Balmier weather and colourful spring blossom may spell the end of winter gloom, but for the UK’s estimated 16 million hay fever sufferers they also herald the start of the annual misery of sneezing, dripping noses and red, itchy eyes.

Allergies are generally on the rise and hay fever, an allergy to pollen, is no exception: the percentage of children with symptoms has trebled in the past 30 years, according to charity Allergy UK.

One theory is that increased pollution and climate change are playing a role.

Modern lifestyles may also contribute: these include spending less time outdoors and diets high in processed foods which contribute to poor gut health – which can alter our immune systems.

What is clear, however, is that hay fever symptoms are becoming longer lasting and more severe than before.

As Professor Michael Rudenko, a consultant in allergy and immunology at The London Allergy and Immunology Centre, explains: ‘Warmer temperatures and higher levels of carbon dioxide in the atmosphere can lead to longer pollen seasons and increased pollen production from plants.

‘This means people are exposed to higher concentrations of pollen for longer periods, so can develop stronger symptoms lasting for longer.’

A US study in 2021 found that the pollen season extended by 30 days between 1990 and 2018.

Although many sufferers have an allergy to grass pollen, it’s becoming more common for people to be allergic to other types, including trees and weeds

Instead of starting in March and ending in September, it now kicks off in late February and continues into October.

Although many sufferers have an allergy to grass pollen, it’s becoming more common for people to be allergic to other types, including trees and weeds.

Meanwhile, ‘urban planners and landscapers have introduced new types of trees and plants that produce highly allergenic pollen’, adds Professor Rudenko. These include birch trees – popular for their silver trunks – and plane trees, the most widely planted tree in London’s streets.

As well as the pollen they produce, plane trees release ‘hairs’ from their leaves and stems into the air – these are known to irritate the throat and skin, exacerbating symptoms for millions.

‘It’s a mistake to trivialise these types of symptoms as “just” hay fever,’ says Stephen Durham, a professor of allergy and respiratory medicine at Imperial College London, and a consultant allergist at the Royal Brompton Hospital.

This is because they are often extremely debilitating and can have profound effects on quality of life. For instance, hay fever also disturbs sleep and puts you at an increased risk of developing asthma, as well as impairing concentration.

Some years are worse for some pollens than others – pollen forecasts are compiled using a combination of data such as current and predicted weather patterns and samples and predictions from pollen monitoring stations.

‘If the weather is warmer in early spring, trees and grasses germinate more effectively and forecasters can predict higher seasonal pollen counts and therefore worse symptoms,’ says Professor Durham.

While forecasters say it’s too early to predict the forthcoming grass pollen season, it’s another matter for tree pollens, which are predicted to exceed last year’s levels because of natural fluctuations, according to Dr Beverley Adams-Groom, a senior pollen forecaster at the University of Worcester.

She explains: ‘Trees that produce allergic pollen in the UK tend to have alternating high and low years of severity – this year is a high year.’

This is due to a phenomenon known as ‘masting’, where some trees produce less pollen one year to have the energy to produce an abundance the following one.

An abundant pollen year will produce an overwhelming quantity of seeds – ensuring that some will survive being eaten by seed-eating animals, such as squirrels and mice.

In addition, tree pollen is made the previous summer – last year was the warmest spring since records began, and this, along with a warm June, made conditions ‘ideal for pollen production’, says Yolanda Clewlow the UK pollen forecast manager at the Met Office. So this year is likely to be high for birch pollen.

So how can you best prepare for the allergy season ahead?

Here, a panel of leading experts offer advice and practical tips on ways you can minimise your exposure to pollen – as well as treatments proven to ease your symptoms, all based on the latest research…

POLLEN CALENDAR TO HELP YOU BE PREPARED

Around 30 different types of trees, grass and weed pollen can cause hay fever symptoms but their peak pollen counts vary throughout the year.

Grass pollen is the most common allergen affecting around nine out of ten sufferers.

It’s possible to be allergic to more than one type of pollen. As Professor Adam Fox explains: ‘Although there are different types of grass, there are sufficient similarities between them that if you are allergic to one, you’ll be allergic to all grass pollens.’

It’s a similar story with trees, he says: ‘If you are allergic, say, to birch tree pollen, you’ll probably be allergic to pollen from other trees in the birch family such as alder, hazel and hornbeam.’

Use this helpful Allergy UK calendar, above, to help predict when you need to be on your guard against the most common pollens as spring and summer progress.

WHY POLLEN MAKES YOU FEEL SO GRIM

Hay fever is an allergy to pollen – and occurs when grass, tree or weed pollen sends the body’s immune system into overdrive. Its medical name is seasonal allergic rhinitis – ‘rhinitis’ refers to inflammation of the nasal lining.

Allergies to other things including pet hair and skin and house dust mites trigger year-round symptoms – known as perennial allergic rhinitis.

Research suggests that 40 to 50 per cent of people with hay fever go on to develop perennial allergic rhinitis, and some progress into asthma, says allergy consultant Professor Michael Rudenko.

While we all have IgE antibodies, those with hay fever produce much larger amounts.

This is particularly true with severe hay fever, adds Professor Adam Fox, a consultant paediatric allergist at Evelina London Children’s Hospital.

Hay fever sufferers are genetically predisposed to produce high levels of the antibody immunoglobulin E (IgE) in response to harmless substances such as pollen.

So while we all have IgE antibodies, (found throughout the body including on the surface of mast cells in the lining of the nose), those with hay fever produce much larger amounts.

When allergens such as pollen enter their nose, they are ‘captured’ by IgE on the mast cell. This in turn triggers the explosive release of certain chemicals – including histamine, from the mast cell – essentially, the immune system tries to flush out the threat, ie the pollen.

The chemicals are responsible for the telltale symptoms – sneezing, runny nose, and sore and streaming eyes – which are all ways the body tries to expel the allergen.

One of these chemicals, histamine, causes leakiness in the tiny blood vessels in the nose and eyes, allowing liquid to leak out into the nearby tissue, causing inflammation, explains Professor Fox.

‘The inflammation in the nasal lining causes excess mucus to be produced, leading to congestion or a runny nose,’ he says.

Histamine also affects nerves and blood vessels in eye tissues, making them itchy and watery.

Other chemicals, called leukotrienes, are also ‘potent activators of mucus’, says allergy consultant Professor Durham.

He adds that ‘it’s not uncommon for patients with hay fever to also have asthma, otitis [inflammation or infection of the ear] eczema or certain food allergies [see right], all linked to their elevated IgE levels.’

And around 30 per cent of hay fever sufferers will have seasonal asthma, as the inflammation in the nose can spread to the lungs, triggering asthma symptoms, says Professor Rudenko.

‘Research has shown that effectively managing hay fever can also reduce the risk of asthma flare-ups, highlighting the importance of treating both of the conditions together.’

Two other symptoms to watch out for

WHEEZING OR SHORTNESS OF BREATH: If you are a hay fever sufferer, this could be a sign that you are developing allergy-related asthma, says GP and allergy specialist Dr Helen Evans-Howells.

‘See your GP. If asthma is not well-controlled as a hay fever sufferer, you are at a much higher risk of anaphylaxis [a severe allergic reaction which can lead to difficulty breathing and needs emergency treatment].’

HEADACHES: Along with sinus pain, these can be a sign that hay fever has developed into sinusitis, inflammation of the tissue lining the air-filled sacs in the forehead, cheeks and nose, says allergy consultant Professor Adam Fox.

‘Swelling caused by the allergic reaction to pollen can block the sinuses, preventing mucus from draining properly.

‘The trapped mucus provides an environment for bacteria to grow, leading to sinusitis. Book an appointment with your GP who can prescribe antibiotics to clear the infection.’

TRY THESE SIMPLE DIY STEPS TO MINIMISE YOUR MISERY…

Stay indoors when pollen levels peak:

Pollen counts are generally high on warmer, dry days. Rain washes pollen from the air so counts should be lower on cooler, wet days, according to Allergy UK.

Check pollen forecasts on the Met Office website (weather.metoffice.gov.uk) or with apps such as My Pollen Forecast UK and Kleenex Pollen Count (both free and available on IOS and Android).

Wear a wide-brimmed hat outside: 

‘Pollen can stick to your hair and the smaller hairs on your arms and legs, so a wide hat helps minimise contact,’ says Holly Shaw, an allergy nurse specialist.

Shower and wash your hair when you return from work or a day out to rinse away any pollen, and change into fresh clothes ‘as pollen will have become trapped in your clothes’, adds Dr Adrian Morris, an allergy consultant at the Surrey Allergy Clinic.

Keep your windows shut:

This is particularly important during the day when pollen levels peak as plants are most active – this is generally for a few hours mid-morning (from around 10am onwards) and early evening (from 6pm), says Dr Morris.

Closing windows will help stop pollen coming into your home, particularly in the bedroom to avoid symptoms when you’re trying to sleep.

Similarly, when driving, close car windows and switch on air conditioning, says Dr Morris.

Don’t hang washing outdoors:

Clothing can act as a ‘pollen trap’, advises Dr Morris. ‘Either dry clothes indoors or use the tumble dryer, if you have one.’

Wipe pets’ coats with a damp cloth: 

 Dogs and cats can carry pollen on their fur which can be transferred when you stroke them, says Holly Shaw. So wipe them down especially if they’ve been outdoors for a long time – then put the cloth in the washing machine.

Apply Vaseline around your nostrils:

This can help trap pollen before it enters the nose, suggests Dr Morris. He also advises rinsing your nasal passages with a dilute salt-water solution or with commercial saline sprays available from chemists (such as Sterimar), at the end of the day.

However, he says don’t use over-the-counter decongestants for more than a few days – ‘if used for more than five days they can result in rebound blockage [where symptoms come back, more severely]’.

P.S. Don’t forget your eyes: 

As it’s carried by the wind, pollen can also get in through your eyes and ‘set off an allergic reaction in the conjunctiva [the transparent covering on the white of the eye] which causes watery, red and itchy eyes,’ says Daniel Hardiman-McCartney, a consultant optometrist and clinical adviser at the College of Optometrists.

Wearing protective wrap-around sunglasses helps prevent pollen getting into your eyes. Also rinse your eyes regularly with a dedicated eye wash, advises the College of Optometrists.

CAN A UV LIGHT UP YOUR NOSE BRING RELIEF FROM SNEEZES?

Dr Helen Evans-Howells, a GP specialising in allergy, offers her verdict on products that claim to help with allergies, which we then rated.

PHILIPS AIR PURIFIER 800 series

£119.99, amazon.co.uk

CLAIM: This has three-layer HEPA filtration that can, it’s claimed, remove 99.9 per cent of pollen, dust mites or pet allergens from the air.

EXPERT VERDICT: Some studies have shown that HEPA air filters can help to improve overnight allergic nose and eye symptoms and reduce night-time waking. But you’d need a number of them throughout the house to help you you manage symptoms. It may at least help to keep your bedroom a safe haven. 7/10

NUAGE HAY FEVER RELIEF WIPES

Pack of 30, £1, morrisons.com

CLAIM: Enriched with tea tree and peppermint oil, these wipes (pictured) ‘remove pollen, dust and pet allergens before they can affect you’.

EXPERT VERDICT: These may wipe pollen from your face, but there’s no evidence they’ll be more effective than a damp cloth. Most pollen is actually inhaled, so these won’t prevent that. 5/10

AIR SUPPLY MINIMATE IONIC PERSONAL AIR PURIFIER

£74.95, allergybestbuys.co.uk

CLAIM: Worn around the neck, this creates an ‘electrostatic shield’ to repel airborne particles, making it ‘ideal for allergy, asthma and hay fever’.

EXPERT VERDICT: Ionic air purifiers claim to release negatively charged ions that then attach to allergens such as pollen, making them heavier so that they fall to the ground – preventing inhalation. However, it’s unlikely that a device such as this would be strong enough to protect against inhaling pollen particles. Any effect is likely to be weak and inconsistent. 3/10

QU-CHI ACUPRESSURE ARM BAND

£12.99, amazon.co.uk

CLAIM: This fabric band can be worn day and night, year round. It claims to offer relief from hay fever ‘by stimulating an acupressure point near the elbow to help unblock energy pathways to the nose and throat’.

EXPERT VERDICT: People who prefer medication-free treatment may wish to trial it, but there are no studies suggesting this provides any benefit. 2/10

ALLERGY RELIEVER

£24.99, kineticwellbeing.com

CLAIM: Once this device is inserted into the nostrils, it emits a red light that, it’s claimed, will suppress inflammation and slow the release of histamine.

EXPERT VERDICT: A 2017 study in Brazil found that UV red and infrared lights can help to reduce sneezing and congestion. The technology is considered safe with minimal side-effects, so this device could be worth a try to see if it eases any symptoms. 7/10

PILLS, SPRAYS, OR EVEN IMMUNOTHERAPY: WHAT’S BEST FOR YOUR HAY FEVER?

You should take hay fever medication such as antihistamine tablets and prescription corticosteroid nasal sprays in advance of the pollen season as it affects you, to allow the full effect to build up, experts say.

Antihistamine tablets

(Start taking these pills one week before pollen season.)

Available over the counter, these can be effective for mild or occasional symptoms. They work by blocking the effects of histamine by locking on to histamine receptors in the nose and throat.

Allergy consultant Professor Stephen Durham recommends using the more modern non-drowsy versions such as cetirizine (brand name Zirtek) and loratadine (Clarityn) – ‘but generic versions of these antihistamines, available on the shelf at the chemist, are just as good and less expensive – it’s what I take for my own hay fever’, he says.

Nahim Khan, a pharmacist and senior lecturer in pharmacology at the University of Chester, advises starting to take these around a week before pollen season starts. ‘The evidence is that all brands are equally effective although loratadine may take longer to work – up to a week.’

A newer option, fexofenadine (Allevia) was prescription-only but is now available over the counter.

‘It’s as effective as loratadine and cetirizine, but more expensive, so I only recommend this to people if the other two haven’t worked,’ says Nahim Khan.

Side-effects are uncommon – cetirizine may very occasionally cause agitation and diarrhoea and loratadine may sometimes cause drowsiness (despite being a non-drowsy antihistamine).

‘I always encourage people to take them for the shortest amount of time they can – if used for the hay fever season, benefits should outweigh any side-effects,’ says Nahim Khan.

Nasal sprays

(Start taking two weeks before pollen season if you use corticosteroid spray.)

Many over-the-counter sprays marketed for hay fever are saline or ‘non-drug’ sprays – this can be helpful in clearing the nose and moisturising nasal passageways for people with mild symptoms or those who don’t want to take drugs, says Nahim Khan – but won’t have a direct effect on the immune system.

If your symptoms aren’t controlled by antihistamines, use a corticosteroid nasal spray as well, says Professor Durham, who advises starting to use these for two weeks before the hay fever season starts.

Over-the-counter sprays, such as beclometasone (brand name Beconase) or fluticasone (Flixonase), work by interrupting the way immune cells communicate – reducing inflammation in the nasal passageways and stopping the production of mucus.

‘Squirt two sprays in each nostril once a day,’ says Professor Durham, adding that they’re ‘very effective’ for most people.

‘They take around two weeks to take full effect and should be used regularly regardless of symptoms.’

You can safely use them for the duration of the hay fever season, says Nahim Khan.

If over-the-counter nasal sprays did not prove effective last summer, see your GP who can prescribe stronger medications. These include nasal sprays that combine antihistamines with corticosteroids, says Professor Durham. These can also be safely used for the hay fever season.

When administering nasal sprays, Professor Durham says you need to tip your head forwards before you squirt the spray into your nostril – if you tip it backwards the medication may go down your throat instead.

Eye drops

(Start taking around one week before pollen season.)

If you suffer badly with itchy, red and streaming eyes, you may also need to use eye drops as well as other medications.

Anti-allergy eye drops containing sodium cromoglicate (brand names Opticrom or Optrex) can provide effective relief, by blocking the release of histamine from mast cells in the eyes but need to be repeated several times a day for several days or weeks to build up full benefit.

Professor Durham also recommends using olopatadine (Opatanol), a prescription-only medication which works in a similar way and needs to be used twice daily but provides rapid relief.

Nahim Khan says that you should ideally begin using sodium cromoglicate one week before the hay fever season begins. ‘But if you don’t, these drops can start working within the hour so do provide some immediate relief.’

Many people with moderately severe symptoms will need to take a regular antihistamine, nasal spray and eye drops to provide relief, says Professor Durham, who adds a combination of these treatments will work for most, if taken regularly.

Immunotherapy

Around 10 per cent of hay fever sufferers won’t find these measures effective and regularly experience summers with miserable symptoms that severely affect their quality of life and ability to work, says Professor Durham.

Immunotherapy, which retrains the immune system, has been shown to be highly effective for severe hay fever.

It involves introducing minute doses of grass or tree pollen extract to gradually build up the body’s tolerance to these pollens – either via weekly, then monthly, injections, or daily tablets that dissolve under the tongue.

Research in the journal Human Vaccines and Immunotherapeutics in 2019 found that patients who took the grass pollen extract Grazax as a tablet experienced the benefits for up to ten years after finishing their treatment.

However, the treatment needs to be administered all year round for three years – ‘after this time the hay fever goes away and stays away’, says Professor Durham. ‘If you stop treatment before three years, you lose the long-term gain.’

Immunotherapy is available on the NHS in theory but, in practice, very few people – or GPs – know about it, although it is widely available in private clinics, says Dr Helen Evans-Howells.

GPs must refer patients to a specialist service – this may be an ear, nose and throat clinic or to respiratory doctors who also specialise in allergies rather than pure allergists.

GRASS PILL HAS ENDED YEARS OF AWFUL SYMPTOMS

Kathryn Osner says she can now ‘enjoy the simple pleasures of the warm weather’

Kathryn Osner, 21, is a student at Bath University. She says:

Last summer, for the first time in five years, I was able to join family barbecues in the garden, sit with friends in a pub garden and even relax on a bench in the park. It felt as though a huge weight had been lifted from my shoulders.

I developed hay fever just before my GCSEs in 2019 – I got through that summer OK but, after that, things were much worse.

Summers became a nightmare from mid-April until the end of August: my eyes would be so itchy, puffy and sore that they would hurt if I went outside or a window was open. My nose was permanently blocked and congested.

I ended up with ice packs on my eyes most evenings to calm the pain. Even prescription antihistamines, eye drops and corticosteroid nasal sprays made no difference.

I always had the windows shut, wore sunglasses and washed my bedsheets regularly – nothing helped. It was just awful and I’d often lie on my bed and cry from frustration and misery. Then my mum did some research online and came across immunotherapy, which takes three years to desensitise your immune system to the pollen you are allergic to.

In November 2022, she paid for me to see Dr Adrian Morris at his allergy clinic in London – blood tests revealed I was allergic to Timothy grass, which is really common.

I was warned not to expect much the first summer, but I did have a mild improvement – though I still took antihistamines.

Last summer was completely different. I could live a normal life, even when the pollen count was high. Now I can enjoy the simple pleasures of the warm weather.