What are the symptoms of hay fever?

Hay fever usually affects the eyes, nose, and throat. The eyes can be itchy and red. The nose feels itchy and the lining tends to swell so blocking the nose and leading to sneezing, watering, and postnasal drip. The throat can feel itchy. Occasionally you may also suffer with headache, earache, tiredness, or sinus pains. Rarely, with a very high pollen count, asthmatic wheeze, breathlessness, and cough can be triggered.

Why do I get hay fever?

Hay fever is a result of pollen coming into contact with the eyes, nose, and upper airways. In some people with a very sensitive immune system this triggers an allergy reaction, leading to irritation in the eyes, nose, and throat. Different pollens are released at slightly different times of the year so some people's symptoms start earlier than others - for instance trees can start to release pollen from as early as March. Grass pollens are released between May and July, but some pollens can still be released into September.

Does hay cause hay fever?

Hay fever is due to a sensitivity in the body to many different pollens including from the grasses which are used to make hay.

Why do I have hay fever symptoms all year?

Your symptoms are unlikely to be caused by true pollen allergy. However, particularly nose symptoms can be caused by a similar process due to sensitivity to house dust or house dust mites. This is often called perennial allergic rhinitis and it can respond well to nasal steroid sprays.

Many people also get eye symptoms similar to hay fever, but triggered by an allergic reaction to cats and dogs.

What treatments can I use for my hay fever?

There are several possibilities for treatment, and all should improve the symptoms. Antihistamine tablets, nose sprays, and eye drops are often used.

What is the best hay fever treatment?

Everyone is individual and it depends on how bad your symptoms are. You should use the minimum amount of medication to give adequate control of the symptoms. This may vary during the course of a hay fever season.

How do I choose which hay fever treatment to try first?

This depends on what is your main symptom. Dr Fox recommends starting with 'topical' - i.e. eye drops and nose sprays - if you have only mild symptoms in one of these areas. If your symptoms are more severe and affect your eyes, nose, and throat, then go straight to an antihistamine tablet. You can then add in eye drops or a nose spray if necessary.

How long can I use hay fever treatment for?

It is recommended to start medication before you expect your symptoms to begin and continue until the end of the pollen season. They should generally be stopped after 12 weeks. Several of the treatments take a few days to stabilise the body's allergic reaction and to settle symptoms. If your symptoms have already begun it is not too late to start and the medication will still help.

How do I use a nose spray?

There is an explanation in the patient leaflet supplied with each spray. There is a helpful How to use nasal spray video on the Asthma UK website.

Will I always have hay fever?

Most people with hay fever have a genetic susceptibility and it can also be linked with asthma and eczema. Because of this, the tendency to hay fever will always be there. There are desensitisation processes using immunotherapy which involve regular exposure to controlled doses of the specific pollen either by injection or under the tongue. Treatment needs to be continued for at least 3 years. This is a very specialist area and there can be a small risk of triggering a severe allergic reaction.

What about testing for allergy?

It is possible to test for the particular pollens which affect you. These tests should be arranged by a specialist. Skin prick tests or blood IgE tests can be used. Skin tests are better, but testing will only be useful if it seems that there is a small range of specific pollens that you react to. It is important not to take antihistamines or steroids or tricyclic antidepressant medication within a few days of having skin tests as they will affect the results.

What other things can I try to help my hay fever?

It is a good idea to try and reduce your exposure to pollen.

• Stay inside as much as possible with windows and doors closed.
• Don't have vases of fresh flowers in your house.
• Consider using Vaseline around the nostrils which may trap pollen and reduce nasal pollen exposure.
• Change clothes and shower to wash off any pollen on returning home after being outdoors.
• Keep an eye on the Met office pollen forecasts, or use a pollen forecast App, and stay indoors if it's due to be high. Sunshine and still weather increases the pollen count.
• Pets can bring in pollen, so keep them out of the house as much as possible during the pollen season, and consider keeping your dog walks away from grassy and freshly mowed places.
• Avoid cutting grass yourself and keep away from freshly cut grass.
• Sunglasses which have a wraparound style or a side shield can reduce pollen access to eyes.
• Vacuum regularly using a vacuum with a high filter (HEPA filter) to reduce pollen and house dust at home.
• Always keep home surfaces clear of dust using a damp-dusting technique which picks up more pollen and dust particles.
• Cigarette smoke can make symptoms worse, so keep away from cigarettes and smoke.
• Clothes dried outdoors could bring pollen in so resist the temptation to hang your clothes in the sunshine to dry.

What is a HEPA filter?

A 'HEPA filter' is a super efficient air filter. HEPA stands for 'High-Efficiency Particulate Air' filter. HEPA filters are used in many situations ranging from hospital operating theatres to vacuum cleaners in our homes. They filter the air and remove very small particles, which can include bacteria and viruses. In a home vacuum cleaner, the HEPA filter will trap small particles including pollen, and house dust mites. Removing these small particles helps to reduce allergy triggers and symptoms.

What is an antihistamine?

Antihistamines are a class of drug which blocks the histamine part of the immune system. Histamine is stored in mast cells as part of our body's immune (defence) system. When the mast cells encounter an alien molecule, such as in pollen, they release histamine to support the defence. The histamine triggers a variety of effects to expel the threatening molecule, including sneezing, itching, swelling, watering eyes. In allergies, the immune system is over-reactive to certain molecules and causes an exaggerated response which isn't needed. Antihistamines block this response, so prevent the annoying unnecessary symptoms.

The older antihistamines had a significant drowsy side effect, which limited their usefulness for conditions like hay fever. This has been reduced greatly and most modern antihistamines are unlikely to make you sleepy. However, if you are affected, you should not drive, cycle, or operate machinery.

How does sodium cromoglicate work?

Sodium cromoglicate is a mast cell stabiliser, which prevents mast cells releasing histamine when they encounter an alien molecule such as pollen.

See also What is an antihistamine?

I am pregnant - what can I do for my hay fever?

As with all medicines in pregnancy, it is best to avoid using eye drops, nose sprays, and tablets to treat your hay fever. Do NOT use nasal decongestant sprays (such as xylometazoline, ephedrine, and pseudoephedrine) as they can reduce the blood flowing through the placenta to your baby. See above about reducing pollen exposure: What other things can I try?

Sometimes symptoms are so bad that a doctor may choose to prescribe for you, and many of the antihistamines do appear to be safe. It is important to check with a doctor, before taking any medicine when pregnant. Dr Fox does not prescribe in pregnancy. More information at BUMPS best use of medicines in pregnancy - Treatment of allergic rhinitis.

I am breastfeeding - what can I do for hay fever?

The best option is sodium cromoglicate which is unlikely to get into breast milk and unlikely to cause any effects on the baby. There is little information about how much of the other nose sprays and eye drops gets into breast milk, so it is best to avoid using them. It is believed that small amounts of the antihistamines will all pass into breast milk. It is therefore recommended not to take antihistamines, unless specifically advised to do so by your own doctor. See above about reducing pollen exposure: What other things can I try?

Are steroid nose sprays safe to use?

Steroids are some of the best drugs available to treat inflammation which is a big part of the hay fever response in the nose. When doctors first used steroids to treat inflammatory conditions, they were used at high doses, often by mouth. Doctors soon learned that this could lead to a lot of unwanted side effects including mimicking a serious disease, Cushing's syndrome, where the body makes too much of its own steroids. So they developed ways of delivering the steroid to exactly where it was needed and at doses just enough to treat symptoms effectively, without those nasty side effects. A steroid nose spray is used to target a small amount of steroid at the nasal passages to reduce the inflammation and swelling. The amount of steroid absorbed into the body from the nose is low. However, it is still possible if using more than the recommended dose or for very prolonged periods, to get too much steroid into your system. The short answer is if used according to the instructions and for the shortest time needed, then steroid nose sprays should be safe.

What about antihistamines and dementia?

A research study published in 2015 linked long term use of the older, first generation, sedating antihistamines with the development of dementia. The study had a lot of flaws but was still widely reported in the media. Most people prefer to use the newer non sedating antihistamines and Dr Fox only supplies these newer types.

I take other medicines - can I use hay fever medication?

None of the hay fever medications supplied by Dr Fox have any clinically significant interactions with other medicines. So, you should be fine to use hay fever medication. If in doubt check with your regular doctor.

Do hay fever tablets contain lactose?

The nose sprays and eye drops supplied by Dr Fox are free from lactose. Telfast is lactose free, but Cetirizine and Loratadine do both contain lactose.

Do I need to worry about side effects?

As with all medicines some people can develop side effects to hay fever treatments.

With the antihistamine tablets, a few people will have some drowsiness despite the newer antihistamines being much less likely to cause this. Other side effects may include headache and dry mouth.

With the nose sprays, very little of the active ingredients are absorbed into the body and as a result there should be very few side effects. You may develop slight soreness and dry skin inside the nose and occasionally a bitter taste.

With the eye drops, the active agents are unlikely to be absorbed into the body. Occasionally your vision may seem blurred for a few minutes after using the eye drops. Sometimes a person develops a sensitivity to the drops which is usually caused by the preservative agent, benzalkonium chloride, leading to some soreness and irritation in and around the eye.

There are more details in the manufacturers' patient information leaflets supplied in medicine packs, which should be read before using.

Can I take alcohol with my antihistamine?

The antihistamines prescribed by Dr Fox are not expected to have any significant effect on your alcohol tolerance.

What if the treatments don't work?

Some people suffer such severe symptoms of hay fever that the usual treatments don't control it. In rare circumstances, or for a special event such as your wedding, a doctor may consider prescribing a short course of steroid tablets to get it under control. Steroid tablets used frequently can have significant side effects so should only be used as a last resort. Another rarely used treatment is a steroid injection (see below). Please see your own doctor if your hay fever is this severe.

What about the hay fever injection?

Many hay fever sufferers used to have an annual long-acting hay fever steroid injection, Kenalog (triamcinolone). It is a slow release steroid injected into the buttock muscle. This can be very effective at damping down the overactive immune response causing hay fever. However, it is no longer recommended by NICE as there are health risks from lowering your immune responses and there can also be serious long term side effects. Some private clinics do however still offer this service after a careful assessment of personal risks.

Can I drive and use hay fever medication?

It is safe to drive if using eye drops or nose sprays. Despite the new antihistamines (including those prescribed by Dr Fox) being less sedating than in the past, some people do experience some mild drowsiness. If affected you should not drive, cycle, or operate machinery.

Hay fever treatment