Hay fever is nothing to sneeze at!

Hay fever sufferers may have noticed that 2020 has been a particularly bad year for symptoms. This is certainly the first time that I have actually ‘suffered’. In previous years I have had mild symptoms or none at all.

The worsening symptoms are thought to have been caused by the driest May on record. Lockdown has also resulted in car pollution levels becoming very low. Both rain and diesel pollution cause pollen to be pulled down out of the atmosphere. The absence of both has resulted in very high pollen levels.

Hay fever can present with sneezing, a runny nose, itchy eyes and nose, and watery eyes. Some people get severe symptoms such as wheezing and difficulty in breathing especially if they have a history of asthma. That is because hay fever and asthma are strongly related. Hay fever can, in fact, trigger wheezing in the absence of any history of asthma and I have seen many patients with this pattern.

What is the treatment?

Hay fever treatment is generally straightforward. Many people have learned to manage the problem themselves with over-the-counter medication.

Medication falls into 3 main categories:

Antihistamines

Antihistamines are available as syrups for children and tablets for adults. Their advantage is that they can help with both eye and nose symptoms and are easy to take. You can divide them into 2 types; short-acting and long-acting antihistamines.

Short-acting antihistamines typically last 6-8 hours and have to be taken 2-3 times per day to get symptom-relief to last all day. These are the older type of antihistamines and can make you feel drowsy so you should be careful if you are driving or operating machinery. However, the drowsy effect can be helpful at night as it can help you get off to sleep. Examples include:

Chlorphenamine (Piriton): Syrup. Tablets.

Diphenhydramine (Benadryl): Syrup. Tablets.

Long-acting antihistamines typically last the whole day and have the advantage of once daily dosing. In general, they are non-sedating and can even be taken by pilots. Examples include:

Loratadine (Clarityn)

Cetirizine (Piriteze)

Fexofenadine: this is prescription-only

Nasal sprays

Many people do not like the effect of taking syrups and tablets because they have other effects on the body such as drowsiness and lethargy. Steroid nasal sprays offer the advantage of having an effect on the nose without the side-effects on the rest of the body. They can help nasal symptoms such as itching, running, sneezing and blockage. With regular use they also help to control eye symptoms.

Most nasal sprays for hay fever can be bought over-the-counter. These include:

Beconase nasal spray: This needs to be used twice a day.

Pirinase nasal spray: This has the advantage of only needing to be used once daily.

One important thing to note is that a nasal spray is a device and should be used correctly to get the best results. Check out the video below:

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Eye drops

Hay fever eye drops are a good option if you only have eye symptoms such as itching and watering. They can also be used if antihistamines or nasal sprays do not give sufficient relief of eye symptoms.

Sodium cromoglycate eye drops: These are the only eye drops available without a prescription.

Sinus rinse

A sinus rinse is not a medication as such. It is a way of treating your nose using a salt solution. Numerous studies have shown that it is effective for reducing symptoms of colds, nasal allergy and sinus symptoms.

A sinus rinse can be used alone or in combination with any of the above treatments that are mentioned. Many of my patients prefer to use it because they can avoid taking medication and they like the fact that it is natural.

It is not known exactly how a sinus rinse works but people think that flushing the nose in this way clears away mucus, pollens and bacteria.

I have found that the easiest to use is Neilmed sinus rinse. It is available for adults and children.

A sinus rinse can take a little getting used to because water is squirted up one nostril and comes down the other. You then change sides. Watch the video below for instructions.

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A sinus rinse can be a great natural way to manage nasal symptoms. Once you have the bottle, there is no need to keep buying the sachets as you can make up the mixture yourself using salt and bicarbonate of soda (baking soda) that you can buy from the supermarket. The mixture should contain twice as much salt as baking powder (2:1 mixture). Just make sure that you use boiled water that has been cooled. Click here for a guide from Guy’s and St Thomas’ Hospital.

Some people find it difficult to tolerate a high volume sinus rinse. If so, they might find a saline nasal spray much easier to use. The most popular one is Sterimar.

Combining medications

You may only need eye drops if you have eye symptoms, or a nasal spray if you have nasal symptoms. Antihistamines will treat both eye and nose symptoms and are convenient. Alternatively, you can use a combination of eye drops and a nasal spray.

In severe cases, you can use all three: an antihistamine, a nasal spray and eye drops together although this is rarely needed. Always seek medical advice if you are unsure especially if you have other medical conditions or are taking other medication. In particular, do not use two different antihistamines together unless you have been advised to by a doctor.

Wheezing or difficulty breathing

A minority of hay fever sufferers start to get wheezing or difficulty in breathing as well as the eye or nose symptoms. For some people, wheezing may be the only symptom.

In this case, it is important to seek medical attention. Using an asthma inhaler is often all that is required to relieve the wheezing. This can be used whenever needed and stopped when the hay fever season is over.

Summary

Hay fever can be a troublesome problem and interfere with your day to day activities. Most symptoms can be resolved using one, or a combination of, over-the-counter medications. There are also natural methods, such as using a sinus rinse, that can help. If you are wheezing or short of breath, then always seek medical advice.