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ALLERGIES

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Hay fever: symptoms, causes & treatment

Hay fever is the most common allergy in Australia. Learn the symptoms, the best treatments, and how to stay safe from thunderstorm asthma.

Dr. Louis J Sisk

BSc(Hons) MBChB MRCS(Glasg) MTrauma(Dist) APRCSA

Medically reviewed by Dr. Anna Sheldon on

Hay fever (allergic rhinitis) is an allergy to pollen from grasses, trees or weeds. It causes sneezing, a runny or blocked nose and itchy eyes, usually at the same time each year. It is very common, and treatment works well for most people.

Emergency

Call triple zero (000) for an ambulance if you or someone with you has:

  • sudden shortness of breath, or cannot speak properly
  • a blue or grey reliever inhaler that is not helping
  • blue or grey lips
  • drowsiness, confusion or collapse

These can be signs of a severe asthma attack, which pollen and thunderstorms can trigger. Tell the operator that it is an ASTHMA EMERGENCY. Start asthma first aid while you wait.

Key points

  • Hay fever is the most common allergy in Australia. About 1 in 4 Australians (24%) have it.
  • In southern Australia, grass pollen season runs from about October to December. In northern Australia, it peaks from about January to March.
  • Symptoms include sneezing, a runny or blocked nose, itchy eyes and an itchy throat.
  • Steroid nasal sprays and non-drowsy antihistamines are the main treatments. Allergy injections or tablets (immunotherapy) can help if these are not enough.
  • If you have hay fever and asthma, you are at higher risk of thunderstorm asthma. Keep your asthma action plan up to date.
  • A Doccy consultation can help with medical certificates and prescriptions for hay fever and asthma, if appropriate.

What is hay fever?

Hay fever happens when your immune system overreacts to pollen. When pollen lands in your nose or eyes, your body releases chemicals such as histamine. These cause sneezing, itching and a runny nose.

The medical name is allergic rhinitis. "Seasonal" allergic rhinitis comes at the same time each year and is usually caused by pollen. Symptoms all year round are more often caused by dust mites, pets or mould.

In Australia, common triggers include:

  • Grasses, such as ryegrass in southern Australia and subtropical grasses in the north. These are the biggest trigger.
  • Weeds, such as plantain, ragweed and Parietaria (asthma weed).
  • Trees, such as cypress, plane tree, birch and olive.

Despite the name, hay fever has nothing to do with hay and does not cause a fever.

How common is hay fever?

About 6.1 million Australians (24%) had hay fever in 2022, according to the ABS National Health Survey. It is most common in people aged 15 to 59.

Hay fever and asthma often go together. Up to 4 in 5 people with asthma also have allergies such as hay fever.

Symptoms of hay fever

Common symptoms include:

  • sneezing, often in bursts
  • a runny, itchy or blocked nose
  • itchy, watery or red eyes
  • an itchy roof of the mouth, throat or ears
  • mucus running down the back of the throat, which can cause a tickly cough
  • tiredness, poor sleep and trouble concentrating

A fever, sore throat or thick yellow or green mucus points to an infection rather than hay fever. Read more about sinusitis and cold vs flu vs COVID.

Thunderstorm asthma

Thunderstorms during grass pollen season can break pollen into tiny pieces. These get deep into the lungs and can cause sudden, severe asthma. This is called thunderstorm asthma. In November 2016, a thunderstorm in Melbourne caused thousands of people to need emergency care, and 10 people died.

You are at higher risk if you:

  • have hay fever in spring, especially if you are allergic to ryegrass
  • have asthma, or have had asthma in the past
  • have asthma symptoms in spring, even without a diagnosis

Some people have their first asthma attack during a thunderstorm. Read more about thunderstorm asthma and asthma.

When to see a doctor

If you have any of the signs in the emergency box at the top of this page, call triple zero (000).

Get an urgent GP appointment, or call healthdirect on 1800 022 222 for advice, if:

  • your asthma is getting worse and you are using your reliever more than usual
  • you have wheeze or chest tightness during pollen season and have never been diagnosed with asthma

See a GP if:

  • hay fever affects your sleep, work or study

  • pharmacy treatments are not helping enough

  • you have asthma and want to review your action plan before pollen season

  • you want allergy testing or are thinking about immunotherapy

  • your nose has been blocked on one side for more than a few weeks

  • you have nosebleeds, facial pain or thick coloured mucus that does not settle

Children can get hay fever too. If your child has symptoms, see your GP or ask your pharmacist.

Causes and risk factors

Hay fever is caused by an allergy antibody called IgE. Over time, some people's immune systems start making IgE against a type of pollen. After that, each time they breathe in that pollen, symptoms start.

You are more likely to get hay fever if you:

  • have a family history of allergies, asthma or eczema
  • have another allergic condition, such as eczema or food allergy
  • were exposed to tobacco smoke as a child
  • live in southern Australia, where ryegrass pollen counts are high in spring

Climate change is making pollen seasons longer and stronger in some parts of Australia.

How hay fever is diagnosed

Most hay fever is diagnosed from your symptoms. Your doctor will ask when your symptoms start, what makes them better or worse, and whether you have asthma or eczema. A clear seasonal pattern usually points to pollen.

Allergy testing can help if the cause is unclear or you are thinking about immunotherapy. There are 2 types:

  • Skin prick testing. Small drops of pollen extract are placed on your forearm and the skin is gently pricked. Results take about 15 to 20 minutes.
  • Blood testing. This measures IgE to specific pollens. It is useful if you cannot stop antihistamines or have widespread eczema.

A positive test only matters if it matches your symptoms.

Treatment for hay fever

Most people get good control by combining a few treatments.

Steroid nasal sprays. These are the most effective treatment for moderate or severe hay fever. Use them every day through your pollen season, not just when symptoms flare. They can take a few days to work fully. Aim the spray slightly away from the middle of your nose, and do not sniff hard.

Non-drowsy antihistamines. These are available from pharmacies as tablets or liquids. They work within an hour and help with sneezing, itching and a runny nose. Avoid older, drowsy antihistamines, because they can affect sleep and driving.

Combination nasal sprays. These contain a steroid and an antihistamine. They can help if a steroid spray alone is not enough. They need a prescription.

Eye drops. Antihistamine eye drops can ease itchy, watery eyes.

Salt water (saline) nose rinses. These wash pollen out of your nose. They are safe to use several times a day.

Decongestant nasal sprays. These can clear a blocked nose quickly. Do not use them for more than 3 to 5 days, because they can make your nose more blocked.

Allergen immunotherapy. This treatment slowly trains your immune system to stop reacting to pollen. It is given as a daily tablet or drops under the tongue, or as injections. A course usually lasts 3 to 5 years and can keep working for years after you stop. Your GP can refer you to an allergy specialist.

Ask your pharmacist or doctor which products suit you.

Self-care and living with hay fever

  • Check the pollen forecast. Counts are usually highest on warm, windy days and lowest after rain.
  • Start your nasal spray early. Begin 2 to 4 weeks before your usual pollen season.
  • Keep pollen out. Close windows on high pollen days and set the car air to recirculate.
  • Wash pollen off. Shower, wash your hair and change clothes after time outside.
  • Protect your eyes and nose. Sunglasses help. A well-fitted face mask can also help on high pollen days.
  • Dry laundry indoors during peak season.
  • Have an asthma plan. If you have asthma, check your preventer and reliever are in date before spring. Avoid being outside just before and during thunderstorms in pollen season.

Hay fever can leave you tired and low for weeks. If you feel like you are pushing through every day, talk to a doctor. There are usually more options to try.

Outlook

Most people with hay fever get good control with treatment. Symptoms often ease with age. Immunotherapy can reduce symptoms for years after a course ends.

Poorly controlled hay fever can affect your sleep, work and driving. It can also make asthma harder to control and lead to sinusitis. Treating your nose helps your chest too.

How Doccy doctors can help

A Doccy consultation can help if you are an adult with hay fever and none of the warning signs on this page. A Doccy consultation can:

  • provide a medical certificate if you need time off work or study, or a carer's certificate
  • provide a special consideration letter if hay fever has affected a university assessment or exam
  • prescribe a nasal spray or eye drops for hay fever, if it is appropriate
  • continue a prescription for your usual asthma preventer or reliever, if it is appropriate

A Doccy consultation is not suitable if you have severe asthma symptoms now, or any of the signs in the emergency box. A doctor cannot examine you remotely. See a GP in person if your nose is blocked on one side, you have nosebleeds or facial pain, or you want allergy testing or immunotherapy.

Resources and support

ASCIA (Australasian Society of Clinical Immunology and Allergy): information on hay fever, pollen allergy and immunotherapy.

National Asthma Council Australia: information on thunderstorm asthma and asthma action plans.

Pollen forecasts: AusPollen, Melbourne Pollen, Canberra Pollen and other local pollen counts publish daily forecasts in season.

healthdirect: health information and a 24-hour nurse advice line on 1800 022 222.

These services and websites can provide extra information, but they do not replace advice from your own doctor.

  1. Australasian Society of Clinical Immunology and Allergy (ASCIA). Allergic rhinitis (hay fever). https://www.allergy.org.au/patients/allergic-rhinitis-hay-fever-and-sinusitis/allergic-rhinitis-or-hay-fever
  2. healthdirect. Hay fever (allergic rhinitis). https://www.healthdirect.gov.au/conditions/allergies/hay-fever
  3. National Asthma Council Australia. Pollen and hay fever. 2024. https://www.nationalasthma.org.au/living-with-asthma/resources/patients-carers/factsheets/pollen-a-trigger-for-hay-fever
  4. National Asthma Council Australia. Thunderstorm asthma. https://www.nationalasthma.org.au/resources/thunderstorm-asthma
  5. Australian Institute of Health and Welfare. Chronic respiratory conditions: allergic rhinitis (hay fever). https://www.aihw.gov.au/reports/chronic-respiratory-conditions/allergic-rhinitis-hay-fever
  6. O'Hehir RE, Varese NP, Deckert K, et al. Epidemic thunderstorm asthma protection with five-grass pollen tablet sublingual immunotherapy: a clinical trial. Am J Respir Crit Care Med. 2018;198(1):126-128. https://pubmed.ncbi.nlm.nih.gov/29461859/

Frequently Asked Questions

When is hay fever season in Australia?

It depends where you live. In southern Australia, grass pollen season runs from about October to December. In northern Australia, grasses peak from about January to March. Tree pollen is highest in late winter and early spring.

Are steroid nasal sprays safe to use every day?

Yes. Very little of the medicine gets into your body, so they are safe for daily use through the season. Decongestant sprays are different. Do not use decongestant sprays for more than 3 to 5 days, because they can make your nose more blocked.

What is thunderstorm asthma?

It is sudden, severe asthma triggered by a thunderstorm during grass pollen season. People with spring hay fever are at higher risk, even if they have never had asthma. Have an asthma plan and avoid being outside during storms in pollen season.

Is immunotherapy worth it?

It can be, if hay fever is moderate or severe despite other treatments. It is the only treatment that changes the allergy itself. A course takes 3 to 5 years, and your GP can refer you to an allergy specialist.

Is telehealth appropriate for hay fever?

Yes, for most adults with typical hay fever. A Doccy consultation can provide a medical certificate and prescribe hay fever or asthma medicines if appropriate. See a GP in person for one-sided nasal blockage, nosebleeds or allergy testing.

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