CAN HAYFEVER MAKE ASTHMA WORSE?

Hay fever is the common name for allergic rhinitis.  It is an allergic reaction to allergens, or triggers in the air – like pollens or grasses, dust mites, mould or animal dander, breathed in through the nose. This causes an immune response in the lining of the nose where the nasal passages become red, swollen, and sensitive. Some people may experience hay fever (allergic rhinitis) at certain times of the year, for example, spring or summer, and other people experience these symptoms all year round.

SYMPTOMS OF HAY FEVER (ALLERGIC RHINITIS)

  • Itchy nose or eyes
  • Runny nose
  • Sneezing
  • Blocked nose
  • Throat clearing or coughing to clear the throat
  • Snoring
  • Mouth breathing
  • Always feeling like you have a head cold

OTHER SIGNS OF HAY FEVER

  • Disturbed sleep
  • Daytime tiredness
  • Poor concentration
  • Recurrent headaches
  • Frequent sore throats
  • Hoarse voice
  • Reduced sense of smell
  • Recurrent sinus infections in adults, causing facial pain or pressure
  • Frequent ear infections in children

You do not need to have all symptoms to have hay fever/allergic rhinitis, you may only experience a few. It is important if you think you have these signs or symptoms to discuss them with your doctor to get a diagnosis, discuss treatment options, and obtain a treatment plan.

HOW CAN HAY FEVER (ALLERGIC RHINITIS) IMPACT YOUR ASTHMA?

Asthma affects 2.7 million Australians, and about 80 percent of people with asthma also have allergic rhinitis. View asthma and allergy statistics here. Asthma and hay fever (allergic rhinitis) both involve airway inflammation and sensitivity throughout the respiratory system. Which means what is happening in the nose can affect the lungs as they are connected, so it is important to treat the nose as well as the lungs to achieve good asthma management.

HAY FEVER (ALLERGIC RHINITIS) CAN MAKE ASTHMA WORSE AND MORE DIFFICULT TO CONTROL

The reason that the presence of allergic rhinitis can make asthma more difficult to control is not entirely clear.  It has been suggested that breathing through your mouth when your nose is blocked can worsen asthma by bypassing the nose’s filtering and humidifying function. Another thought is that nasal inflammation (sensitivity and irritation) can trigger or set off the lower airways or lungs inflammation, sensitivity, and narrowing.  People with asthma who have hay fever (allergic rhinitis) experience:

  • More asthma flare-ups
  • More visits to their GP and have more asthma-related hospitalisations
  • More time off work or school
  • Higher yearly medical costs  2,3,4

Research shows treating hay fever (allergic rhinitis) can reduce asthma-related emergency department visits and hospitalisations, and may help to improve your asthma symptoms.  It is important to treat and manage both your asthma and allergic rhinitis to feel well.

Asthma and allergies

TIPS FOR PEOPLE WITH HAY FEVER (ALLERGIC RHINITIS)

If you have allergic rhinitis and asthma, treating your allergic rhinitis will help keep your asthma under control.

  • Know the symptoms of hay fever (allergic rhinitis) and asthma
  • Have the right plan and medications in place to best handle your symptoms
  • Check you are using your asthma and allergic rhinitis medications correctly

Before starting allergic rhinitis treatment tell your doctor or pharmacist if you have any other medical conditions, are pregnant, taking other medications, or experience nose bleeds.  If you have allergic rhinitis and/or asthma you may be at risk of  thunderstorm asthma.  For those interested in the science – pollen grains from grasses get swept up in the wind and are carried for long distances; some burst open and release tiny particles that are concentrated in the wind gusts that come just before a thunderstorm, causing thunderstorm asthma. For information and support about asthma or hay fever (allergic rhinitis) call our Asthma Educators on 1800 ASTHMA (1800 278 462).

HOW TO TREAT YOUR HAY FEVER (ALLERGIC RHINITIS) SYMPTOMS

Managing allergic rhinitis is an important part of overall asthma care as allergic rhinitis can make asthma worse and more difficult to control. Treatment of allergic rhinitis depends on the severity and frequency of your allergic rhinitis symptoms.  There are a range of different treatments available.  For mild allergic rhinitis symptoms that only happen occasionally, speak to your doctor or pharmacist about:

Antihistamines

Antihistamines tablets, syrups, intranasal sprays, and eye-drops are the most common choice for people with mild or occasional hay fever (allergic rhinitis). They help to relieve a runny nose, sneezing, itching and eye symptoms. They are less effective in treating a blocked nose.  Antihistamines are available over the counter at your pharmacy. You should avoid the types of antihistamines that can make you drowsy.  Newer antihistamines known as non-sedating antihistamines are less likely to make you drowsy and are a common choice for people with milder or occasional symptoms of hay fever (allergic rhinitis). Avoid using sedating antihistamines in children. The advantage of antihistamines is their flexibility, as you can take them when you have problems, and avoid them when you are well.

Saline sprays/irrigation

Saline solutions can be used to help clear nasal congestion, wash away dust, pollen and other irritants and as a result, have the potential to relieve some allergic rhinitis symptoms. They should be used about 10 – 15 minutes before other medicated nasal sprays.  Saline washes and sprays are available preservative-free and may be preferable for those with sensitive noses.   If your hay fever (allergic rhinitis) symptoms are persistent, around all the time or moderate-to-severe, but intermittent – around every now and again,  speak to your doctor or pharmacist about intranasal corticosteroid nasal sprays.

Intranasal corticosteroid nasal sprays

These nasal sprays are the most effective treatment for persistent or moderate to severe allergic rhinitis symptoms. They work to reduce the swelling in the lining of your nose (just like your asthma preventer medications). They can reduce all symptoms of allergic rhinitis, particularly nasal congestion (blocked nose) but need to be taken regularly to work properly – they may take a few days to start to work, though continuous use is more effective in treating hay fever, than occasional usage. For people who experience hay fever, particularly in spring and who do not use intranasal corticosteroid treatment all year, starting treatment 6 weeks before the pollen season (or exposure) and continuing until throughout spring or troublesome times is recommended. Some corticosteroid nasal sprays are available over the counter at your pharmacy and others are available with a prescription and come in different strengths. You should speak to your doctor or pharmacist about which intranasal corticosteroid nasal spray is best for you. As with all medications, it is important to take them correctly to see a benefit.

Tips for using nasal sprays 

  • Shake the bottle before each use
  • Blow nose before spraying if blocked by mucus
  • Tilt head slightly forward and gently insert nozzle into nostril
  • Aim the nozzle slightly away from the middle of the nose in line with the roof of the mouth
  • Press down the spray but avoid sniffing hard during or after spraying

Short-term addition of decongestants

Decongestant nasal sprays or tablets are used to unblock the nose. They should not be taken for more than a few days at a time. If you still continue to experience symptoms you should speak to your doctor. Ask your pharmacist or doctor about using a preservative-free nasal decongestant spray and when and how long to use it for.  Speak to your doctor or pharmacists about the best treatment for your allergic rhinitis.

Allergen Immunotherapy

Specific allergen immunotherapy is a targeted medical program involving gentle and gradual exposure to your trigger/s, called immunotherapy. Benefits can be experienced within months after starting treatment but the full course of treatment will usually be up to several years. The aim of this treatment is to desensitise the immune system to the known allergen so that it no longer overreacts to that allergen.  Speak to your doctor for more information about immunotherapy or desensitisation. The aim of this treatment is to desensitise the immune system to the known allergen so that it no longer overreacts to that allergen. Speak to your doctor for more information about immunotherapy or desensitisation. Watch a quick explainer video on allergy immunotherapy here. 

Learn more about Allergen Immunotherapy here

Asthma Allergen Immunotherapy

Flo and Stallergenes Greer are campaign partners of Asthma Australia and have not been involved in the development of this webpage.

This page was last updated 11/09/2020

REFERENCES AND FURTHER INFORMATION

  1. Australian Institute of Health and Welfare. Allergic rhinitis (‘allergic rhinitis’) in Australia. Cat. no. ACM 23. Canberra: AIHW; 2011. Available from: http:// www.aihw.gov.au/publication-detail/?id=10737420595
  2. Bousquet, J., Gaugris, S., Kocevar, V. S., Zhang, Q., Yin, D. D., Polos, P. G. and Bjermer, L. (2005), Increased risk of asthma attacks and emergency visits among asthma patients with allergic rhinitis: a subgroup analysis of the improving asthma control trial. Clinical & Experimental Allergy, 35: 723–727.doi:10.1111/j.1365-2222.2005.02251.x. http://onlinelibrary.wiley.com/doi/10.1111/j.1365-2222.2005.02251.x/full
  3. Pawankar R, Bunnag C, Chen Y, et al. Allergic rhinitis and its impact on asthma update (ARIA 2008)–western and Asian-Pacific perspective. Asian Pac J Allergy Immunol. 2009; 27: 237-243. Available from: http://www.ncbi.nlm.nih.gov/pubmed/20232579
  4. Price D, Zhang Q, Kocevar VS, et al. Effect of a concomitant diagnosis of allergic rhinitis on asthma-related health care use by adults. Clin Exp Allergy. 2005; 35: 282-7. Available from: http://www.ncbi.nlm.nih.gov/pubmed/15784104