The allergic march and hay fever: what experts say, how often both appear together, and what you keep records of

The allergic march is the idea that one allergy moves a floor deeper, into the lungs. From an allergic nose, asthma can develop after some years. Allergy UK and the ACAAI both describe a link between the two, but it does not have to happen, and asthma can appear without hay fever. If you have both, a record with two separate courses helps at the appointment. In Sam the asthma diary and the hay fever diary each keep their own report, and sleep and respiratory rate from Apple Health sit next to your entries. How you keep both programs in Sam is covered below.

This text sorts out what the experts really say about the link between the two conditions. Then it covers your record: what you note for which condition, and what you take to which appointment.

What the allergic march really means

The ACAAI describes an "allergic march" or "atopic march". The idea is that allergic conditions often appear one after another, usually starting with eczema in early childhood and later moving toward food allergies, hay fever and asthma. When several conditions appear together, the ACAAI notes that people often have more severe disease.

Here is the honest part. The march is a pattern seen in many people, not a law for you. Many people have hay fever and never develop asthma. The ACAAI and Allergy UK describe a higher risk and a link between the two, not that one always follows the other. What happens in your own course is for your doctor to assess, and a diary shows what happened on which day, not what will happen next.

Does hay fever cause asthma?

The experts are careful with the word "cause". Allergy UK says people with allergic rhinitis are at a higher risk of developing asthma, and that the inflammation in the nasal passages can extend to the lower airways, potentially triggering or worsening asthma symptoms. A 2026 Allergy UK pollen-season article adds that unmanaged hay fever symptoms can give rise to the development of asthma or cause asthma to worsen.

Asthma and Lung UK puts the practical point simply: hay fever can make your asthma or lung condition symptoms worse. The ACAAI lists both conditions among those driven by type 2 inflammation, which is one reason they can appear together.

So the link is real, and it is about risk and about the two conditions strengthening each other, not about a fixed outcome. New or stronger airway symptoms, such as a wheeze, a tight chest or breathlessness during pollen season, are worth raising with your doctor. For what a diagnosis of asthma means, see asthma diagnosis: what now.

How often do both appear together?

The numbers vary by study and population. A 2012 review in Therapeutic Advances in Respiratory Disease reports that asthma affects under 2% of people without rhinitis and 10% to 40% of people with rhinitis, and says reported rates differ with survey methods and definitions. A 2019 meta-analysis of studies from China found asthma in about 10% of people with allergic rhinitis (10.17%); these are data from China, not from the UK or the US. Asthma and Lung UK says hay fever can make asthma symptoms worse, and that treating hay fever makes an asthma attack less likely to be triggered.

These figures describe groups, not you. No diary can tell a single person what will happen. If you notice more attacks when the pollen flies, that is a useful observation to bring along. Our guide to hay fever symptoms and the season shows how to capture the season.

Two conditions, two records

Here it is only about writing things down, on paper or in Sam. What you take, how you take it and what you do day to day are for your doctor.

For the asthma:

• Reliever: which days, and how many puffs.
• Nights when symptoms woke you.
• Attacks: date, how strong, whether the reliever helped.
• Days you had to step back from activities.
• Your guess at what came before: cold air, an infection, smoke, stress, pollen. That is your note, not proof.

For the hay fever:

• Every day, including the good ones: good, medium or poor. Calm days are your comparison.
• Nose and eyes: blocked, runny, sneezing, itching, watery eyes.
• Sleep and daily life: did it limit your nights or your days?
• What you took, including on good days. Otherwise a day with a tablet looks like a day without.
• Wheeze, chest tightness or breathlessness.

The last point belongs to both conditions. Write it in the hay fever record on the day it happens, and mention it at both practices. A sudden, severe breathlessness is an emergency, for your local emergency number (112 in the EU, 999 in the UK, 911 in the US). You can log it afterwards. For a calmer look at the season, see living with allergic rhinitis through pollen season.

Two appointments, two reports

The practices focus on different things. The asthma team wants to know how often you used the reliever, how many nights were disturbed and whether there were attacks. The allergy side asks about symptom days, sleep, medicines and when it started.

An example with invented numbers, the same four spring weeks, two answers:

• To the asthma team: "Reliever on 5 of 28 days, 1 attack, woken once at night."
• To the allergy team: "Symptoms on 17 of 28 days, poor on 4 of those, poor sleep on 6 nights."

You do not have to remember any of this. You read it out. Take both courses to each appointment and put the fitting one on top. Whether your asthma is under control is for your doctor, but our guide on what 'not controlled' means can help you prepare.

Start before the pollen season

In many places tree pollen starts early in the year, so a record that begins with your first symptoms has no calm days to compare against. Start before the season, and a good day appears in the course from the beginning.

Keep the same fields all year. If you invent new fields in May, you cannot compare May with March. Two or three entries a day beat ten that you give up on after a week. In Sam you set up a program before the season, so the calm days are already in the course. For the setup on Apple Watch and Sam, see our guide to the allergy diary and asthma diary.

Keep your two courses in Sam and take the fitting report to the appointment

You go to the appointment with the course the practice wants to see, instead of pulling numbers together from two paper sheets.

• Attacks, reliever use and nights you woke go into the asthma program, and nose, eyes and sleep into the hay fever program. Instead of paper, each program has its own dated diary.
• Sleep and respiratory rate come from Apple Health, and pollen and air quality are shown when you share your approximate location. You enter only what you know yourself.
• Each program makes its own doctor report as a PDF. Take the asthma report to the asthma team and the hay fever report to the allergy team.

There is no combined report, and when you set up a program you confirm that your doctor has diagnosed the condition.

Try Sam for free

Sam is a wellness companion, not a medical device. The app does not diagnose, treat, cure or prevent any condition or health state. Always consult qualified professionals for medical decisions.

Related reading

• Hay fever symptoms and the season: a diary
• Living with allergic rhinitis through pollen season
• Asthma diagnosis: what now
• Symptoms in Sam and the doctor report as PDF

Sources

Updated: October 2026

• Allergy UK: Hay fever and allergic rhinitis
• Allergy UK: Hay fever help as the 2026 pollen season lands
• Ozdoganoglu T, Songu M: The burden of allergic rhinitis and asthma, Therapeutic Advances in Respiratory Disease 2012;6(1):11-23
• Shen Y et al.: Prevalence of allergic rhinitis comorbidity with asthma and asthma with allergic rhinitis in China: a meta-analysis, Asian Pacific Journal of Allergy and Immunology 2019;37(4):220-225
• American College of Allergy, Asthma and Immunology (ACAAI): Understanding the Type 2 Inflammation Connection
• Asthma + Lung UK: Hay fever (seasonal allergic rhinitis) (last reviewed 3 March 2025)