Hayfever vs Nasal Polyps: How to Tell the Difference
As April’s Allergy Awareness Week shines a spotlight on the growing burden of allergic conditions in the UK, it is worth noting that not every blocked, runny, or congested nose is hay fever. This is despite the Met Office just issuing a week-long ‘red alert’ warning for hay fever sufferers.
Hay fever and nasal polyps share many symptoms, and patients frequently mistake one for the other. Understanding the difference matters because the treatments are quite distinct and, in the case of polyps, delaying the right care can lead to months of unnecessary suffering.
Why hay fever is getting harder to ignore
Hay fever, or allergic rhinitis, is already one of the most common conditions in the UK, affecting around 16 million people, or roughly one in four adults, according to Allergy UK. That figure has been climbing steadily: the prevalence of diagnosed allergic rhinitis in children has trebled over the last three decades, and hay fever cases have tripled in the last 20 years.
The UK Health Security Agency has confirmed that climate change is extending the UK pollen season. Research tracking every city in the UK found that England now experiences around 20 more pollen-producing days per year than it did 30 years ago.
Hay fever symptoms are linked directly to when plants release pollen. As a general guide, tree pollen peaks between February and June, grass pollen between May and July, and weed or flower pollen between June and September. For Londoners, urban air pollution intensifies the body’s reaction to pollen, worsening symptoms.
Common hay fever symptoms include sneezing, a runny or blocked nose, itchy and watery eyes, and itching in the ears or throat. They typically ease when pollen counts drop, after rain, in cooler weather, or indoors with windows closed.
What are nasal polyps and why do they get mistaken for hay fever?
Nasal polyps are soft, painless, non-cancerous growths that develop in the lining of the nasal passages or sinuses. They are most common in adults and often develop alongside chronic inflammation, particularly in people with long-standing hay fever, asthma, or aspirin sensitivity.
Because polyps cause nasal congestion, a reduced or lost sense of smell, postnasal drip, and a persistent feeling of pressure across the face and sinuses, they can be almost indistinguishable from hay fever. However, while hay fever symptoms follow the pollen calendar, nasal polyps cause symptoms that do not significantly improve when pollen is absent, and do not respond fully to standard antihistamines.
Other signs that point towards polyps rather than hay fever include a significantly impaired sense of smell that has developed gradually, worsening snoring, and congestion that persists regardless of the season.
Treating nasal polyps
Smaller polyps are often managed initially with steroid nasal sprays and sometimes a short course of oral steroids to reduce inflammation. For patients whose symptoms are driven by underlying hay fever, immunotherapy – a course of treatment that gradually desensitises the immune system to specific pollen allergens – can also play a useful role in reducing the chronic inflammation that allows polyps to develop or return.
However, when polyps are large enough to block airflow or sinuses, or when they are not responding to medication, surgical treatment may be recommended.
A polypectomy is a modern procedure for removing nasal polyps that are obstructing airflow. It’s performed using endoscopic techniques, allowing the surgeon to work through the nasal passages without any external incisions. Most patients notice a meaningful improvement in breathing and sense of smell in the weeks following surgery.
When to seek a specialist opinion
Allergy Awareness Week is a good moment to reassess symptoms that you may have been managing year after year without fully resolving.
Prolonged nasal congestion, loss of smell, and persistent sinus pressure deserve a proper diagnosis. An ENT consultant can examine the nasal passages with an endoscope to check for polyps, assess whether chronic sinusitis is contributing, and arrange allergy testing if needed to understand exactly what you are reacting to.
Dr Veeresh Patil is our in-house Consultant Allergist who can advise on allergies beyond the nose. He also oversees our in-house oral desensitisation programme for allergy sufferers with more severe symptoms, who do not respond satisfactorily to conventional treatment by avoidance, antihistamines and nasal steroid sprays.
If your symptoms are not in line with the pollen season or are significantly affecting your quality of life, our specialists at The Harley Street ENT Clinic are here to help. Get in touch today to book an appointment.