Hay fever

Medical information

Written and reviewed by a team of doctors. Dr Fox is regulated by the CQC & GPhC.

Symptoms of hay fever

Symptoms of hay fever develop if the body is sensitive to pollen or dust. Symptoms usually affect:

• Eyes: itchy, sore, red, watering.
• Nose: itchy, sneezing, congestion, running.
• Throat: itchy.

Some people may also get headache, earache, tiredness, sinus pains, post nasal drip, and less often asthmatic wheeze, breathlessness, and cough.

General information about hay fever at bottom of page.

Selecting hay fever treatment

Antihistamine tablets taken on their own or with eye drops and/or nasal sprays improve the symptoms of hay fever.

If you have just nasal or eye symptoms you could try nasal sprays or eye drops first, and then add antihistamine tablets as well if needed.

Response to hay fever treatments varies from person to person and sometimes from season to season. If your existing treatment isn't very effective or stops working, it is worth trying different hay fever treatments.

For detailed information about each treatment - including cautions, how to take, and potential side effects - please read the manufacturer's patient information leaflets (links below).

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Antihistamine tablets

Dr Fox provides a choice of cetirizine, loratadine, and fexofenadine (Telfast) antihistamine tablets.

How antihistamine tablets work

Hayfever symptoms are caused by histamine release in reaction to pollens. Antihistamine tablets work by blocking the inflammatory actions of histamine. Antihistamine tablets start to work within 30 minutes of being taken. The antihistamine tablets Dr Fox supplies are all non-sedative.

Trying different tablets

Different people often respond better to one antihistamine than another. It is therefore worth trying a different tablet if one doesn't seem to help or has stopped working.

Symptom control

In addition to preventing the sneezing, runny nose, and the sore eyes of hay fever, antihistamine tablets can also be used for allergies to house dust, pets and to prevent and to treat the allergic skin reaction of hives (urticaria).

Possible side effects of antihistamine tablets

Even with non-sedative antihistamine tablets some people occasionally experience drowsiness as a side effect. If you feel sleepy with the tablets, then you should not drive, cycle, or operate machinery. Other common (1 in 100 people) reported side effects, which are not usually troublesome, can include headache, dry mouth, dizziness, nausea, diarrhoea, and poor sleep. For more details see the patient information leaflets (links below).

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Nasal sprays

Steroid nasal sprays: Beconase & Avamys

Beconase (beclometasone) aqueous and Avamys (fluticasone) contain steroids. These steroid sprays control hay fever symptoms by reducing inflammation of the membranes inside the nose. They should not be used together or at the same time as Dymista or Ryaltris nasal sprays, which also contain a steroid.

Steroid nose sprays used regularly morning and night are effective in relieving the nasal symptoms of hay fever. The occasional spray now and then will not work and they don't give immediate symptom relief. Symptoms are only controlled if a steroid nose spray is used on a regular basis throughout the hay fever season. It takes at least 3-4 days to get the best effect. They should not be used continuously for more than 12 weeks.

Antihistamine nasal sprays: Rhinolast and Azelair

Rhinolast and Azelair contain the fast-acting antihistamine azelastine. Azelastine controls hay fever by stopping histamine from being released into the membranes inside the nose. Rhinolast and Azelair should NOT be used at the same time as each other, or with Dymista (azelastine & fluticasone) nasal spray, as they all contain azelastine.

Rhinolast and Azelair work within 15 minutes of the spray being used. Symptom relief lasts about 12 hours. If hay fever is severe or has been present for many days they will not immediately settle down all the inflammation that has built up. Used regularly morning and night, Rhinolast will provide continuous antihistamine action. Azelair is initially used once daily but can be increased to twice daily if necessary.

Steroid plus antihistamine nasal spray: Dymista and Ryaltris

Dymista and Ryaltris combine two medications in one treatment. They therefore have a dual action. Dymista contains a fast-acting antihistamine called azelastine and a steroid called fluticasone. Ryaltris contains the antihistamine olopatadine and the steroid mometasone.

The antihistamines usually starts to work within 15-30 minutes, giving quick symptom relief. For ongoing and improving symptom relief, Dymista and Ryaltris should be continued twice daily. It takes a few days of regular use for the steroid part of the spray to reduce inflammation.

The antihistamine effect of Dymista and Ryaltris wears off over 12-24 hours and the steroid effects usually wear off over a few days after stopping the spray.

Dymista and Ryaltris should NOT be used together, or with other nasal sprays, for allergic rhinitis. These may contain the same or similar ingredients and you may get a double dose.

Possible side effects of nasal sprays

Very little of the active ingredients of nasal sprays are absorbed into the body and as a result systemic side effects are minimal. There may be soreness and dry skin inside the nose, mild nosebleed, and possibly taste disturbance. If using a steroid nasal spray regularly there is a small risk of developing thrush within the nose. If you think you may have thrush, stop the nasal spray and consult your regular doctor.

Manufacturers recommend avoiding use of these sprays in pregnancy and whilst breastfeeding and also where there is known allergy or sensitivity to the ingredients.

Beconase, Avamys, Dymista, and Ryaltris contain steroids which on rare occasions could damage the eye. Any vision problems or disturbances should be checked by an optician.

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Eye drops

How eye drops work

Dr Fox supplies two different types of eye drop: Sodium cromoglicate which is used 4 times a day to stop histamine release, and Optilast (azelastine) a fast-acting antihistamine which blocks the inflammation caused by histamine and also reduces histamine release.

One type of eye drop may work better for you than another, so it can be useful to try different drops. It is advisable to begin with using only one type of eye drop at a time but in severe cases both sodium cromoglicate and Optilast can safely be used together.

Using eye drops

Eye drops are effective if used before dust and pollen exposure, or for control of symptoms once they have started. Sodium cromoglicate drops take a few days of regular use to be effective. Optilast will give rapid relief when used, but can also be used regularly to prevent symptoms.

Possible side effects of eye drops

Very little of the active agents are absorbed into the body. Systemic side effects are unlikely. There may be short lived blurring of vision when drops are applied. Sensitivity reactions can lead to soreness and irritation in and around the eye, but this is unusual. Sometimes sensitivity is to the preservative benzalkonium chloride and Dr Fox can supply preservative-free sodium cromoglycate eye drops (Catacrom).

Eye drops for hay fever should not be used whilst wearing contact lenses. Wait at least 15 minutes after eye drop application before inserting contact lenses.

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For further details about each product see the links below to manufacturer's product leaflets.

Buy treatment

Dr Fox supplies medication for hay fever on prescription – you are required to answer a short medical questionnaire before your order can be completed.

Product leaflets

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Hay fever - general information

How a hay fever attack happens

Hay fever symptoms arise if the body is sensitive to pollen or dust. This sensitivity results in the release of histamine which in turn causes inflammation. The runny nose, sneezing, and sore eyes of hay fever are a result of this. The histamine comes from cells that normally fight infection. In hay fever these cells become abnormally sensitised to pollen, and so they release histamine and cause symptoms, when pollen levels rise.

Hay fever is usually treated with medication which prevents histamine release or prevents the inflammation caused by histamine. Other ways to prevent hay fever include avoiding pollen and dust, and in some cases, undergoing treatments aimed at desensitising the body.

Preventing hay fever

It is difficult to avoid pollen but it may be possible to reduce exposure.

• Use vaseline around your nostrils. This can trap pollen and stop it getting into your nose.
• Avoid grass cutting and places where pollen counts are high.
• Vacuum regularly, preferably using a vacuum cleaner with a HEPA filter.
• Keep pets out of the house during the hay fever season.
• Stay indoors when pollen counts are high. You can check the pollen forecast or there are many helpful apps available.
• Keep windows and doors closed.
• Wraparound sunglasses reduce pollen contacting the eyes.
• Shower after going outside.

Further information about hay fever

• NHS - Hay fever
• Allergy UK - Hay Fever (Allergic Rhinitis)

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