Hay fever (allergic rhinitis)
Inflammation of the nasal lining caused by an allergic reaction to airborne particles. It affects about one in four Australians.
Symptoms may be seasonal, from spring and summer pollens, or year-round, usually from dust mite or pets. In Perth, grass pollens are the main culprit from roughly October to December, sometimes starting in September.
The usual symptoms are sneezing, an itchy or runny nose, a blocked nose, mucus down the back of the throat, itchy watery eyes, and snoring or poor sleep. Left uncontrolled, allergic rhinitis makes asthma, sinus disease and sleep quality worse, so it is worth treating properly.
How it is diagnosed
The pattern of your symptoms is usually enough: what sets them off, when they happen, and where you are at the time. Allergy testing, either skin prick testing or a blood test, identifies exactly which allergens are involved. That matters if you are considering desensitisation or want to target your avoidance measures.
I will also examine the inside of your nose to check for polyps, a deviated septum, or other causes of blockage that can mimic allergy or sit alongside it.
What actually works
A daily steroid nasal spray is the most effective single treatment, and unlike tablets it also relieves blockage. Two things matter more than which brand you buy: using it every day through your season, because it prevents inflammation rather than relieving it on the spot, and using the correct technique. Most people aim it at the middle of the nose, which is the one place it should not go.
For moderate or severe symptoms, combination sprays that pair a steroid with an antihistamine in one bottle work faster and are preferred by most patients. Antihistamine tablets help sneezing, itch and a runny nose but do little for blockage. Salt water rinses wash pollen out of the nose and make your spray work better.
Decongestant sprays should not be used for more than a few days. Longer use causes severe rebound blockage that outlasts the original problem.
If symptoms remain troublesome, desensitisation treatment retrains the immune system to tolerate the allergen, given as injections or as daily tablets or drops under the tongue. A course takes three to five years and can give five to ten years of tolerance afterwards. It is the only treatment that changes the underlying allergy rather than suppressing its effects.
When surgery helps
Surgery does not treat the allergy, and it is not a substitute for sprays, rinses or desensitisation, which continue afterwards. What it treats is the physical blockage that allergy leaves behind once the lining and the structures inside the nose have been swollen for years. I consider it when the nose stays blocked despite about three months of well-taken medical treatment, particularly when the blockage disturbs your sleep.
Reducing the turbinates, the ridges along the side wall of the nose, reliably opens the airway. It is day surgery through the nostrils with no cuts on the face. I deliberately keep the reduction conservative and preserve the lining, because taking away too much can leave a nose that feels permanently dry and uncomfortably open. If the septum is also deviated, straightening it is often done at the same time.
Worth being seen if you have
- Symptoms persisting after four weeks or more of a daily spray used with the correct technique
- Blockage mainly on one side, recurrent nosebleeds, loss of smell, or facial pain
- Asthma that flares during your hay fever season, including any history of thunderstorm asthma
Patients under my care receive a detailed handout covering spray technique, allergen avoidance and the full range of surgical options.
This page is general information and does not replace advice about your own case. Reviewed August 2026.