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Allergic rhinitis (hay fever)

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Also called: hay fever, pollen allergy, nasal allergy, seasonal allergic rhinitis, perennial allergic rhinitis, dust allergy

Allergic rhinitis (hay fever) is swelling inside the nose caused by an allergy to things like pollen, house dust mites or animal fur. It causes sneezing, a runny or blocked nose and itchy eyes. It is not dangerous, and steroid nose sprays and antihistamines control it well.

General health information for Pakistan. It does not give doses or brand advice. If you are worried, or symptoms are severe, see a doctor. When to see a doctor

Overview

Allergic rhinitis is inflammation (swelling and irritation) of the lining of the nose. It happens when the body's defence system overreacts to a harmless thing in the air, called an allergen. Common allergens are pollen from trees, grass and weeds, house dust mites, mould, and fur or skin flakes from pets. When the allergen touches the nose or eyes, the body releases chemicals such as histamine. These cause sneezing, a runny or blocked nose and itching.

It is very common. About one in six people have it, and it often starts in childhood or early adult life. Some people get symptoms only in certain seasons, when a particular pollen is in the air. This is often called hay fever. Others have symptoms all year round, usually from dust mites or pets. Many people have a mix of both. Unlike a cold, which clears in one to two weeks, symptoms can go on for weeks or months.

Allergic rhinitis is not dangerous, but it can spoil sleep, cause tiredness and affect work, school and mood. It is closely linked to asthma and eczema. Avoiding triggers, steroid nose sprays and antihistamines help most people. When these are not enough, a specialist may offer allergy immunotherapy (slowly training the body to tolerate the allergen).

In Pakistan: what studies show

Pakistani studies show allergic rhinitis is common: 28.50% of Karachi schoolchildren surveyed in 2007, and 19.2% of health workers at one Karachi hospital in 2018. In Islamabad, paper mulberry pollen is a major trigger: 41.5% of people with asthma in one study were allergic to it.

  • In a 2007 survey of 2,325 schoolchildren aged 3 to 16 in Karachi, 28.50% had allergic rhinitis.[1] (cross-sectional school survey, data 2007)
  • A questionnaire survey of adults aged 18 to 60 in three areas of Balochistan found allergic rhinitis in 35.0% of people.[2] (cross-sectional questionnaire survey, data not stated)
  • At one hospital in Karachi in early 2018, 19.2% of 167 health workers (doctors, nurses, technicians and pharmacists) had allergic rhinitis.[3] (cross-sectional survey, data January 2018 - April 2018)
  • In a 2017 survey at Rawalpindi Medical University, 59% of 289 students had allergy symptoms, and dust was the most common trigger.[4] (descriptive cross-sectional, data February 2017 - June 2017)
  • In one Islamabad study of 284 people with asthma, 41.5% were allergic to paper mulberry pollen, and these patients more often had asthma attacks in March, when this pollen peaks.[5] (observational feasibility study, data clinical records 2000-2019; A&E and peak flow data 1 Mar 2020 - 31 Jul 2021)
  • Among people with allergic rhinitis skin-tested at the National Institute of Health in Islamabad in 2013-2014, 83.62% reacted to pollens and 79.96% to house dust.[6] (retrospective clinic-based cross-sectional, data July 2013 - June 2014)
  • In 105 adults with asthma tested in Rawalpindi in 2014-2016, house dust mite was the most common allergen (33.3%), followed by paper mulberry (31.4%).[7] (descriptive cross-sectional, data March 2014 - March 2016)
  • An older Islamabad study (2005-2006) skin-tested 702 people and found 48% reacted to paper mulberry pollen, the city's main spring pollen.[8] (cross-sectional, data January 2005 - December 2006)

What we do not know yet: There is no national survey of allergic rhinitis in Pakistan; the school study in Karachi is from 2007 and the Islamabad pollen skin-test study from 2005-2006, so newer community data are needed. The Balochistan figure comes only from a conference abstract, and the NIH Islamabad paper gives two different figures for how many patients had both rhinitis and asthma.

Pakistan studies cited

  1. Hasnain SM, Khan M, Saleem A, et al. Prevalence of Asthma and Allergic Rhinitis Among School Children of Karachi, Pakistan, 2007. Journal of Asthma 2009;46(1):86-90. doi:10.1080/02770900802513023. Open source
  2. Gul R, Jan SU, Qadir M, et al. Prevalence of Asthma and Allergies in Balochistan (ISPOR 2020 abstract PRS39). Value in Health (ISPOR 2020 conference abstract) 2020;23(5) Suppl 1. Open source
  3. Siddiqui MI, Dhanani R, Moiz H. Prevalence of allergic rhinitis among healthcare workers and its impact on their work: a cross-sectional survey at a tertiary healthcare centre in Pakistan. Journal of the Pakistan Medical Association 2020;70(8). doi:10.5455/JPMA.17588. Open source
  4. Ahmed MK, Mazhar A, Saadat R, et al. The frequency and characteristics of allergies in students of Rawalpindi Medical University. Students' Supplement of Journal of Rawalpindi Medical College 2019;23(S-1). doi:10.37939/sjrmu.v23iS-1.48. Open source
  5. Yusuf OM, Rextin AT, Ahmed B, et al. Association of asthma exacerbations with paper mulberry (Broussenetia papyrifera) pollen in Islamabad: An observational study. Journal of Global Health 2023;13:04091. doi:10.7189/jogh.13.04091. Open source
  6. Hussain A, Ahmed F, Dharmage SC, et al. Aero and Food Allergens Sensitization Patterns in a Clinic-Based Sample in Pakistan: A One Year Retrospective Study. Pakistan Journal of Zoology 2019;51(4):1429-1437. doi:10.17582/journal.pjz/2019.51.4.1429.1437. Open source
  7. Khan SW, Hamid A, Siddiqi FA, et al. Frequency of allergic asthma and common aeroallergens sensitization in Pakistani patients of bronchial asthma. Journal of the Pakistan Medical Association 2018;68(8):1217. Open source
  8. not stated on the opened index page (IMEMR emr-134022) Aerobiology and pollen allergy in Islamabad. Pakistan Journal of Medical Research 2009;48(4):79-82. Open source

Symptoms

  • Sneezing, often several times in a row
  • Runny nose with clear, watery mucus
  • Blocked or stuffy nose, sometimes with breathing through the mouth
  • Itchy nose, throat, mouth or ears
  • Itchy, red or watery eyes
  • Mucus dripping down the back of the throat (postnasal drip), with throat clearing or cough
  • Reduced sense of smell
  • Headache or pain around the forehead and sides of the head
  • Tiredness and poor sleep
  • Dark circles under the eyes (allergic shiners) and a crease across the nose from rubbing, mainly in children

Causes and risk factors

Causes

  • An allergic reaction in the lining of the nose: the immune system makes allergy antibodies (IgE) against a harmless substance
  • Pollen from trees, grasses and weeds, which causes seasonal symptoms (hay fever)
  • House dust mites, which cause symptoms all year round
  • Mould spores and fur, skin flakes or saliva from pets such as cats and dogs
  • Smoke, strong smells, perfumes and cold air, which can make an already sensitive nose react more

What makes it more likely

  • A family history of allergies, asthma or eczema
  • Having asthma or eczema yourself
  • Being a child, teenager or young adult; it is most common between the ages of about 10 and 40
  • Being male
  • Being exposed to tobacco smoke as a baby
  • Living in an area with a lot of an allergenic pollen, such as paper mulberry in Islamabad

Complications

Allergic rhinitis is not life-threatening, but it can affect quality of life. A blocked, itchy nose can disturb sleep and lead to tiredness and poor focus at work or school. It is closely linked to asthma: many people with allergic rhinitis also have asthma, and pollen can trigger asthma flare-ups. Long-lasting swelling in the nose can lead to long-term sinus inflammation (chronic rhinosinusitis), nasal polyps (soft, non-cancerous growths in the nose), enlarged adenoids, and blocked ear tubes. It can also lead to fluid behind the eardrum (glue ear). Overusing decongestant nose sprays can cause a rebound blocked nose.

When to see a doctor

  • Wheezing, chest tightness, cough or shortness of breath: this may be asthma and needs a doctor; get emergency help if breathing is very hard
  • Swelling of the lips, tongue or throat, trouble breathing or fainting after an allergy injection or tablet: this is an emergency
  • A blocked nose, growth or bleeding on one side of the nose only
  • Pain or pressure in the face with thick nasal discharge that lasts for weeks
  • In a child: blocked ears or hearing problems, loud snoring or always breathing through the mouth
  • Symptoms that are getting worse, or that do not improve after medicines from the pharmacy

Diagnosis

Allergic rhinitis is usually diagnosed from your symptoms and history. The doctor asks when symptoms happen, how long they last, what seems to trigger them (for example a season, dust or pets) and whether you or your family have asthma or eczema. They look inside the nose, where the lining is often swollen and pale with clear mucus. Getting better with a steroid nose spray also supports the diagnosis.

Allergy tests are not needed for everyone. They are used when symptoms do not respond to treatment, when the exact allergen needs to be found, or before allergy immunotherapy. The two main tests are a skin test, where tiny amounts of allergens are placed on the skin, and a blood test for allergy antibodies to a specific allergen (specific IgE). Some medicines can affect skin tests, so tell the doctor what you take. Scans are not routine; they are mainly used if a sinus problem is suspected.

Treatment

  1. Reduce contact with your triggers where you can, for example pollen, dust mites, pets and smoke (see self-care).
  2. For mild or occasional symptoms, use a non-drowsy antihistamine tablet or an antihistamine nose spray. A pharmacist can advise; your doctor or pharmacist decides the dose.
  3. For a blocked nose, frequent or more severe symptoms, use a steroid nose spray every day. Guidelines prefer it to antihistamine tablets. It takes a few days to work fully. Aim the spray towards the outer side of the nose, away from the middle wall.
  4. If symptoms are still not controlled, a doctor may advise a combined steroid and antihistamine nose spray, or add an antihistamine tablet or eye drops for itchy eyes.
  5. A decongestant nose spray can be used for a few days only for a badly blocked nose; longer use makes the blockage worse.
  6. Steroid tablets or injections are not used routinely because of their side effects.
  7. If moderate to severe symptoms continue despite these medicines and an allergy test confirms the trigger, a specialist may offer allergy immunotherapy (injections or tablets under the tongue). It usually continues for several years and can give lasting benefit.

Medicines in Pakistan

Medicines a doctor may use, by group. Each link opens our page for that medicine, with every brand and its official DRAP price. Your doctor decides which medicine and dose are right for you.

GroupRoleMedicines
Steroid nose sprays (intranasal corticosteroids)first choice for moderate to severe or persistent symptoms and for a blocked nose; work better than antihistamine tablets; take a few days to reach full effect; side effects are mainly nose irritation and nosebleeds; your doctor decides the doseFluticasone propionate (1 brand), MOMETASONE FUROATE (3 brands), Budesonide (23 brands), Beclomethasone dipropionate (5 brands)
Non-drowsy antihistamines (second generation)first choice for mild or occasional symptoms; help sneezing, runny nose and itchy eyes; can be taken with a steroid nose spray; fexofenadine causes the least drowsiness and cetirizine the most in this groupCetirizine (42 brands), Loratadine (175 brands), Fexofenadine (46 brands), Desloratadine (1 brand)
Older antihistamines (first generation)work for itching and sneezing but often cause drowsiness and other side effects; newer non-drowsy antihistamines are usually preferredChlorpheniramine (6 brands)
Leukotriene receptor antagonistsless effective than steroid nose sprays and antihistamine tablets; the ARIA guideline advises against adding them to an antihistamine routinely; a doctor decides if they are suitableMontelukast (16 brands)
Nasal decongestantsshort-term relief of a badly blocked nose only, for no more than about a week, because longer use causes a rebound blocked nose (rhinitis medicamentosa)Xylometazoline (6 brands)

Also used (not yet in our price list): Azelastine nasal spray (an antihistamine nose spray), alone or combined with a steroid nose spray, Sodium cromoglicate (cromolyn) nose spray or eye drops, Antihistamine eye drops for itchy, watery eyes, Ipratropium nose spray for a very runny nose, as an add-on when a doctor advises, Allergen immunotherapy (allergy injections or tablets under the tongue), given by a specialist, Omalizumab, an injected specialist medicine that is effective but costly

Self-care and prevention

Self-care

  • Rinsing the nose with salt water (saline) can be used alongside your medicines
  • In pollen season, keep windows and doors closed as much as you can, and avoid cutting or walking on grass
  • After being outdoors, shower and change your clothes; wraparound sunglasses, a mask or a hat help keep pollen off
  • Dry clothes indoors during pollen season, and do not keep fresh flowers in the house
  • Against dust mites, wash bedding in hot water, use allergen-proof covers on pillows and mattresses, and dust with a damp cloth
  • Vacuum often, using a vacuum with a HEPA filter if you have one, and keep pets out of the bedroom
  • Do not smoke, and avoid other people's smoke
  • Some antihistamines cause drowsiness; ask a pharmacist for a non-drowsy one if you need to stay alert

Prevention

  • Find out what triggers your symptoms and reduce contact with it
  • Keep homes free of smoke, damp and mould, and reduce dust mites in bedrooms
  • Check local pollen forecasts and limit time outdoors on high-pollen, windy days
  • For people with long-lasting moderate to severe allergy, immunotherapy from a specialist can reduce symptoms for years after it ends

Common questions

Is it hay fever or a cold?

Both cause sneezing and a runny or blocked nose. A cold usually clears within one to two weeks. Hay fever often comes with itchy eyes, nose and throat, can go on for weeks or months, and tends to come back at the same time each year or when you meet the same trigger.

Can allergic rhinitis be cured?

Medicines control the symptoms but do not cure the allergy. Allergy immunotherapy is the only treatment that changes the allergy itself, and its benefit can last after it stops. Many people also find their symptoms ease as they get older; in one long study more than half improved over the years.

Is it safe to use a steroid nose spray for a long time?

Steroid nose sprays act mainly inside the nose, and their usual side effects are irritation and nosebleeds. They are a first-choice treatment in guidelines. Use the right technique and see your doctor for regular review if you need one long term.

Can hay fever make asthma worse?

Yes. Allergic rhinitis and asthma often occur together, and pollen can trigger asthma flare-ups. A study in Islamabad found that people with asthma who were allergic to paper mulberry pollen had more asthma attacks in March, when this pollen peaks. Treating the nose well and following your asthma plan both help.

Do antihistamines make you sleepy?

Older antihistamines often cause drowsiness. Newer ones cause much less; fexofenadine is the least sedating, while cetirizine can make some people a little sleepy. Ask your pharmacist for a non-drowsy option if you need to stay alert.

Sources

  1. NHS. Hay fever - NHS (2024).
  2. NICE. 12 SQ-HDM SLIT for treating allergic rhinitis and allergic asthma caused by house dust mites (TA1045) (2025).
  3. NICE. 2 The condition, current treatments and procedure (NICE interventional procedures guidance IPG616) (2018).
  4. ARIA / EAACI. Allergic Rhinitis and Its Impact on Asthma (ARIA)-EAACI Guidelines—2024–2025 Revision: Part I—Guidelines on Intranasal Treatments (Allergy, doi 10.1111/all.70131) (2025).
  5. ARIA / EAACI. Allergic Rhinitis and Its impact on Asthma (ARIA)-EAACI guidelines-2024-2025 revision: Part II-guidelines on oral and ocular treatments (Allergy, doi 10.1111/all.70305) (2026).
  6. StatPearls (NCBI Bookshelf). Allergic Rhinitis - StatPearls - NCBI Bookshelf (2023).
  7. Journal of Global Health. Association of asthma exacerbations with paper mulberry (Broussenetia papyrifera) pollen in Islamabad: An observational study - PMC (2023).
  8. Geospatial Health. Assessment of the health impact of paper mulberry (Broussonetia papyrifera L.), an invasive plant species in Islamabad, Pakistan (2019).

Prepared from the sources listed below by the MedInfoBase team. Last reviewed 16 October 2026. This page is general health information, not medical advice. It gives no doses and does not replace a doctor: talk to your doctor or pharmacist before starting, stopping or changing any medicine. How we write and check our pages.

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