Hayfever & Allergic Rhinitis

They are essentially the same condition. Hayfever is the common term most people use, particularly when symptoms are triggered by seasonal pollen exposure. Allergic rhinitis is the medical term and includes both seasonal symptoms and year-round symptoms caused by triggers such as house dust mite, pet dander, or mould. Many patients have both seasonal and perennial components.

Very common. According to the Australian Institute of Health and Welfare, around 6.1 million Australians — approximately one in four people — had allergic rhinitis in 2022. This makes allergic rhinitis one of the most common chronic allergic conditions in Australia.

In Sydney, common triggers include grass pollen during spring and early summer, as well as year-round exposure to house dust mite, pet dander, mould, and cockroach allergen. Some patients are also sensitive to weed pollens. House dust mite is a particularly important perennial trigger in Sydney's humid coastal environment. Wattle is often blamed for spring symptoms, but allergy testing less commonly confirms it as the main cause.

Yes — the link is well established and clinically important. The nose and lungs are part of the same airway, and inflammation in one area often affects the other. Poorly controlled allergic rhinitis can worsen asthma control, and treating hayfever properly often helps asthma symptoms as well. In Australia, grass pollen is also associated with thunderstorm asthma, where storm conditions break pollen into very small particles that can reach deep into the lungs and trigger severe asthma attacks. Patients with asthma and seasonal hayfever should make sure their asthma treatment is optimised before pollen season.

Seasonal allergic rhinitis causes symptoms at particular times of year, usually when certain pollens are present. Perennial allergic rhinitis causes symptoms throughout the year because triggers such as house dust mite, pet dander, or mould are present more continuously in the environment. Many patients have a year-round baseline with seasonal flares on top of that.

Intranasal corticosteroid sprays are the evidence-based first-line treatment for moderate or persistent hayfever. They are generally more effective than oral antihistamines alone for nasal blockage and ongoing nasal symptoms. Common Australian options include mometasone furoate (Nasonex), budesonide (Rhinocort), and fluticasone furoate (Avamys). They work best when used consistently, and the full benefit may take one to two weeks to develop. For some patients, a combined corticosteroid-antihistamine nasal spray may also be appropriate. For mild or intermittent symptoms, a non-sedating oral antihistamine such as cetirizine, loratadine, or fexofenadine may be enough. Eye drops can be added when eye symptoms are prominent.

For mild or occasional symptoms — especially sneezing, itch, or watery eyes — a non-sedating antihistamine tablet may be appropriate and effective. However, for persistent or more troublesome hayfever, particularly when nasal blockage is a major issue, antihistamine tablets alone are often not enough. In those situations, an intranasal corticosteroid spray is usually more effective. Older sedating antihistamines such as promethazine can cause drowsiness and are best avoided during the day.

Allergen immunotherapy — sometimes called desensitisation — is the only treatment that aims to modify the underlying allergic response rather than simply control symptoms. It works by exposing the immune system to carefully controlled amounts of the relevant allergen over time, with the goal of reducing sensitivity. In Australia it is available as subcutaneous injections given in a clinic, or as prescribed sublingual tablets for selected allergens such as grass pollen and house dust mite. Treatment usually continues for three to five years, and the benefits can persist for years after completion. Immunotherapy should be initiated and supervised by a clinical immunology or allergy specialist.

There is no guaranteed permanent cure. However, allergen immunotherapy can produce long-lasting improvement in carefully selected patients by reducing sensitivity to the relevant allergen. For most people, the goal is excellent symptom control that allows normal sleep, concentration, and daily function, using the minimum treatment needed.

Both may have a role. An ENT surgeon is particularly helpful when nasal blockage is prominent, when there may be structural problems such as a deviated septum or nasal polyps, or when symptoms are not settling with standard treatment. An allergist or clinical immunologist is the appropriate specialist for formal allergy testing, confirmation of allergen sensitivities, and consideration of allergen immunotherapy. Your GP is usually the best starting point and can help direct you to the right specialist.

Symptoms often fluctuate over time rather than steadily worsening. Some people find their symptoms improve, while others develop new sensitivities or notice symptoms change after moving to a different environment or climate. Pregnancy can also make rhinitis symptoms worse. If symptoms that were previously manageable become more troublesome, it is worth seeking review.

Individual surgeons within My-ENT may approach assessment and management differently based on their subspecialty training and clinical experience. Your surgeon will discuss the most appropriate pathway for your specific situation at your consultation.