Ah, springtime: lambs are frolicking across the fields, the chill of winter starts to fade, and about one in five Australians might consider clawing their (itching, watering) eyes out to escape the cursed symptoms of hay fever.

Hay fever, or allergic rhinitis, can strike year round – any time that allergens such as dust mites, mould, or certain pollens are present.

But for those who suffer seasonal allergic rhinitis, there are concerns the ongoing rain along the east coast of the country will lead to above-average pollen production, and a particularly sneezy spring.

Coordinator of Melbourne Pollen Count, Associate Prof Ed Newbigin, says if these conditions continue through the next few months, Sydney will probably see a heavier grass pollen season than last year, while Canberra and Melbourne’s might be roughly the same as in 2021.

“That said, 2021 was one of Canberra’s biggest grass pollen seasons, so saying it’s looking similar won’t be too much comfort for Canberrans with hay fever and asthma,” he says.

“Last year, Melbourne had an average-ish grass pollen season and that’s how things are currently tracking again this season.”

Because subtropical grasses tend to flower later than temperate grasses (in late summer and early autumn), Newbigin says it’s too early to comment on Brisbane’s season, which won’t peak until next year.

“The current Indian Ocean dipole and BoM‘s forecast of a 70% chance of another La Niña season suggests that above median September-to-November rainfall is likely for most of the eastern half of Australia,” Newbigin says.

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“While a wet spring should mean lots of grass growth and lots of grass pollen, forecasts aren’t promises and we’re very likely to see big differences in grass pollen levels across the different regions of eastern Australia.”

Get a diagnosis

Sinthia Bosnic-Anticevich, professor at the Woolcock Institute of Medical Research, encourages anyone with allergic rhinitis symptoms to seek a doctor’s diagnosis. “We know that up to 40% of people with allergic rhinitis have asthma, and about 80% of people who have asthma also have allergic rhinitis, which, if left untreated or sub-optimally treated, can impact on asthma symptom control.”

She also warns the problem often goes undiagnosed in children.

The researcher and respiratory pharmacist led a recent study of more than 1,500 Australian parents that found children’s sleep, schoolwork and daily life suffered when allergic rhinitis was poorly controlled.

“In some ways perhaps it is not surprising; children often have runny noses, sniffles, colds etc,” Bosnic-Anticevichsays. “It can be difficult to determine whether the symptoms are a cold or allergic rhinitis.”

But optimal treatment could be “life-changing”.

“I really cannot stress how important it is for parents to seek advice and potentially a diagnosis, if their child is experiencing recurrent cold-like symptoms.”

Find the right treatment

Bosnic-Anticevich recommends speaking to a pharmacist or GP before starting any treatments, noting many adults are selecting their own over-the-counter medication – with poor results.

“It’s mostly people with moderate-severe allergic rhinitis, or people who report it impacts their day-to-day living in some way, who seek healthcare. When it comes to their choice of medication, 70% select their own medication without assistance from the pharmacy.

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“Unfortunately, less than 20% select optimal medication.”

Most choose antihistamine tablets as their first-line treatment, regardless of how severe their symptoms are, Bosnic-Anticevich says.

“In fact, only a very small proportion of people will get optimal benefit from oral antihistamine tablets, and this tends to set up a cycle of medication trials and errors, with an under-treatment of allergic rhinitis.

“Generally, we would expect that most people who report allergic rhinitis has an impact on their day-to-day living would be treated with intranasal sprays – either antihistamine or anti-inflammatory, or a combination of both.”

Dr Kerry Hancock, an Adelaide-based GP with a special interest in respiratory medicine, urges those already using nasal sprays to pay attention to the instructions.

“It’s really, really important for people taking nasal sprays to take them correctly to get the maximum benefit from them and lessen side effects. Many people give up taking nasal steroids due to blood nose but this is often because they are not using the sprays correctly.”

For people who aren’t responding to over-the-counter treatments, GPs can also trial more potent medications.

Those with severe allergies might also be referred to a specialist for allergen immunotherapy.

“Those with more bothersome and/or persistent symptoms would benefit from allergy testing which can be arranged by their GP relatively easily, either by blood tests or by referring for skin prick tests,” Hancock says.

Have a gameplan

Doctors can also draw up action plans in case symptoms escalate. Hancock noted people with seasonal allergic rhinitis, asthma or both are at higher risk of the uncommon, but potentially life-threatening, thunderstorm asthma.

Director of the Canberra Pollen Monitoring Program, Prof Simon Haberle, says that while allergenic pollen can have severe health impacts, there’s an increasing amount of information available to help allergic rhinitis and asthma sufferers manage the risks.

These include Pollen Forecast and AirRater. The Victorian Government also provides thunderstorm asthma resources in multiple languages and a risk forecast between October and December.

“By following the advice of your GP and keeping an eye on the daily pollen counts the health outcomes can be much improved,” Haberle says.

Who’s to blame?

Haberle says most plants that cause allergic rhinitis were introduced to Australia through colonisation, for pastures and urban landscapes.

“The main culprit in the southern temperate regions of Australia is ryegrass (Lolium perenne) that flowers between the months of October and December, peaking during November.” Living far from fields is no guarantee of reprieve, either. Haberle says “allergenic grasses can be produced in abundance and carried many tens of kilometres”.

The full effects of “non-grass” pollen on allergies is not fully understood, but Haberle says trees with allergenic pollen include cypress pines, ash, birch, plane, poplar, elm and oak, along with the native casuarina species.

The climate crisis may make flowering seasons less predictable, too.

“Our monitoring records are short but there’s some indication the grass pollen seasons are starting earlier and much more pollen is being produced,” Haberle says. “These two trends are in line with the observations of changing pollen seasons in the northern hemisphere and have been linked to climate change impacts.”