Hay fever is among the most common allergic conditions in the UK. For affected children, the spring and summer months bring a predictable deterioration in symptoms – runny nose, itchy eyes, sneezing, congestion – that can affect sleep, concentration, and daily functioning. Effective management significantly improves quality of life during pollen season.
Healthbooq covers children's health and allergy management through the early years.
Understanding Hay Fever
Hay fever is an IgE-mediated allergic response to inhaled pollen particles. In a sensitised individual, the immune system has developed IgE antibodies against specific pollen proteins. When airborne pollen is inhaled and contacts the nasal and conjunctival mucosa, mast cells release histamine and other inflammatory mediators, causing the characteristic symptoms.
The UK pollen season is divided broadly into three phases:
Tree pollen (February to June): birch, hazel, alder, and oak are the main culprits. Birch pollen is particularly potent and can cause severe symptoms in sensitised individuals.
Grass pollen (May to July): grass pollen produces the highest pollen counts (billions of grains per day at peak) and is the most common cause of hay fever in the UK. This period is when the majority of sufferers are most symptomatic.
Weed and mould pollen (June to September): nettle, dock, and plantain pollens; fungal spores from Cladosporium and Alternaria contribute later in the season.
Research by Jean Emberlin at the National Pollen and Aerobiology Research Unit (now based at Worcester University) has been foundational in characterising UK pollen seasons and forecasting pollen counts.
Symptoms in Children
Children with hay fever typically present with: bilateral nasal congestion and/or discharge; sneezing (often in runs); itchy, red, watery eyes (allergic conjunctivitis occurs in 50-70% of hay fever sufferers); itchy nose and palate; and occasionally itchy ears. Some children also experience postnasal drip, throat clearing, and nocturnal cough from mucus draining from the nose.
In school-age children, hay fever may impair sleep (nasal congestion is worse when lying down) and reduce academic performance. A study by Carol Walker and colleagues at the University of Southampton found that hay fever symptoms are more prevalent during GCSE exam season in June, when grass pollen counts are highest.
Treatment Options
Non-sedating antihistamines (first-line). Cetirizine (available from age 1) and loratadine (from age 2) are the standard first-line treatment. They are most effective for sneezing and itching but less effective for nasal congestion. Non-sedating antihistamines should be taken regularly during pollen season rather than on an as-needed basis for maximum efficacy.
Intranasal corticosteroid sprays (most effective for nasal symptoms). Preparations such as fluticasone (Flixonase) and mometasone (Nasonex) reduce nasal inflammation and are more effective than antihistamines for nasal congestion. They require regular use for several days before reaching maximum effect. Available from age 4-6 depending on preparation.
Sodium cromoglicate eye drops. Effective for allergic conjunctivitis; can be used in children from age 5.
Combination. For moderate-to-severe hay fever, antihistamine plus intranasal corticosteroid is more effective than either alone.
Pollen Avoidance Measures
Pollen avoidance is imperfect but can reduce allergen load. Practical measures: checking pollen forecasts and keeping children indoors during high-count days or at peak pollen times (late morning and evening when levels are highest); keeping windows closed during pollen season, particularly at night; showering and changing clothes after outdoor time; wearing wrap-around sunglasses to reduce pollen contact with eyes; applying a small amount of petroleum jelly to the nostrils before outdoor time to trap pollen particles.
Key Takeaways
Hay fever (seasonal allergic rhinitis) is caused by sensitisation to airborne pollens, most commonly grass pollen (which produces the highest pollen counts and the most severe symptoms in the UK from May to July). It affects approximately 10-15% of children in the UK and often begins in children aged 5 and older. Treatment is stepwise: non-sedating antihistamines are first-line, intranasal corticosteroid sprays are more effective for nasal symptoms, and sodium cromoglicate eye drops help for ocular symptoms. Pollen avoidance measures have modest but real benefit. The pollen season and symptom severity vary year to year with weather.
