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Sneezing, a stuffy nose, eye irritation... The symptoms of so-called "hay fever" are well known to every fourth Bulgarian (according to national statistics). The most affected are children aged 5-6 years, but while they have a chance to outgrow the problem, for adults, it tends to persist for life.
The condition typically worsens in spring and summer, causing discomfort to about 1 billion people worldwide each year. For them, every outdoor activity becomes a nightmare, and even the smallest bouquet of spring flowers can trigger tears and a runny nose—not out of sentiment but due to allergy symptoms. The good news is that despite the discomfort it causes, the condition can be well controlled, allowing people to truly enjoy their time in nature.
Hay Fever or Allergic Rhinitis?
In fact, both terms describe the same condition—pollen allergy. As the name suggests, it is an intolerance (allergy) to pollen—tiny particles released into the air during the flowering of various trees and grasses. The body reacts to pollen with inflammation of the nasal mucosa, medically known as allergic rhinitis. The typical symptoms include:
- Itchy nose
- Itchy, red, and watery eyes
- Persistent nasal congestion
- Sneezing
- Burning and dryness in the throat
- Persistent runny nose with clear, watery, but abundant discharge
Other common symptoms of allergic rhinitis include reduced sense of smell, swelling of the vocal cords causing hoarseness, coughing, headaches, drowsiness, and general discomfort. Affected individuals often feel fatigued, irritable, and suffer from sleep disturbances. Symptoms usually worsen in sunny, dry, and windy weather and improve in humid and rainy conditions.
Don't Underestimate a Runny Nose!
Experts warn that hay fever symptoms can be serious, even if they resemble a common cold. If left uncontrolled, the condition can lead to severe complications and chronic illnesses.
Seasonal allergic rhinitis often worsens other conditions, such as allergic cough. It can also trigger conjunctivitis, as the eye mucosa is also inflamed. In extreme cases, severe swelling of the bronchial mucosa can cause asthma-like symptoms and difficulty breathing. Statistics show that allergic rhinitis increases the risk of developing bronchial asthma in 45-64% of cases, and conversely, over 85% of asthma patients also suffer from allergic rhinitis. Even more alarming is that 80% of children with hay fever later develop bronchial asthma.
If your symptoms persist for a month and occur more than four days a week, consult an allergist or an ENT specialist. Only they can distinguish hay fever from a common cold, sinusitis, or another health issue.
Don’t Delay Seeing a doctor!
From the first worrying symptom to the visit to a doctor and receiving a diagnosis, months or even a year may pass, specialists say. The reason is that people often resort to self-medication to temporarily suppress symptoms. However, this does not treat the condition, which recurs repeatedly. Another issue is that hay fever is seasonal—when the pollen season ends, symptoms disappear on their own. Patients feel relieved and postpone consulting a specialist until the next seasonal outbreak.
To distinguish between a common cold and allergic rhinitis, the doctor first determines whether the symptoms are linked to specific allergen exposure. In other words, does the usual Saturday picnic in the forest always cause a runny nose, or is it a one-time event? It's also important to establish whether symptoms occur year-round or only in a specific season and how long and severe they are. If you have relatives with allergies, you are more likely to have inherited a genetic predisposition.
The final diagnosis is confirmed through a skin test to identify the specific allergen the body is sensitive to. This test is usually done outside the pollen season. However, if allergic rhinitis is associated with other issues (e.g., enlarged adenoids, serous otitis, sinusitis, postnasal drip, and chronic cough), the test can be performed immediately. It detects antibodies produced by the body in response to different allergens. Experts emphasize that there is no risk of severe allergic reactions during the test since it is conducted at the skin level.
Avoid Allergens!
This is the most effective way to avoid discomfort from a constantly blocked nose, itching, and a runny nose. But it’s not always possible! You can't isolate yourself from the outside world or stay locked indoors just to avoid airborne pollen. However, modern medicine offers various methods to manage symptoms and alleviate the condition.
The treatment of allergic rhinitis is complex and long-term, sometimes lasting a lifetime. It involves a combination of medication and lifestyle adjustments that find how quickly and smoothly one can "survive" spring and summer. Patients adopt habits that help them in daily life, such as:
- Avoiding outdoor activities when pollen levels are high (morning hours or on dry, sunny, and windy days)
- Keeping home and car windows closed during pollen season and reducing ventilation.
- Showering after coming home from outside.
- Wearing sunglasses
- Avoiding walks near grassy areas
Staying away from smoke, cigarette fumes, strong odors and perfumes, polluted air in public places, and other irritants
In addition, allergic rhinitis is managed with new-generation antihistamines, which relieve itching, sneezing, and nasal discharge by blocking histamine, the main culprit behind allergic reactions. These medications reduce nasal mucosal swelling, suppress allergic inflammation, and decrease symptom recurrence. They are taken once daily and start working within an hour.
The only treatment that can alter the natural course of seasonal allergies is specific immunotherapy (also called desensitization). It is prescribed by an allergist and administered as an injection—either alone or in combination with other treatments. The goal is to reduce the body's reaction (and so nasal inflammation) upon future exposure to the allergen. It is particularly beneficial for patients who cannot effectively control their condition with medication or prefer not to take drugs.
Allergic rhinitis can also be managed with homeopathy and herbal remedies, but only after consultation with an allergist. Herbal treatment is recommended only when it is confirmed that the herbs themselves are not allergens.
Trees and Grasses with the Most Aggressive Pollen
If you struggle to tell willow from birch or plantain from dock, your first hay fever attack will turn you into a botany expert. This knowledge will help you plan outdoor activities without encountering the plants that trigger your symptoms. Additionally, understanding plant species allows you to mark their peak pollen seasons in your calendar, helping you stay indoors during high-risk periods.
Many plants produce pollen that can cause allergic reactions, including:
Trees:
- Birch family: Birch, alder, hornbeam, hazel
- Cypress family: Cypress, juniper, thuja
- Beech family: Beech, chestnut, oak
- Olive family: Ash, olive, privet
- Pine family: Fir, pine, spruce, cedar
- Plantain family: Plantain
Grasses:
- Cereal grass: Oats, wheat, corn, barley, etc.
- Forage grass: Timothy grass, meadow fescue, ryegrass, etc.
Weeds:
- Pigweed
- Nettle
- Plantain
- Dock
- Mugwort
Due to the diversity of plant species and their individual flowering periods, hay fever lasts for two seasons—from March to October. It starts with tree pollen in spring, followed by grass pollen in late spring and summer (May–August, when pollen levels peak). Weed pollen appears in summer and fall (July–October). Pollen calendars, which track flowering periods, help assess peak airborne pollen concentrations.
Pollen Isn't the Only Culprit!
Hay fever is the most common allergic condition and is triggered by exposure to specific allergens. However, pollen isn’t always the cause. Allergens can come from both outdoor and indoor environments and are found everywhere around us.
Common allergens include:
- Pollen
- Mold spores
- House dust mites
- Animal danger
- Insect debris
- Fungi
- Air pollution
- Viruses
In modern cities, high levels of sulfur and nitrogen oxides, ozone layers, and exhaust fumes contribute to the increasing prevalence of hay fever. This is why allergic rhinitis is more common in urban areas than in rural ones.
Although allergic rhinitis is not life-threatening (except in severe asthma or anaphylaxis), it significantly reduces quality of life, affects work and school performance, and impacts concentration and mood. However, good management and regular medical check-ups can eliminate its daily impact.
