What are the symptoms of seasonal allergic rhinitis (hay fever)?

From the Guidelines

For the treatment of seasonal allergy symptoms, intranasal corticosteroids are recommended as the initial treatment for persons aged 12 years or older, rather than a combination of an intranasal corticosteroid and an oral antihistamine. This recommendation is based on the strongest and most recent evidence from the 2017 Joint Task Force on Practice Parameters 1. Seasonal allergy symptoms typically include sneezing, runny or stuffy nose, itchy or watery eyes, itchy throat or ears, and postnasal drip, which occur when the immune system overreacts to allergens like pollen, grass, or mold spores.

Some key points to consider in the management of seasonal allergies include:

• The use of over-the-counter antihistamines like cetirizine (Zyrtec) 10mg, loratadine (Claritin) 10mg, or fexofenadine (Allegra) 180mg taken once daily to help reduce symptoms.
• Nasal corticosteroids such as fluticasone (Flonase) or triamcinolone (Nasacort), used as 1-2 sprays per nostril daily, are effective for nasal congestion.
• Decongestants like pseudoephedrine can provide temporary relief but shouldn't be used for more than 3 days to avoid rebound congestion.
• Saline nasal rinses using a neti pot or squeeze bottle can flush allergens from nasal passages.
• Practical measures include keeping windows closed during high pollen seasons, showering after outdoor activities, using air purifiers with HEPA filters, and tracking local pollen counts to limit exposure on high-count days.

These symptoms occur because the body releases histamine and other chemicals when exposed to allergens, causing inflammation in the nasal passages, eyes, and respiratory system. The evidence from the 2017 Joint Task Force on Practice Parameters 1 supports the use of intranasal corticosteroids as the initial treatment for seasonal allergic rhinitis, and this recommendation is based on the highest quality and most recent evidence available.

From the FDA Drug Label

Astelin® Nasal Spray is indicated for the treatment of the symptoms of seasonal allergic rhinitis such as rhinorrhea, sneezing, and nasal pruritus in adults and children 5 years and older Temporarily relieves these symptoms due to hay fever or other upper respiratory allergies: • runny nose • itchy, watery eyes • sneezing • itching of the nose or throat

Seasonal allergy symptoms can be treated with azelastine (IN) or loratadine (PO).

• Azelastine (IN) is indicated for symptoms such as rhinorrhea, sneezing, and nasal pruritus 2.
• Loratadine (PO) temporarily relieves symptoms including runny nose, itchy, watery eyes, sneezing, and itching of the nose or throat 3.

From the Research

Seasonal Allergy Symptoms

• Seasonal allergic rhinitis typically presents with symptoms of nasal congestion, rhinorrhea, postnasal drainage, sneezing, and itching of the eyes, nose, and throat 4.
• The most common symptoms of allergic rhinitis are rhinorrhea (90.38%) and nasal congestion (94.23%) 4.
• Patients with seasonal allergic rhinitis typically have physical examination findings of edematous and pale turbinates 4.

Treatment Options

• First-line treatment for mild intermittent or mild persistent allergic rhinitis may include a second-generation H1 antihistamine (eg, cetirizine, fexofenadine, desloratadine, loratadine) or an intranasal antihistamine (eg, azelastine, olopatadine) 4.
• Patients with persistent moderate to severe allergic rhinitis should be treated initially with an intranasal corticosteroid (eg, fluticasone, triamcinolone, budesonide, mometasone) either alone or in combination with an intranasal antihistamine 4.
• Fexofenadine-pseudoephedrine and loratadine-montelukast have comparable efficacy in improving symptoms, RQLQ scores, and nasal obstruction in seasonal allergic rhinitis 5.
• Second-generation oral antihistamines and intranasal corticosteroids are the mainstays of treatment, with practice guidelines recommending intranasal corticosteroids as first-line treatment for moderate to severe allergic rhinitis 6.

Management

• The management of allergic rhinitis includes allergen avoidance, pharmacotherapy, and immunotherapy 6.
• Current pharmacologic options include oral and intranasal antihistamines, intranasal corticosteroids, oral and intranasal decongestants, oral and intranasal anticholinergics, and leukotriene receptor antagonists 6.
• Pharmacotherapy is patient-specific, based on type, duration, and severity of symptoms, comorbidities, prior treatment, and patient preference 6.