Allergic rhinitis (hay fever) is very common and is caused by the nose and/or eyes coming into contact with allergens in the environment. These include pollens (from grasses, weeds or trees), dust mites, moulds and animal dander (skin flakes from animals with fur). Allergic rhinitis can cause a runny, itchy or congested nose, sneezing and itchy/watery eyes. These symptoms may be mistaken for infections such as colds and flu, but treatments are different. Sinusitis can occur if allergic rhinitis is not treated correctly. 

Effective allergic rhinitis treatments are available from pharmacies and include sinus rinses or sprays, antihistamines, corticosteroid (anti-inflammatory) nasal sprays and combination nasal sprays that contain corticosteroid and antihistamine.  If these treatments don't control symptoms, allergen immunotherapy (desensitisation) may be prescribed by a doctor, after allergy testing confirms which allergens are causing symptoms. Allergen minimisation can also help reduce symptoms due to allergic rhinitis or asthma.

Information about non-allergic conditions (vocal cord dysfunction and non-allergic rhinitis) are available on this page, as they are often mistaken as allergic conditions, but require different treatments. 

Fast Facts

Fast Facts about allergic rhinitis (hay fever) 

Treatment Plan

ASCIA Treatment Plan for Allergic Rhinitis 

Click on the links below for more information (A-Z)

Allergen Immunotherapy 

Allergen Minimisation

Allergic Conjunctivitis 

Allergic Rhinitis (Hay Fever)

Nasal Polyps

Non-Allergic Rhinitis

Pollen Allergy 

Sinusitis and Allergy

Vocal Cord Dysfunction

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Animation videos about allergic rhinitis (hay fever) and how to use treatments - a National Allergy Council initiative  

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ASCIA PCC Sinusitis and allergy 201986.35 KB

Sinusitis is an inflammation of the nasal sinuses. It may be a short-term, acute inflammation caused by bacterial infection such as the common cold. However, sinusitis can sometimes be a long term, chronic condition, complicated by allergies and/or structural problems in the nose, which can affect quality of life.

What are sinuses?

The sinuses are hollow cavities in the skull, allocated between and behind the eyes, in the forehead, and cheeks. They are connected to the nose through small tubes that are not much wider than a pinhead.

Nasal sinuses are located within the cheeks, around and behind the nose. Their main function is to warm, moisten and filter the air in the nasal cavity. They also help people to vocalise certain sounds.

Blocked sinuses can be due to untreated allergy, colds or polyps (growths on the sinus linings) and often cause pain in the face. Blocked sinuses also create an environment that favours the overgrowth of bacteria.

Colds and allergies are the main risk factors for developing sinusitis

Sinusitis is an inflammation of the nasal sinuses, commonly caused by bacterial infection following a viral infection such as the common cold. Other risk factors for developing sinusitis include untreated allergies, crooked nasal anatomy, smoking, nasal polyps and overuse of decongestant nasal sprays.

Sinusitis can be acute or chronic

There are two types of sinusitis:

• Acute sinusitis can last for up to three weeks, and is caused by bacterial infection in most cases. This usually occurs as a secondary complication of a viral respiratory infection such as the common cold, or as a result of untreated allergies.
• Chronic sinusitis can last more than three weeks. This may be caused by bacterial infection, or more often, it is a chronic inflammatory disorder similar to bronchial asthma. Chronic sinusitis can last for months or years if not treated. Allergies, structural problems or immune system problems may lead to chronic sinusitis.

Signs and symptoms of sinusitis

The signs and symptoms of sinusitis vary depending on the severity of the inflammation and which sinuses are involved. Symptoms and signs of sinusitis are:

• Thick, green or yellow coloured mucus from the nose or down the back of the throat.
• Loss of sense of smell or taste.
• Bad breath and/or bad taste in the mouth.
• Sore throat and/or cough.
• Tiredness.
• Temperature or shivers (fever).
• Facial congestion (a feeling of fullness) and pain.
• Headache.
• Toothache.
• Sensation of pressure that is worse with leaning forward.
• Obstructive sleep apnea.
• Post nasal drip.

It is important to consult your doctor if these signs or symptoms develop.

How is allergy a risk factor for developing sinusitis?

Allergy can cause chronic inflammation of the sinus and mucus linings. This inflammation prevents the usual clearance of bacteria from the sinus cavity, increasing the chances of developing secondary bacterial sinusitis. If you test positive for allergies, your doctor can advise on appropriate measures and/or prescribe medications to control them, thereby reducing the risk of developing a sinus infection.

Environmental irritants may increase symptoms

People with sinus problems and allergies should avoid environmental irritants such as tobacco, smoke and odours, which may make symptoms worse.

Effective treatment depends on correct diagnosis

To confirm diagnosis, your doctor will take a medical history, and conduct a physical exam. Skin tests or blood tests for allergen specific IgE tests may be needed, and X-rays of the sinuses may be taken.

Sinusitis versus rhinitis

Although many symptoms are similar, sinusitis should not be mistaken for rhinitis. Rhinitis is an inflammation of the mucus membrane of the nose, not the sinuses. It is often caused by allergic rhinitis (also known as hay fever), or increased sensitivity to irritants such as smoke, temperature changes or the overuse of decongestant nasal sprays. Poorly controlled rhinitis can lead to sinusitis.

Early treatment can reduce the need for medications

Around half of all sinus infections will resolve without antibiotics. In people with frequent infections it is important to treat the underlying problems, such as allergy, and to treat symptoms quickly to prevent the need for antibiotics.

Examples of treatments include:

• Steam inhalations use a bowl of hot water with a towel over your head. This will help to thin the mucus and make it easier to drain
• Salt water irrigation of the nose using a commercial preparation (spray or douche) will assist in nasal drainage
• Antibiotics should be prescribed if symptoms persist.
• Surgical removal of disease tissue, polyps and/or drainage of sinuses may be required for some people with chronic sinusitis, if medications do not control symptoms.

© ASCIA 2019

ASCIA is the peak professional body of clinical immunology/allergy specialists in Australia and New Zealand.

ASCIA resources are based on published literature and expert review, however, they are not intended to replace medical advice. The content of ASCIA resources is not influenced by any commercial organisations.

For more information go to www.allergy.org.au

To donate to immunology/allergy research go to www.allergyimmunology.org.au

Updated May 2019

ASCIA PCC Pollen allergy 2022156.34 KB

Pollen from grasses, weeds or trees can trigger symptoms of allergic rhinitis (hay fever), and asthma. Pollen seasons can last for several months and exposure is difficult to avoid. However, there are several ways to prevent or reduce pollen allergy symptoms.

What is pollen?

The word pollen is derived from the Greek word meaning 'fine flour' and the role of the pollen grain is to fertilise the female flower to reproduce plant species.

Pollen grains can be spread by birds, insects (bees, butterflies and moths), andwind:

• Some plants such as flowering plants, including wattle trees, produce small amounts of pollen which are distributed by birds and insects from one plant to another.
• Other plants such as pasture grasses and weeds, rely on wind to spread their pollen. These pollens are produced in large amounts, blow long distances and cause allergies in people, even if they live a long way from the source.

Most of the pollens that cause allergies are produced by airborne pollen from northern hemisphere grasses, trees and weeds:

• Improved pasture grasses are more allergenic than Australian native grasses.
• Pollen from exotic trees, which are planted for their autumn colour, is more allergenic than pollen from Australian trees.

Several types of weeds with highly allergenic pollen have been introduced to Australasia, including:

• Pellitory weed (also known as asthma weed), was accidentally introduced in a shipload of marble from Italy in the early 1900s. It is mainly found in Sydney.
• Paterson's Curse (Echium plantagineum) is a flowering plant that was deliberately brought from England in the late 1800's by Dr Paterson. It has taken over large areas of grass in rural Australia and produces highly allergenic pollen.
• Ragweed and Parthenium weed were introduced in pasture seed imported from the United States. They have spread throughout Queensland and northern New South Wales.

Pollen allergy causes allergic rhinitis

The correct name for hay fever is seasonal allergic rhinitis. Symptoms are caused by the body's immune response to inhaled pollen, resulting in chronic inflammation of the eyes and nasal passages.

Allergic rhinitis symptoms include:

• Runny, itchy, congested nose.
• Irritable, itchy, watery and red eyes.
• Itchy ears, throat and palate.

Allergic rhinitis is a common and debilitating disease

• Allergic rhinitis affects around 18% of people in Australia and New Zealand.
• Allergic rhinitis predisposes people to more frequent sinus infections.
• People with allergic rhinitis are often tired due to poor sleep quality. 
• Moderate or severe allergic rhinitis can affect general health, impair learning, increase time off work, and reduce productivity.
• Around 80% of people with asthma have allergic rhinitis, which can make asthma difficult to control.

Pollen can trigger asthma

Pollen can directly trigger asthma and allergic rhinitis. Small particles of allergens can penetrate deep into the airways of the lung. Thunderstorms can also contribute to this:

• When pollen granules come into contact with water, starch granules are released that are small enough to be breathed into the airways, causing allergic rhinitis and asthma in some people
• People who wheeze during spring and/or summer, should see their doctor for advice.

Pollen seasons can last for months

In Australia pollen numbers are lower on the east coast where most winds come from the sea, and where there is protection from westerly winds by the Great Dividing Range. Pollen numbers are higher on the Victorian south coast because most winds are from the north carrying pollen from the northerly grasslands. In South Australia and Western Australia, the amount of pollen can vary according to the wind.

Pollination times vary with the plant variety and its location.

• Trees usually pollinate in late winter and early spring.
  • White Cypress (Murray) Pine is the only Australian tree that produces highly allergenic pollen. It grows from the western slopes and plains of Eastern Australia across to Western Australia, south of the Tropic of Capricorn, and flowers from late July through to the end of August.
  • Wattle trees are frequently blamed for early spring symptoms but tests raraely confirm that Wattle pollen is the cause.
  • There are many species of Casuarina or Australian Oak trees, which produce pollen throughout the year and may cause allergic rhinitis symptoms at any time of the year.
• Grasses flower next, and the weed 'Plantain' flowers from August through to May. 

The principal grasses growing in the northern coastal areas are subtropical and mainly flower in January, February and March. Allergenic grasses in the southern part of Australia are mostly Northern hemisphere grasses, with the main flowering period from October to December.

Diagnosis is important

A history should be taken of the timing of symptoms, identifying plants and trees that grow in the area, and if relief comes by going away on holiday. When the person's allergy history has been obtained, skin prick tests and/or blood allergen specific IgE tests, should be done using allergens that are in the area of their home and work. Test results can be interpreted by a doctor trained in allergy, in conjunction with the person's history.

Tips for reducing pollen exposure

• Stay indoors until after midday, particularly in the pollen season and on windy days.
• Avoid going out just before, during, or after thunderstorms, particularly when pollen counts are high. 
• Wear sunglasses, carry tissues, shower when you arrive home, and rinse your eyes with water. 
• Do not mow grass and stay inside when it is being mown. If mowing is unavoidable, wear a mask or take a non-drowsy antihistamine.
• Keep windows closed at home and in the car. Use recirculating air conditioning in the car.
• Do not picnic in parks or in the country during the pollen season.
• Try to plan holidays out of the pollen season or holiday at the seaside.
• If landscaping at home, research plants less likely to trigger allergic rhinitis or asthma. If you are sensitive to particular weeds or trees that are outside your bedroom window, have them removed.

Effective treatments are available

Seek advice from your pharmacist or doctor about medications that will relieve your symptoms. Although medications do not cure allergies, they are much more effective with few side effects. It is important to use them correctly, and to avoid medications that can cause problems such as frequent decongestant (unblocking) nose sprays or tablets.

Antihistamine tablets or syrups (non-sedating) help to reduce symptoms (sneezing, itchy and irritated eyes), but they are not as effective in controlling severe nasal blockage and dribble. The advantage of antihistamines is their flexibility; you can take them when you have symptoms, and avoid them when you are well. Antihistamine eye drops can also be helpful in controlling watery eyes due to allergies.

Intranasal corticosteroid nasal sprays (INCS) have a potent action on inflammation when used regularly (like asthma preventer medications). These need to be used regularly and with careful attention to the way in which they are used. Different brands of INCS vary in strength and effectiveness, so it is important to read the labels and check details with your pharmacist or doctor.

Combination medications containing an antihistamine and intranasal corticosteroid nasal spray are available and offer the combined advantages of both medications.

Decongestant sprays unblock and dry the nose, but should not be used for more than a few days as they can cause long term problems in the nose

Decongestant tablets unblock and dry the nose, but should be used with caution as they can have 'stimulant' side effects like tremors, trouble sleeping, anxiety or an increase in blood pressure. People with high blood pressure should not take decongestant sprays.

Natural products such as salt water nasal sprays or douches can be effective in relieving symptoms.

Appropriate management of pollen asthma includes commencing asthma preventer medication before, or at the first sign of asthma symptoms. Some people undergoing allergen immunotherapy for allergic rhinitis find that their asthma improves as well.

Allergen immunotherapy is a long-term treatment option

Medications only reduce the severity of symptoms and do not cure allergic rhinitis. Another treatment option is allergen immunotherapy (AIT) which is also known as desensitisation. AIT switches off the allergic reaction, by repeatedly introducing small doses of allergen extracts, by injection, sublingual tablets, sprays or drops.

AIT is a long term treatment which is usually given over a few years.

It should only be started after assessment by a clinical immunology/allergy specialist to determine if this is a suitable treatment option.

© ASCIA 2022

ASCIA is the peak professional body of clinical immunology/allergy specialists in Australia and New Zealand.

ASCIA resources are based on published literature and expert review, however, they are not intended to replace medical advice. The content of ASCIA resources is not influenced by any commercial organisations.

For more information go to www.allergy.org.au

To donate to immunology/allergy research go to www.allergyimmunology.org.au

Updated September 2022

ASCIA PCC Nasal polyps 201956.54 KB

Nasal polyps are soft, jelly-like overgrowths of the lining of the sinuses. They look like grapes on the end of a stalk. They occur in around 1 in 200 people, mostly by the age of 40 years.

Symptoms of nasal polyps

Nasal polyps do not always cause symptoms. As they usually grow through the tunnel that connects the sinuses to the nose, the result is often a blocked nose. Nasal polyps can block the tunnels connecting the nose to the sinus cavities, and this can lead to sinus infections.

Causes of nasal polyps

The cause of nasal polyps is unknown, but inflammation in the sinuses (from allergy or infection) may trigger polyps and make them grow faster. Sometimes other conditions such as sinus infections, asthma and allergy to aspirin can occur more often in people with nasal polyps. 

Treatment of nasal polyps

Treatment options include:

• Surgical removal, although they will regrow eventually in around 50% of people.
• Cortisone tablets will shrink nasal polyps temporarily, but cannot be taken long term due to side effects.
• Intranasal corticosteroid sprays (INCS) can slow polyp growth and people with recurrent polyps who have had many operations are often advised to use INCS in the long term. In people with recurrent nasal polyps, INCS should be considered for continuous use. Slower growth means fewer sinus infections, less antibiotics and less frequent surgery.
• Allergen immunotherapy (AIT) is also known as desensitisation, and is sometimes used in people with allergic rhinitis (hay fever) as well as nasal polyps. While AIT often helps allergic rhinitis, it is not known if AIT helps shrink nasal polyps.
• A condition known as the aspirin triad occurs when people have aspirin allergy, nasal polyps and asthma. People with this condition have the treatment option of aspirin desensitisation, which can reduce asthma severity, the rate of polyp regrowth and the severity of sinusitis. The decision to undertake aspirin desensitisation should be made by a clinical immunology/allergy specialist.

© ASCIA 2019

ASCIA is the peak professional body of clinical immunology/allergy specialists in Australia and New Zealand.

ASCIA resources are based on published literature and expert review, however, they are not intended to replace medical advice. The content of ASCIA resources is not influenced by any commercial organisations.

For more information go to www.allergy.org.au

To donate to immunology/allergy research go to www.allergyimmunology.org.au

Content updated April 2019