If you have an allergy, your immune system reacts to something that doesn’t bother most other people. People with seasonal allergies (also called hay fever or allergic rhinitis) react to pollen from plants. Symptoms may include sneezing, coughing, a runny or stuffy nose, and itching in the eyes, nose, mouth, and throat.

What the Science Says

Complementary approaches can be classified by their primary therapeutic input (how the therapy is taken in or delivered), which may be:

• Nutritional (e.g., special diets, dietary supplements, herbs, probiotics, and microbial-based therapies).
• Psychological (e.g., meditation, hypnosis, music therapies, relaxation therapies).
• Physical (e.g., acupuncture, massage, spinal manipulation).
• Combinations such as psychological and physical (e.g., yoga, tai chi, dance therapies, some forms of art therapy) or psychological and nutritional (e.g., mindful eating).

Nutritional approaches include what NCCIH previously categorized as natural products, whereas psychological and/or physical approaches include what was referred to as mind and body practices.

Many complementary health approaches have been studied for allergic rhinitis. There’s some evidence that a few may be helpful.

Psychological and Physical Approaches

• A 2015 evaluation of 13 studies of acupuncture for allergic rhinitis, involving a total of 2,365 participants, found evidence that this approach may be helpful.
• Rinsing the sinuses with a neti pot (a device that comes from the Ayurvedic tradition) or with other devices, such as nebulizers or spray, pump, or squirt bottles, may be a useful addition to conventional treatment for allergic rhinitis.

Nutritional Approaches

• A 2007 evaluation of six studies of the herb butterbur for allergic rhinitis, involving a total of 720 participants, indicated that butterbur may be helpful.

• Researchers have been investigating probiotics (live microorganisms that may have health benefits) for diseases of the immune system, including allergies. Although some studies have had promising results, the overall evidence on probiotics and allergic rhinitis is inconsistent. It’s possible that some types of probiotics might be helpful but that others are not.

• It’s been thought that eating honey might help to relieve pollen allergies because honey contains small amounts of pollen and might help people build up a tolerance to it. Another possibility is that honey could act as an antihistamine or anti-inflammatory agent. Only a few studies have examined the effects of honey in people with seasonal allergies, and their results have been inconsistent.

• Many other nutritional approaches have been studied for allergic rhinitis, including astragalus, capsaicin, grape seed extract, omega-3 fatty acids, Pycnogenol (French maritime pine bark extract), quercetin, spirulina, stinging nettle, and an herb used in Ayurvedic medicine called tinospora or guduchi. In all instances, the evidence is either inconsistent or too limited to show whether these products are helpful.

Side Effects and Risks

• People can get infections if they use neti pots or other nasal rinsing devices improperly. The U.S. Food and Drug Administration (FDA) has information on how to rinse your sinuses safely.

  • Most important is the source of water that is used with nasal rinsing devices. According to the FDA, tap water that is not filtered, treated, or processed in specific ways is not safe for use as a nasal rinse. Sterile water is safe; over-the-counter nasal rinsing products that contain sterile saline (salt water) are available.

  • Some tap water contains low levels of organisms, such as bacteria and protozoa, including amoebas, which may be safe to swallow because stomach acid kills them. But these organisms can stay alive in nasal passages and cause potentially serious infections. Improper use of neti pots may have caused two deaths in 2011 in Louisiana from a rare brain infection that the state health department linked to tap water contaminated with an amoeba called Naegleria fowleri.

• Acupuncture is generally considered safe when performed by an experienced practitioner using sterile needles. Improperly performed acupuncture can cause potentially serious side effects.

• Raw butterbur extracts contain pyrrolizidine alkaloids, which can cause liver damage and cancer. Extracts of butterbur that are almost completely free from these alkaloids are available. However, no studies have proven that the long-term use of butterbur products, including the reduced-alkaloid products, is safe.

• In healthy people, probiotics usually have only minor side effects, if any. However, in people with underlying health problems (for example, weakened immune systems), serious complications such as infections have occasionally been reported.

• Be cautious about using herbs or bee products for any purpose. Some herbs, such as chamomile and echinacea, may cause allergic reactions in people who are allergic to related plants. Also, people with pollen allergies may have allergic reactions to bee products, such as bee pollen, honey, royal jelly, and propolis (a hive sealant made by bees from plant resins). Children under 1 year of age should not eat honey.

• Talk to your health care provider about the best way to manage your seasonal allergies, especially if you’re considering or using a dietary supplement. Be aware that some supplements may interact with medications or other supplements or have side effects of their own. Keep in mind that most dietary supplements have not been tested in pregnant women, nursing mothers, or children.

There are data from some randomized controlled trials that suggests that acupuncture may improve some symptoms of allergic rhinitis, as well as quality of life.

What Does the Research Show?

The available data on the efficacy of acupuncture for allergic rhinitis consist of several reviews and meta-analyses, as well as clinical practice guidelines issued in 2015 by the American Academy of Otolaryngology.

• Clinical practice guidelines issued in 2015 by the American Academy of Otolaryngology include the following recommendation: “Clinicians may offer acupuncture, or refer to a clinician who can offer acupuncture, for patients with allergic rhinitis who are interested in nonpharmacologic therapy.”
• A 2015 systematic review and meta-analysis of 13 studies involving a total of 2,365 participants found that compared with a control group, the acupuncture treatment group had a significant reduction in nasal symptom scores, medication scores, and serum IgE, and an increase in quality of life scores.
• A 2015 review concluded that there are high-quality randomized controlled trials that demonstrate efficacy for acupuncture in the treatment of both seasonal and perennial allergic rhinitis; smaller studies show some preliminary benefit of acupuncture when compared with antihistamines, but these had some methodological limitations.

Safety

• Relatively few complications from the use of acupuncture have been reported. Still, complications have resulted from inadequate sterilization of needles and from improper delivery of treatments. A 2015 systematic review and meta-analysis examined the safety and efficacy of acupuncture for allergic rhinitis and concluded that the meta-analysis suggests that acupuncture could be a safe and valid treatment option for patients with allergic rhinitis.

There is some evidence that butterbur extract can decrease the symptoms associated with seasonal allergies.

What Does the Research Show?

The available data on efficacy of butterbur for seasonal allergies consist of only a few rigorous randomized controlled trials.

• Findings from a 2007 systematic review of six randomized controlled trials suggest that butterbur is superior to placebo or similarly effective compared with nonsedative antihistamines for intermittent allergic rhinitis. However, firm conclusions could not be drawn because three of the large trials reviewed received financial support from a manufacturer of butterbur, which represents a conflict of interest.
• A 2003 review of several modalities used to treat ocular allergies found that in one study of 125 participants, butterbur was just as effective as a commonly used oral antihistamine for itchy eyes.

Safety

• Butterbur may cause allergic reactions in people who are sensitive to plants such as ragweed, chrysanthemums, marigolds, and daisies.
• Raw extracts of this herb contain toxic pyrrolizidine alkaloids, which can cause liver damage and cancer. Extracts of butterbur have been prepared that are almost completely free from these alkaloids. However, no long-term studies of butterbur products have been conducted, including the reduced-alkaloid products, so its long-term safety is unknown.

There is no convincing scientific evidence that honey relieves seasonal allergies.

What Does the Research Show?

The available data on efficacy of honey for seasonal allergy symptoms consist of only a few randomized controlled trials.

• A 2011 randomized controlled pilot study of 44 patients with physician-diagnosed birch pollen allergy found that patients who used pre-seasonal birch pollen honey had significantly better control of their symptoms compared to those on conventional allergy medication, and they had marginally better control of their symptoms compared to those using regular honey. However, these results should be regarded as preliminary.

Safety

• Eating honey is generally safe; however, children under 1 year of age should not eat honey due to the potential risk of contracting Clostridium botulinum. People who are allergic to pollen may also be allergic to honey.

There is some limited evidence that suggests that probiotics may improve some symptoms, as well as quality of life, in patients with allergic rhinitis, but overall the data on probiotics and allergic rhinitis is inconsistent and effects may vary from one probiotic formulation to another.

What Does the Research Show?

The available data on efficacy of probiotics for allergic rhinitis consist of several systematic reviews and meta-analyses of small randomized controlled trials with a high degree of heterogeneity.

• A 2015 systematic review of 11 randomized controlled trials concluded that current evidence is not sufficiently strong to verify a preventive role of probiotics in allergic rhinitis, but probiotics may improve the overall quality of life and nasal symptom scores. Because available data are only from a small number of studies with a high degree of heterogeneity, routine use of probiotics for prevention and treatment of allergic rhinitis cannot be recommended.
• A 2015 systematic review and meta-analysis of 23 studies involving a total of 1,919 patients concluded that probiotics may be beneficial in improving symptoms and quality of life in patients with allergic rhinitis; however, current available evidence is limited due to study heterogeneity and variable outcome measures.
• A 2016 review of probiotics for allergy prevention concluded that to date, expert bodies do not generally recommend probiotics for allergy prevention; however, the review notes that World Allergy Organization guidelines suggest considering using probiotics in pregnant women, during breastfeeding and/or for the infant if at high risk of developing allergic disease.
• A 2013 randomized controlled trial of 60 patients with allergic rhinitis examined the effects of probiotic consumption (Lactobacillus casei Shirota) on clinical and immunological parameters of seasonal allergic rhinitis in an out-of-season single nasal allergen challenge. Results of the study showed that daily oral supplementation with Lactobacillus casei Shirota modified some parameters of allergic inflammation at the nasal mucosa but there were no significant changes of clinical symptoms of seasonal allergic rhinitis.

Safety

• In healthy people, probiotics usually have only minor side effects, if any. However, in people with underlying health problems, serious complications such as infections have occasionally been reported.

There is some evidence to suggest that saline nasal irrigation may modestly improve some seasonal allergy symptoms.

What Does the Research Show?

The available data on efficacy of saline nasal irrigation for seasonal allergy symptoms consist of several randomized controlled trials in both adults and children, as well as a systematic review and meta-analysis.

• A 2012 systematic review and meta-analysis of 10 studies found that saline nasal irrigation administered regularly over a period of up to 7 weeks was observed to have a beneficial effect on nasal symptoms, reduction in medicine consumption, acceleration of mucociliary clearance time, and quality of life in adults and children with allergic rhinitis.
• A 2012 review of nasal saline irrigation in the management of sinonasal disease found that nasal saline irrigation appears to demonstrate some modest clinical benefits.

Safety

• Nasal irrigation is generally safe; however, neti pots and other rinsing devices must be used and cleaned properly.
• Most important is the source of water that is used with nasal rinsing devices. According to the U.S. Food and Drug Administration, tap water that is not filtered, treated, or processed in specific ways is not safe for use as a nasal rinse. Some tap water contains low levels of bacteria and protozoa, including amoebas, which can stay alive in nasal passages and cause potentially serious or fatal infections.
• Improper use of neti pots may have caused two deaths in 2011 in Louisiana from a rare brain infection that the state health department linked to tap water contaminated with an amoeba called Naegleria fowleri.

Seasonal allergies, also called hay fever or allergic rhinitis, are triggered each spring, summer, and fall when trees, weeds, and grasses release pollen into the air. When the pollen ends up in your nose and throat, it can bring on sneezing, runny nose, coughing, and itchy eyes and throat. People manage seasonal allergies by taking medication, avoiding exposure to the substances that trigger their allergic reactions, or having a series of “allergy shots” (a form of immunotherapy).

People also try various complementary approaches to manage their allergies. If you are considering any complementary health approach for the relief of seasonal allergy symptoms, here are some things you need to know.

1. Nasal saline irrigation. There is some good evidence that saline nasal irrigation (putting salt water into one nostril and draining it out the other) can be useful for modest improvement of allergy symptoms. Nasal irrigation is generally safe; however, neti pots and other rinsing devices must be used and cleaned properly. According to the U.S. Food and Drug Administration, tap water that is not filtered, treated, or processed in specific ways is not safe for use as a nasal rinse.
2. Butterbur extract. There are hints that the herb butterbur may decrease the symptoms associated with nasal allergies. However, there are concerns about its safety.
3. Honey. Only a few studies have looked at the effects of honey on seasonal allergy symptoms, and there is no convincing scientific evidence that honey provides symptom relief. Eating honey is generally safe; however, children under 1 year of age should not eat honey. People who are allergic to pollen or bee stings may also be allergic to honey.
4. Acupuncture. A 2015 evaluation of 13 studies of acupuncture for allergic rhinitis, involving a total of 2,365 participants, found evidence that this approach may be helpful.
5. Probiotics. There is some evidence that suggests that probiotics may improve some symptoms, as well as quality of life, in people with allergic rhinitis, but because probiotic formulations vary from study to study, it’s difficult to make firm conclusions about its effectiveness.
6. Talk to your health care provider. If you suffer from seasonal allergies and are considering a complementary health approach, talk to your health care provider about the best ways to manage your symptoms. You may find that when the pollen count is high, staying indoors, wearing a mask, or rinsing off when you come inside can help.