More and more people are suffering from hay fever these days. This widespread condition can limit sufferers in their daily lives and impair their quality of life. Here’s an overview of the most important information.
What is hay fever?
Around twelve million people in Germany suffer from hay fever. According to information from the Federal Ministry of Health, studies suggest that such allergic respiratory diseases are becoming increasingly common. Hay fever refers to an allergic reaction to pollen from grasses, trees, or herbs. Strictly speaking, however, this is not the disease itself, but rather the visible symptom of a pollen allergy – medically known as allergic rhinitis or pollinosis.
From a medical perspective, pollinosis is the actual hypersensitivity reaction of the immune system to certain proteins in pollen. Hay fever, on the other hand, describes the resulting symptoms. In affected individuals, the immune system mistakenly classifies the otherwise harmless pollen as a threat and responds with a defensive reaction. Pollen, also known as flower dust, is produced by plants for reproduction. In people with allergies, the neurotransmitter histamine is released, among other substances, triggering inflammation primarily in the mucous membranes. Typical symptoms therefore occur mainly in the upper respiratory tract and in the eyes.
Important to know: If a pollen allergy remains untreated, it can lead to what is known as a “shift in severity.” In this process, the inflammation spreads from the upper to the lower respiratory tract and eventually affects the bronchi as well. In the worst case, this can develop into allergic bronchial asthma.
When is the pollen season usually?
Pollen can generally be found in the air all year round. However, for nearly 60 percent of allergy sufferers, grass pollen in particular triggers symptoms and is therefore considered the most significant allergen. Their dispersal period generally extends from March to October, with a peak season between May and July. The most common grass pollens include, above all, sweet grasses such as meadow grass, tufted hairgrass, and timothy grass, as well as cereal pollens from rye and wheat. Among herbs mugwort, sorrel, and stinging nettle are considered particularly allergenic. According to the German Conference of Head Gardeners (GALK), allergies most frequently occur in response to pollen from hazel, alder, birch, beech, oak, and poplar. The German Allergy and Asthma Association (DAAB) provides an overview of when specific pollens are in the air. However, due to rising temperatures resulting from climate change, the pollen season is starting earlier and earlier and lasting longer, extending well into the fall.
Hay Fever Symptoms
Typical symptoms primarily affect the eyes and nose. If allergens come into contact with the nasal mucosa, an allergic rhinitis (rhinitis allergica) may develop. If they come into contact with the eyes, this often leads to conjunctivitis. However, other areas may also be affected—often even simultaneously. The most common symptoms include:
- itchy, burning, watery, and red eyes with swollen eyelids
- persistent itching in the nose, frequent sneezing, clear, watery nasal discharge, and a stuffy nose
- Itching or a scratchy sensation in the throat, a tickling sensation, hoarseness, or a feeling of tightness when breathing
- Itching on the palate
In addition, many sufferers report general symptoms such as fatigue, exhaustion, or lethargy—and the skin can also be affected by hay fever. Furthermore, headaches, difficulty concentrating, and sleep problems may occur, partly as a result of persistent irritation of the mucous membranes and nighttime breathing difficulties. Similar symptoms also occur with a cold. However, there are some typical characteristics that generally allow hay fever and a cold to be distinguished from one another
Possible causes of hay fever
Hay fever is caused by an overreaction of the immune system to certain proteins in otherwise harmless pollen. Upon first contact with these allergens, the body’s defense system produces so-called IgE antibodies, which are special defense substances of the immune system. When the pollen later comes into contact again with the mucous membranes of the nose, eyes, or airways, the IgE antibodies bind to mast cells, which are also part of the immune system. These then release inflammatory mediators (histamine). This triggers the typical symptoms of hay fever. Those affected usually react to the pollen of specific plant species.
Often, there is also sensitization to several different types of pollen.
Hay fever particularly affects older adults, adult women, and young boys. The exact causes of hay fever have not yet been fully clarified. Possible risk factors include a genetic predisposition as well as air pollution, as reported by the online portal t3n.de. Climate change also influences the development of pollen allergies. For example, new plant species are increasingly spreading, whose pollen can trigger allergic reactions, such as ragweed or the olive tree. At the same time, the pollen season is starting earlier in the year in many places and lasting longer. Higher CO₂ concentrations also promote plant growth and thus pollen production. Rising temperatures and more frequent storms can further increase allergen exposure.
What helps with hay fever?
Hay fever is more than just a bothersome allergy: if left untreated, the condition can develop into asthma. This is highlighted, among others, by the German Nature Conservation Union (NABU). Early diagnosis and treatment are therefore crucial to slowing the progression of the disease. Diagnosis involves not only observing individual symptoms but also medical tests. This allows for the detection of typical antibodies in the blood, while skin and so-called provocation tests provide additional insight into which allergens the body reacts to. If a pollen allergy is diagnosed, various treatment approaches are available, which should always be coordinated with a doctor:
Non-medicinal measures
- Avoid pollen as much as possible: A key measure is to reduce contact with pollen. Checking the pollen forecast helps you identify high-pollen periods. During peak pollen season, however, outdoor activities—especially in meadows or fields and in sunny weather—should be limited. If possible, spending time by the sea, on islands, or in the mountains can provide relief.
- Adjusting daily life and household routines: Pollen exposure can also be significantly reduced in everyday life. You should keep windows closed at night and in the early morning. Ideally, ventilate in the evening until midnight. Pollen screens can offer additional protection, as recommended by the Center for Rhinology and Allergology in Wiesbaden, if you don’t want to completely forego fresh air. It is best not to dry laundry outdoors. Regular vacuuming with suitable filters helps reduce allergens in the home. It is also advisable not to store clothes worn outside in the bedroom and to wash your hair before going to bed if you have been outside. When outdoors, wearing sunglasses can protect your eyes.
Hay Fever Medications
When applied topically, the side effects that are often feared are generally mild.
Hyposensitization for Hay Fever: How the Therapy Works
If standard measures against hay fever are insufficient, hyposensitization – also known as specific immunotherapy (SIT) – may be an option for some patients. It is performed by specialists in otolaryngology, dermatology, pulmonology, pediatrics, or by allergists. Hyposensitization is the only therapy that directly addresses the cause of an allergy . In this process, the immune system is gradually acclimated to the allergens: small amounts of the allergens are administered as diluted extracts in the form of injections, drops, or tablets. At this dosage, the body can tolerate the allergens without triggering an allergic reaction. Injection therapies are often administered as depot preparations. These release the active ingredient slowly over an extended period, so that treatment needs to be repeated less frequently and side effects are minimal. The injection is administered almost painlessly with a fine needle under the skin of the upper arm. Ideally, therapy begins before the pollen season. Various forms of treatment are available for hyposensitization:
- Year-round therapy: In year-round hyposensitization, the allergen is administered continuously. In subcutaneous therapy (SCIT), the dose is increased weekly until the maintenance dose is reached before the pollen season. The titration phase lasts about four months, followed by monthly injections. With sublingual immunotherapy (SLIT), you take the allergen daily for three years.
- Seasonal therapy: Alternatively, therapy can be limited to the pollen season—presasonal or co-seasonal short-term therapy. With pre-seasonal SCIT, there is a shortened titration phase with weekly injections, followed by a monthly maintenance dose and completed before the start of the pollen season. It is then repeated. Pre-seasonal SLIT increases the dose up to the season, pauses during it, and repeats this over three years. With co-seasonal SLIT, treatment continues until the peak of the pollen season and then pauses.
Discuss with your allergist which method is best suited for you. After an injection, temporary side effects may occur, such as redness or hives at the injection site, nausea, vomiting, sweating, tingling in the hands or feet or a drop in blood pressure. These reactions usually subside on their own. The prognosis following desensitization is very good: approximately 90 percent of patients benefit in the long term, often for up to ten years. As with vaccinations, the allergen can be re-administered for a short time if necessary should symptoms return. The therapy is recommended for children aged five and older. In cases of certain pre-existing conditions—such as severe cardiovascular disease, thyroid disorders, cancer, AIDS, or tuberculosis—or when taking certain medications like ACE inhibitors, specific immunotherapy should generally not be performed.
When should you see a doctor for hay fever?
If you have typical hay fever symptoms, it is generally advisable to first have a medical allergy test performed to ensure that you actually have a pollen allergy. If you already know that you suffer from hay fever and one or more of the following points apply to you, you should seek medical advice:
- Your symptoms are severe and show little improvement despite taking over-the-counter medications (e.g., nasal sprays or antihistamines).
- The symptoms persist throughout most of the pollen season.
- You feel significantly limited in your daily life, for example due to sleep disturbances or difficulty concentrating.
- You notice breathing difficulties such as wheezing, coughing fits, or a tightness in the chest. This may indicate the onset of allergic asthma.
- You belong to a high-risk group: children, pregnant women, or people with pre-existing conditions (e.g., asthma or cardiovascular disease).
