazoline)
Act quickly against nasal congestion, but should typically not be used for more than a few days — habituation and rebound effect are possible. These are not allergy medications in the strict sense.
Leukotriene receptor antagonist (montelukast)
Prescription only. Can be useful in allergic rhinitis with concurrent asthma.

6. Allergen immunotherapy

Allergen immunotherapy (AIT, formerly desensitisation) is the only treatment that addresses the underlying 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
The body is exposed to increasing amounts of the allergen over months to years to acclimatise the immune system to the trigger. Goal: lasting tolerance.
Subcutaneous immunotherapy (SCIT) — the injection therapy
The allergen is regularly injected under the skin (usually at the medical practice). Initiation phase with increasing doses, followed by a maintenance phase over three to five years.
Sublingual immunotherapy (SLIT) — the tablet/drop therapy
The allergen is taken as a tablet or drops under the tongue. Can be done at home. The first dose is typically given under medical supervision.

Effectiveness and suitability

  • Effectiveness is well-documented in studies for grass and birch pollen as well as dust mites.
  • Product selection matters — not all products have equivalent evidence of effectiveness. Guidelines recommend products with documented evidence.³
  • Suitable for IgE-mediated allergies when medical therapy is insufficient or to influence the course of the disease.
  • Can be used from childhood onwards.

7. Allergen avoidance — practical tips

Pollen allergy

  • Check pollen forecasts (e.g. via local weather services or pollen apps)
  • On heavy pollen days, keep windows closed and use pollen filters in the car
  • Wash hair in the evening and don't leave clothes in the bedroom
  • Ventilation: in rural areas in the morning, in cities in the evening (pollen flight patterns)

Dust mite allergy

  • Encasings (mite-proof covers) for mattress, pillow and duvet
  • Wash bed linen regularly at high temperatures
  • Keep the bedroom cool and dry
  • Where possible, avoid carpets and dust-collecting items in the bedroom

Animal dander allergy

  • Keep the animal out of the bedroom if possible
  • Vacuum regularly (HEPA filter) and ventilate
  • In severe cases, rehoming the animal may be necessary — a difficult decision that needs to be weighed individually

8. Daily life with allergic rhinitis

  • Medication: Regular use of corticosteroid nasal spray is more effective than as-needed use — the full effect builds up over days.
  • Cross-reactions: Many pollen allergy sufferers also react to certain foods (oral allergy syndrome, e.g. birch → apple, hazelnut, cherry). If tingling in the mouth or swelling occurs after eating, an evaluation can be useful.
  • Driving: Older antihistamines (e.g. diphenhydramine) can cause drowsiness and impair driving ability. Newer generations (cetirizine, loratadine) typically have very little of this effect.
  • Children: Allergic rhinitis often appears in childhood. Mouth breathing, snoring and concentration problems at school can be hints. Early evaluation and, where appropriate, immunotherapy are recommended.

How brite helps with hay fever & co.

Corticosteroid nasal spray every morning, antihistamine as needed, perhaps a SLIT tablet for immunotherapy — allergy treatment only works with routine. brite keeps the plan together.

  • Intake reminder — mometasone nasal spray daily (even on good days), cetirizine in the evening, SLIT tablet on an empty stomach: brite reminds you on time.
  • Drug interaction check — antihistamine combined with other medications? Need to stop before a skin prick test? brite checks for free.
  • Health journal — track symptom intensity, pollen season, medication usage and side effects. Helps for the next visit to the allergist.
  • Digital medication plan — all allergy medications clearly organised for ENT, allergist, GP and pharmacy.
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FAQ: Common questions about hay fever & allergic rhinitis

Hay fever is the colloquial term for seasonal allergic rhinitis triggered by pollen. Allergic rhinitis is the broader medical term and also includes the perennial form (e.g. caused by dust mites or animal dander).
Yes — allergen immunotherapy is the only causal treatment for allergic rhinitis. It can substantially reduce symptoms long-term and may lower the risk of developing asthma. Effectiveness is well-documented for grass pollen, birch pollen and dust mites. Treatment typically lasts three to five years.¹˒³
Intranasal corticosteroid sprays (e.g. mometasone, fluticasone) are considered the most effective medications for allergic rhinitis — particularly for nasal congestion. They typically need to be used daily, with the full effect appearing after several days. Decongestant sprays (xylometazoline) should only be used short-term.¹
Yes — allergic rhinitis and asthma are closely linked. A significant proportion of those affected develop allergic asthma over time. Early treatment — particularly immunotherapy — may possibly lower this risk.¹
Older antihistamines (e.g. diphenhydramine) can cause significant drowsiness. Newer generations (cetirizine, loratadine, desloratadine, fexofenadine, bilastine) typically have very little of this effect. Individual sensitivity is still possible.
Many pollen allergy sufferers also react to certain foods because the allergens have a similar structure (e.g. birch and apple, hazelnut, cherry). Typical symptoms: tingling or swelling in the mouth after eating. This is called oral allergy syndrome.
Typically three to five years. Shorter courses are usually not sufficient for a lasting effect. Treatment can be administered as injections (SCIT, in 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). For more severe symptoms or treatments beyond OTC (immunotherapy, montelukast), a medical consultation is recommended.
Asthma Cetirizine Loratadine Cetirizine or loratadine? Medication and driving Drug interactions

Sources

  1. ARIA Guidelines: Allergic Rhinitis and its Impact on Asthma (Update 2023). aria.who.int
  2. BSACI Guideline for the diagnosis and management of allergic and non-allergic rhinitis. bsaci.org
  3. S2k Guideline Allergen Immunotherapy (DGAKI, AWMF Reg. No. 061-004, 2022). awmf.org
  4. gesundheitsinformation.de (IQWiG): Hay fever. gesundheitsinformation.de
Medical disclaimer: This article is for general information only and does not replace medical advice, diagnosis or treatment. For severe or persistent symptoms, an allergological evaluation should be sought. Allergen immunotherapy requires careful indication assessment by a clinician experienced in allergology. For any unclear or severe symptoms — especially shortness of breath — seek medical help immediately. Last updated: April 2026.