Hay fever, or allergic rhinitis, is an inflammatory condition of the nasal passages caused by an overreaction of your immune system to airborne allergens. When your body encounters these normally harmless substances, it mistakenly identifies them as threats and releases chemicals like histamine, triggering the familiar symptoms of sneezing, congestion, and itching. In Singapore, hay fever is a common chronic condition that can affect both adults and children. Unlike the common cold, hay fever symptoms can persist for weeks or months, particularly when exposed to year-round allergens common in our tropical climate.
Hay Fever Treatment in Singapore
Persistent sneezing, a runny nose, and itchy eyes can significantly disrupt daily life, especially in Singapore’s tropical climate, where allergens are present year-round. Hay fever, medically known as allergic rhinitis, is a common condition that affects many people worldwide and is prevalent in urban environments. Untreated hay fever may impact work productivity, sleep quality, and overall well-being. Our ENT Specialist understands the challenges of managing hay fever in Singapore’s environment and offers treatment tailored to specific triggers and symptoms.
*Individual results and treatment responses may vary.*
Dr Gan Eng Cern
MBBS
MRCS (Edin)
mmed (orl)
FAMS
What is Hay Fever?
Types of Hay Fever
Seasonal Allergic Rhinitis
Less common in Singapore due to our consistent climate, seasonal allergic rhinitis occurs when specific allergens are more prevalent. In our region, this typically happens during the flowering seasons of imported plants or during haze periods when air quality deteriorates.
Perennial Allergic Rhinitis
This is a common form in Singapore, occurring year-round due to constant exposure to indoor allergens. Patients may experience persistent symptoms that can fluctuate in severity.
Occupational Rhinitis
This type develops from workplace exposure to specific irritants or allergens. Common in industries involving chemicals, latex, wood dust, or laboratory animals, occupational rhinitis can affect work performance and may require workplace modifications in addition to medical treatment.
Causes & Risk Factors
Causes
Hay fever occurs when your immune system produces antibodies called Immunoglobulin E (IgE) in response to allergen exposure. Common triggers in Singapore include:
- House dust mites (a prevalent trigger in humid climates)
- Cockroach droppings and body parts
- Pet dander from cats and dogs
- Mould spores that can thrive in tropical environments
- Pollen from grasses and imported flowers
- Air pollutants and haze particles
Risk Factors
- Family history of allergies or asthma
- Having other allergic conditions like eczema or food allergies
- Being born during high allergen seasons
- Early childhood exposure to cigarette smoke
- Living in urban areas with higher pollution levels
- Male gender in childhood (though this equalises in adulthood)
- Being the firstborn child
- Exposure to diesel exhaust particles is common in urban environments
Signs & Symptoms
Mild Symptoms
- Clear, watery nasal discharge
- Occasional sneezing
- Mild nasal itching
- Slight nasal congestion
- Intermittent eye watering
- Occasional throat clearing
- Mild fatigue during flare-ups
Moderate Symptoms
- Frequent sneezing fits
- Persistent runny or stuffy nose
- Noticeable eye redness and itching
- Postnasal drip causing throat irritation
- Disrupted sleep due to nasal congestion
- Reduced sense of smell and taste
- Dark circles under eyes (“allergic shiners”)
- Difficulty concentrating at work or school
Severe Symptoms
- Continuous sneezing throughout the day
- Complete nasal blockage requiring mouth breathing
- Severe eye symptoms affecting vision
- Persistent cough from postnasal drip
- Significant sleep disruption that may lead to daytime exhaustion
- Recurring sinus infections
- Ear pressure or pain from eustachian tube dysfunction
- Severe headaches from sinus pressure
Symptoms typically begin within minutes of allergen exposure and persist as long as exposure continues. Symptoms may be more noticeable upon waking or when entering air-conditioned environments where dust mites thrive.
Experiencing these symptoms?
Consult with an ENT specialist for an accurate diagnosis and treatment plan.
When To See an ENT Specialist
medications or significantly impact your daily activities. Red flag symptoms requiring immediate medical attention include severe facial pain, high fever, yellow or green nasal discharge, or symptoms affecting only one side of your face.
Seek treatment when symptoms first interfere with sleep, work performance, or quality of life. Early intervention may help prevent complications such as the development of chronic sinusitis or asthma. During your first consultation, an ENT specialist may review your medical history, perform a nasal endoscopic examination, and recommend allergy testing to identify specific triggers.
## Diagnosis & Testing Methods
Accurate diagnosis begins with a detailed medical history and physical examination of your nasal passages, throat, and ears. Our ENT Specialist uses a thin, flexible endoscope to visualise the inside of your nasal cavity and check for inflammation, polyps, or structural abnormalities. This procedure takes a few minutes and provides a visual assessment of nasal inflammation.
Allergy testing helps identify specific triggers through either skin prick tests or blood tests measuring IgE antibodies. Skin prick tests can test for common allergens, including various dust mite species, cockroach allergens, pet dander, and local moulds. Blood tests may be preferred for patients taking antihistamines or those with severe eczema, as these conditions can affect the accuracy of skin testing.
Additional diagnostic tools may include nasal smears to examine cellular composition, CT scans if sinusitis is suspected, and rhinomanometry to objectively measure nasal airflow. These tests help differentiate hay fever from other conditions, such as non-allergic rhinitis or chronic sinusitis, supporting appropriate treatment planning.
Treatment Options Overview
Nasal Corticosteroid Sprays
These are commonly used treatments for hay fever, providing direct anti-inflammatory effects on the nasal tissues. Modern corticosteroid sprays have minimal systemic absorption. These sprays can help reduce nasal symptoms, including congestion, a runny nose, sneezing, and itching.
Antihistamines
Available in both oral and nasal spray forms, antihistamines block histamine receptors to help relieve symptoms. Newer generation antihistamines like cetirizine, loratadine, and fexofenadine may cause minimal drowsiness. Combination therapy with nasal corticosteroids may help control symptoms of moderate to severe hay fever. An ENT specialist can recommend specific antihistamines based on your symptom pattern and lifestyle needs.
Nasal Saline Irrigation
Regular nasal washing with saline solution may help remove allergens and mucus from nasal passages, potentially providing symptom relief. This treatment can work in Singapore’s urban environment and may help reduce the need for medications. Proper technique using sterile or boiled water is essential to prevent infections. Some patients find that irrigation may help improve their quality of life.
Leukotriene Receptor Antagonists
These oral medications block inflammatory chemicals called leukotrienes, which may be beneficial for patients with concurrent asthma or exercise-induced symptoms. Montelukast is commonly prescribed and may work for patients who prefer oral medication over nasal sprays.
Immunotherapy (Desensitisation)
For patients with severe hay fever unresponsive to standard treatments, immunotherapy may offer potential relief by gradually desensitising the immune system to specific allergens. Sublingual immunotherapy tablets are available for house dust mite allergy. This treatment may provide benefit and potentially help modify the underlying allergic disease process.
Nasal Decongestants
Decongestant sprays can help relieve severe nasal congestion, particularly during acute flare-ups. Use must be limited to prevent rebound congestion (rhinitis medicamentosa). Oral decongestants may be prescribed for patients who cannot use nasal sprays but require monitoring for blood pressure effects.
Combination Nasal Sprays
Formulations combining corticosteroids with antihistamines in a single spray may offer convenience and efficacy for moderate to severe symptoms. These may provide a faster onset of action than corticosteroids alone, while maintaining a similar safety profile. Patients may prefer the simplified treatment regimen, potentially improving medication adherence.
Every patient’s condition is unique.
An ENT specialist may assess your specific situation and recommend the most suitable treatment.
Complications if Left Untreated
Untreated hay fever can progress beyond nasal symptoms to affect multiple aspects of your health. Chronic nasal inflammation may increase susceptibility to bacterial sinus infections. The constant postnasal drip can trigger chronic cough and throat irritation, sometimes leading to voice changes.
Sleep quality may suffer when nasal congestion forces mouth breathing, potentially leading to snoring, dry mouth, and frequent awakening. This sleep disruption can cause daytime fatigue, reduced concentration, and decreased work or school performance. Children with untreated hay fever may experience learning difficulties and behavioural problems related to poor sleep.
Long-term complications may include nasal polyps, loss of smell, and an increased risk of asthma. Untreated childhood hay fever may increase the likelihood of developing other allergic conditions. Chronic inflammation can cause structural changes in the nasal passages, potentially requiring surgical intervention.
Individual experiences and outcomes may vary. Consult an ENT specialist for proper evaluation and management.
Prevention
Whilst complete prevention of hay fever may not be possible for those genetically predisposed, several strategies may help minimise symptom occurrence and severity. Environmental control can be an essential component of management in Singapore’s allergen-rich environment.
Reducing dust mite exposure may involve using allergen-proof bedding covers, washing sheets weekly in hot water above 60°C, and maintaining indoor humidity below 50% with dehumidifiers. Regular vacuuming with HEPA filters and removing carpets from bedrooms may help reduce allergen load. For pet allergies, keeping animals out of bedrooms and regular bathing can help, though complete avoidance may be necessary for severe allergies.
Air purifiers with HEPA filters may help remove airborne allergens, which could be particularly beneficial during haze seasons. Keeping windows closed on high-pollen or high-pollution days and showering after outdoor activities may help remove allergens from hair and skin. Starting preventive medications before expected allergen exposure, such as before cleaning or visiting homes with pets, might help prevent symptom development.
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Frequently Asked Questions (FAQ)
Is hay fever the same as sinusitis?
While both conditions affect the nasal passages, they are different. Hay fever is an allergic reaction causing inflammation of the nasal lining, while sinusitis is inflammation or infection of the sinus cavities. However, untreated hay fever may lead to sinusitis as chronic nasal inflammation can block sinus drainage. Hay fever symptoms typically include itchy eyes and sneezing, which are uncommon in sinusitis. An ENT specialist can differentiate between these conditions through examination and determine whether you have one or both, which may require treatment.
Can hay fever be cured permanently?
While there is no permanent cure for hay fever, treatments can help control symptoms in many patients. Immunotherapy offers an approach that may provide longer-lasting improvement even after treatment stops. Many patients achieve symptom control with appropriate medications and allergen avoidance. Some children may outgrow their allergies, though this is less common with hay fever than with food allergies. The key is finding the right treatment combination for your specific triggers and symptoms.
How long does hay fever treatment take to work?
Treatment response varies depending on the medication type and severity of symptoms. Antihistamines typically provide relief, making them useful for symptom control. Nasal corticosteroid sprays begin working but require regular use for optimal benefit. Immunotherapy requires a longer commitment but may offer potential improvement. Most patients may experience improvement with appropriate treatment.
Can I take hay fever medications long-term?
Modern hay fever medications are designed for long-term safety when used as directed. Nasal corticosteroid sprays have minimal systemic absorption and can be used safely for extended periods. Second-generation antihistamines are non-sedating and safe for extended use. Regular monitoring by an ENT specialist can help in optimal treatment with minimal side effects. The goal is to use the minimum effective dose to control symptoms while maintaining quality of life.
Why is my hay fever worse in air-conditioned rooms?
Air-conditioning can worsen hay fever symptoms through several mechanisms. The cold, dry air can irritate sensitive nasal passages, potentially triggering sneezing and congestion. Air-conditioning systems can harbour mould and circulate dust mite allergens if filters aren’t regularly cleaned. The temperature change when entering air-conditioned spaces may trigger vasomotor rhinitis in addition to allergic symptoms. Regular air-con servicing and the use of HEPA filters can help reduce these effects.
Should I get an allergy test for hay fever?
Allergy testing may be recommended when symptoms are moderate to severe, year-round, or not adequately controlled with standard treatments. Testing helps identify specific triggers, allowing targeted avoidance measures and consideration of immunotherapy. It also differentiates between allergic and non-allergic rhinitis, which can help guide appropriate treatment. An ENT specialist may determine if testing would benefit your treatment plan based on your symptom pattern and medical history.
Can hay fever develop suddenly in adults?
Yes, adult-onset hay fever can occur, even in people without childhood allergies. Changes in the environment can expose you to new allergens. Hormonal changes, stress, and viral infections may trigger the development of allergies in predisposed individuals. Adult-onset hay fever often requires a comprehensive evaluation, as symptoms may be more severe than childhood-onset cases.
Conclusion
Living with hay fever in Singapore’s tropical climate presents unique challenges, but with proper diagnosis and treatment, symptoms can be effectively managed. Treatment options range from simple saline rinses to immunotherapy, offering approaches for different severity levels. The key to management lies in identifying your specific triggers and developing a personalised treatment plan that fits your lifestyle.
Our ENT Specialist combines experience with current evidence-based treatments to help support symptom management. Rather than accepting hay fever as an unavoidable part of life in Singapore, consider taking proactive steps to improve nasal health and quality of life.
*Individual results and treatment responses may vary.*
Take the First Step Towards Better Health
Living with hay fever can be challenging, but you don’t have to face it alone. Our ENT Specialist has experience diagnosing and treating hay fever using current evidence-based approaches.
Dr Gan Eng Cern
MBBS
MRCS (Edin)
mmed (orl)
FAMS
With over 15 years of experience, Dr Gan specialises in the comprehensive management of a broad range of conditions related to the ear, nose and throat (ENT), and head and neck.
Dr. Gan has contributed to the academic field as a Senior Clinical Lecturer at the Yong Loo Lin School of Medicine, National University of Singapore. He is recognised for his extensive research work, with numerous contributions to reputable international ENT journals. Dr Gan is also highly sought after as a speaker and has shared his surgical knowledge as a surgical dissection teacher at various prominent ENT conferences and courses.
- 2020 – Reader’s Choice Gold Award for Best ENT Specialist (Expat Living Singapore)
- 2016 – Best Educator Award (Eastern Health Alliance)
- 2016 – “Wow” Award (Patient Compliment)
- 2014 – Eastern Health Alliance Caring Award – Silver
- 2014 – 19th Yahya Cohen Memorial Lectureship (awarded by the College of Surgeons, Academy of Medicine Singapore for best scientific surgical paper)
- 2012 – Human Manpower Development Award (Ministry of Health, Singapore)
- 2007 – Singhealth Best Doctor Award
Qualifications
- MBBS – Bachelor of Science, Bachelor of Medicine, Bachelor of Surgery (University of New South Wales, Sydney, Australia)
- MRCS (Edin) – Member of the Royal College of Surgeons Edinburgh, United Kingdom
- MMed (ORL) – Master of Medicine in ENT (National University of Singapore)
- FAMS – Fellow of the Academy of Medicine Singapore
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