Sinus / Hayfever
Symptoms, Causes & Treatment
Sinus problems and hayfever (allergic rhinitis) affect millions in the UK, causing nasal congestion, sneezing, runny nose, and facial pressure that significantly impact quality of life.
What are Sinus & Hayfever Conditions?
Sinus and hayfever conditions encompass allergic rhinitis (seasonal hayfever, perennial rhinitis), non-allergic rhinitis, acute and chronic sinusitis, and nasal polyps. Allergic rhinitis affects around 1 in 4 people in the UK and frequently co-exists with asthma.
Symptoms of Sinus & Hayfever
Sinus and hayfever symptoms depend on the underlying cause. Identifying whether seasonal or perennial, allergic or infective, guides treatment.
Nasal congestion and runny nose · Facial pressure or pain (frontal, cheek, or behind the eyes) · Postnasal drip · Persistent sneezing · Itchy or watery eyes (hayfever) · Loss of smell · Scratchy or sore throat from drip
Severe facial pain with fever and swelling (periorbital or cheek) · Sudden severe headache · Neck stiffness or photophobia with sinusitis · Vision changes with facial swelling (orbital cellulitis risk)
Facial swelling with fever and vision change, or neck stiffness with sinusitis headache — attend A&E immediately.
What Causes Sinus Problems & Hayfever?
Sinus and hayfever symptoms arise from inflammation of the nasal mucosa triggered by allergens, infections, or non-allergic stimuli.
Allergic rhinitis is an IgE-mediated hypersensitivity to inhaled allergens. Seasonal hayfever is triggered by tree (spring), grass (summer), or weed (autumn) pollens. Perennial rhinitis is triggered year-round by house dust mites, pet dander, and mould.
Acute sinusitis is usually viral and caused by rhinovirus or coronavirus. Bacterial sinusitis (less than 2% of cases) is caused by S. pneumoniae or H. influenzae and is suggested by symptoms persisting beyond 10 days, severe facial pain, and purulent discharge.
Nasal polyps are benign inflammatory growths in the nasal passage that obstruct airflow and impair drainage. They are associated with chronic rhinosinusitis, asthma, and aspirin sensitivity. Treatment is with nasal steroids; recurrent polyps may require surgery.
Non-allergic rhinitis (vasomotor rhinitis) is triggered by temperature changes, exercise, strong smells, alcohol, or hormonal changes. It is mediated by autonomic nerve dysregulation, not IgE. Treatment is with saline irrigation and ipratropium nasal spray.
Community-acquired pneumonia (CAP) is the most common serious form of chest infection. It is caused by Streptococcus pneumoniae (most common), Haemophilus influenzae, atypical organisms (Mycoplasma, Legionella), and viral pathogens. CAP carries significant mortality in elderly patients.
Acute bronchitis is inflammation of the bronchi, almost always viral in origin. It is characterised by a productive cough, chest discomfort, and wheeze. Antibiotics are not routinely indicated as it resolves without treatment in most cases within 3 weeks.
Key Risk Factors
Diagnosing Sinus & Hayfever Problems
Hayfever and rhinitis are usually diagnosed clinically. Allergy testing is used when the specific trigger is unclear or immunotherapy is being considered.
Treatment for Sinus & Hayfever
Nasal corticosteroids are the cornerstone of management for both rhinitis and sinusitis, with antihistamines and saline irrigation as adjuncts.
Supportive Measures
Nasal saline irrigation twice daily. Steam inhalation for congestion. Warm facial compresses for sinus pain. Stay hydrated. Avoid alcohol and smoke. Keep windows closed on high pollen days.
Chronic & Recurrent Sinusitis
Chronic rhinosinusitis (symptoms lasting more than 12 weeks) or recurrent acute sinusitis requires specialist ENT assessment. Nasal endoscopy and CT guide medical or surgical management decisions.
When to Seek Help
Sinusitis with severe facial swelling, periorbital oedema, fever, stiff neck, vision change, or confusion — call 999 immediately.
See a GP if not responding to over-the-counter treatment, if smell loss persists, or if facial pain with fever is present.
Preventing Hayfever & Sinusitis
Hayfever and sinusitis symptoms can be significantly reduced through early treatment, allergen avoidance, and nasal hygiene.
Start nasal corticosteroid spray 2 weeks before the anticipated pollen season. For grass pollen allergy in the UK, this means beginning treatment in late April to achieve full mucosal effect by June.
Monitor local pollen counts (available on the Met Office website). Avoid peak outdoor exposure on high pollen days (warm, windy afternoons). Keep windows closed and change clothes after outdoor exposure.
Use allergen-proof mattress and pillow covers, wash bedding weekly at 60°C, avoid soft furnishings in the bedroom, and consider using a HEPA air purifier to reduce house dust mite exposure.
Nasal saline irrigation twice daily clears allergens, reduces inflammation, and improves nasal drainage. It is evidence-based and can significantly reduce medication requirements when used consistently.
A healthy diet rich in vitamins C and D, regular exercise, adequate sleep, and avoidance of excess alcohol all support immune function and reduce susceptibility to respiratory infections.
For those at aspiration risk (dysphagia, oesophageal reflux), head elevation at 30–45 degrees, thickened fluids, and speech and language therapy assessment significantly reduce aspiration pneumonia risk.
Getting Treatment
A GP can diagnose and manage rhinitis, hayfever, and sinusitis. An online GP consultation is an effective first step for prescription treatments and allergy referrals.
Expert clinical advice, when you need it.
Sinus & Hayfever — Frequently Asked Questions
Hayfever (allergic rhinitis) is caused by an immune reaction to pollen. When pollen is inhaled, the immune system recognises it as a threat and releases histamine, which causes sneezing, runny nose, itchy eyes, and congestion. The reaction is mediated by IgE antibodies on mast cells in the nasal lining.
The most effective treatment combines a nasal corticosteroid spray (e.g. fluticasone, mometasone) started 2 weeks before the pollen season with a daily non-sedating antihistamine (cetirizine, loratadine). For year-round rhinitis, the nasal spray alone is often sufficient.
Acute sinusitis usually resolves without antibiotics within 10 days. Antibiotics are only recommended if symptoms persist beyond 10 days with severe pain, fever, or purulent discharge. Decongestant nasal sprays, saline irrigation, and paracetamol manage symptoms effectively.
The best time to start hayfever treatment is 2 weeks before your symptoms usually begin. Nasal corticosteroid sprays take up to 2 weeks to reach their full anti-inflammatory effect, so starting early is important for optimal control during the season.
Yes. Allergen immunotherapy (allergy shots or sublingual drops/tablets) desensitises the immune system to specific allergens over 3–5 years. It provides long-term benefit after treatment ends and is particularly effective for grass pollen and house dust mite allergy.
Nasal saline irrigation involves rinsing the nasal cavity with a saltwater solution. It physically removes allergens and mucus, reduces mucosal inflammation, and significantly improves nasal symptoms. It is safe, non-pharmacological, and can be used daily alongside other treatments.
Drowsy (sedating) antihistamines like chlorphenamine cause significant daytime sedation and impair driving and cognitive function. Non-sedating antihistamines (cetirizine, loratadine, fexofenadine) are preferred for daytime use. Even non-sedating antihistamines can cause mild sedation in some people.
See a GP if hayfever or sinusitis symptoms are severely impacting quality of life despite over-the-counter treatments, if you have frequent sinusitis requiring antibiotics, if you have lost your sense of smell, or if you are experiencing significant asthma worsening during pollen season. Specialist referral for immunotherapy may be appropriate.