Hay Fever and Seasonal Allergies in Australia

According to the Australian Institute of Health and Welfare (AIHW), allergic rhinitis (hay fever) affected around 6.1 million Australians in 2022, or nearly 24% of the population. It is one of the most prevalent chronic respiratory conditions in the country. Despite being widely regarded as a minor inconvenience, hay fever can impair sleep, concentration, work, study, exercise, and quality of life, and it is closely linked with asthma in some people.

Allergic rhinitis is an IgE-mediated hypersensitivity reaction in the nasal mucosa. When a sensitised person inhales an allergen - pollen, dust mite, pet dander, or mould - the immune system releases histamine and other mediators. These cause the classic symptoms: nasal congestion, rhinorrhoea, sneezing, and itching.

ASCIA distinguishes two patterns:

• Seasonal allergic rhinitis: triggered by pollens, most prominent in spring and summer
• Perennial allergic rhinitis: triggered year-round by dust mites, pet dander, or mould

Many Australians have both patterns - seasonal triggers on top of a perennial baseline.

Hay fever triggers vary by region, season, home environment, and personal sensitisation pattern.

• Grass pollen: often peaks from September to January, although timing varies by region. Check AusPollen forecasts and keep windows closed on high-pollen days.
• Tree pollen: usually peaks from late winter into spring. Morning outdoor activity can be harder when pollen concentrations are high.
• Weed pollen: tends to peak from late summer into autumn. Wraparound glasses, showering after outdoor exposure, and changing clothes can reduce carry-in exposure.
• Dust mites: present year-round and often worse in humid conditions. Wash bedding weekly at 60C where fabric allows and consider dust-mite-proof mattress and pillow covers.
• Pet dander: can trigger year-round symptoms, with cats a common sensitiser. Keeping pets out of bedrooms and using HEPA filtration may help when the trigger is clear.
• Mould spores: worse in damp or humid environments. Address moisture sources, run exhaust fans, and dehumidify affected rooms where possible.

Australian pollen monitoring services can help people anticipate high-risk days. On forecast high-pollen days, taking planned treatment before predictable exposure is often more useful than waiting until symptoms are severe.

Allergic rhinitis symptoms reflect inflammation of the nasal mucosa and, frequently, the conjunctiva:

• Runny or blocked nose
• Sneezing, often in bursts
• Itchy, watery eyes (allergic conjunctivitis can occur alongside rhinitis)
• Itchy throat, mouth, or ears
• Fatigue from disrupted sleep
• Reduced sense of smell in severe cases

An important distinction from common cold: hay fever does not cause fever, body aches, or productive cough. If those symptoms are present, a viral infection is the more likely diagnosis. ASCIA notes that misidentifying colds as hay fever (and vice versa) is common and leads to inappropriate self-treatment.

Formal diagnosis is typically clinical, based on symptom history, trigger pattern, examination where needed, and response to treatment. Allergy testing (skin prick test or allergen-specific IgE blood testing) confirms sensitisation and is useful when immunotherapy is being considered, when the trigger is unclear, or when symptoms are persistent despite reasonable management.

Australian primary-care and allergy guidance supports a stepwise approach to treatment, starting with exposure reduction and pharmacy options, then escalating if symptoms are not controlled or if asthma, sleep, or daily function is affected.

Treatment choice depends on dominant symptoms, severity, timing, and whether asthma is also present.

Control stack

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Exposure reduction, correct spray use, and allergy medicines each solve a different part of the problem.

• Non-drowsy oral antihistamines: block the H1 receptor and reduce sneezing and itch. They are best suited to mild-to-moderate symptoms and on-demand use, with effect often within 30-60 minutes.
• Saline nasal rinses: mechanically remove pollen and mucus. They are safe for daily use and can be used before other sprays.
• Intranasal corticosteroid sprays: reduce nasal mucosal inflammation and are especially useful for moderate-to-severe symptoms with nasal congestion. They often take 3-7 days for full effect.
• Antihistamine nasal sprays: provide local antihistamine effect and may work faster than steroid sprays for nasal symptoms where tablets are insufficient.
• Antihistamine eye drops: target itchy, watery eyes directly and often have rapid onset.
• Intranasal combination sprays: combine antihistamine and steroid effects for moderate-to-severe rhinitis needing both actions.

Intranasal Corticosteroid Sprays

Intranasal corticosteroid sprays, including fluticasone propionate, mometasone, and budesonide, are a key treatment class for moderate-to-severe symptoms, particularly nasal blockage. Healthdirect and ASCIA note that these sprays work best when used consistently, not only after symptoms have become severe.

Oral Antihistamines

ASCIA and RACGP recommend second-generation antihistamines such as cetirizine, loratadine, and fexofenadine over first-generation antihistamines such as promethazine because of the superior safety profile and lower risk of significant sedation.

ASCIA, healthdirect, and asthma guidance identify allergic rhinitis as a risk factor for asthma symptoms and asthma exacerbations. This is often described as the "united airway" concept - the upper and lower airways share related inflammatory pathways. In practical terms, uncontrolled hay fever can worsen asthma symptoms, and asthma symptoms during pollen season should not be dismissed as "just allergies".

For people with both conditions, treating hay fever well is part of asthma management. ASCIA recommends that all patients with asthma be assessed for allergic rhinitis, and vice versa.

For patients with confirmed allergen sensitisation whose symptoms are not adequately controlled with medications, ASCIA recommends consideration of allergen immunotherapy (AIT). AIT works by gradually desensitising the immune response through repeated, escalating doses of the allergen.

Two forms are available in Australia:

• Subcutaneous immunotherapy (SCIT): weekly injections administered at a clinic over 3-5 years, followed by a maintenance phase
• Sublingual immunotherapy (SLIT): daily drops or tablets placed under the tongue, taken at home

Both have strong evidence for reducing both rhinitis and asthma symptoms, and for preventing progression of rhinitis to asthma. The TGA has approved several SLIT products for grass pollen, the most common allergen trigger in Australia. AIT requires specialist assessment (allergist or immunologist) and is not appropriate for all patients.

Seek medical review if:

• Over-the-counter treatments are not providing adequate control after 2-4 weeks
• Symptoms are significantly disrupting sleep or daytime function
• You have asthma and hay fever is making it worse
• You are considering allergen immunotherapy (requires specialist referral)
• You need treatment options beyond pharmacy medicines or a written management plan

Red flags

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Wheeze, chest tightness, shortness of breath, or persistent cough during pollen season need an asthma safety plan.

Seek urgent care if you experience:

• Difficulty breathing or wheezing
• Severe facial pain (which may indicate sinusitis requiring antibiotic assessment)
• Vision changes

Practical measures based on ASCIA guidance:

• Monitor AusPollen forecasts (auspollen.com.au) and restrict outdoor exposure on high days
• Stay indoors between 10am and 3pm on high-pollen days when concentrations peak
• Keep car and home windows closed on high-pollen days
• Shower and change clothes after spending time outdoors
• Wear wraparound sunglasses to reduce eye exposure
• Dry laundry indoors on high-pollen days

These measures complement medication but rarely eliminate symptoms alone in moderately sensitive individuals.

• AIHW: Allergic rhinitis (hay fever)
• healthdirect: Hay fever
• ASCIA: Allergic Rhinitis Frequently Asked Questions
• ASCIA: Allergic Rhinitis Treatment Plan
• RACGP AJGP: Approach to allergic rhinitis in the primary care setting
• National Asthma Council Australia: Thunderstorm asthma
• healthdirect: Thunderstorm asthma