IMPORTANT The information provided is of a general nature and should not be used as a substitute for professional advice. If you think you may suffer from an allergic or other disease that requires attention, you should discuss it with your family doctor. The content of the information articles on this website remains the intellectual property of Dr Raymond Mullins and cannot be reproduced without written permission.

What is hay fever?
Strictly speaking, "hay fever" (also known as allergic rhinitis and allergic conjunctivitis) describes the itchy eyes, nose and mouth, sneezing and runny, blocked nose that occurs during spring and summer when grass pollens are blowing around. Since similar problems can be caused by other allergens like house dust mite and animal proteins, "Hay fever" can in fact occur all year around.

There are only a few options for treating hay fever.

-Avoid the cause

-Treatment without medication

-Medication

-Immunotherapy (to "switch off" the allergy)

Avoiding the cause
Identifying (by allergy testing) and avoiding your allergic triggers are essential components of allergy management. These topics are covered in other articles.

Treatment without medication
Steam and salt water sprays can soothe a blocked nose. Some people swear by the effect of Horseradish and Garlic, eucalyptus, menthol or peppermint inhalations or lollies.

Diet and hay fever
Some people find that milk, MSG or alcohol seem to make their nose a lot worse. Despite public common mythology, there is no good evidence that drinking milk makes asthma or hay fever worse or makes us produce more mucus. The temporary sensation of "thick mucus" that some people feel when they drink milk is because proteins in milk stick to proteins in saliva. Unfortunately, strict "elimination diets" are usually disappointing and not very good for children's health.

Treatment with medication
Although drugs do not cure allergies, the medicines available for treatment these days are much more effective with fewer side effects than those available 20 years ago. You just need to know the best way to use them, and to avoid medicines that can cause more problems than they solve, like decongestant ("unblocking") nose sprays. Your doctor can advise you as to the best medicines to use for treating your symptoms.

Pseudoephedrine tablets will unblock and dry the nose. Uncomfortable "stimulant" side effects like tremors, trouble sleeping, anxiety or an increase in blood pressure are common and people with high blood pressure should not take it.

Antihistamine tablets help sneeze, itch and irritating eyes, but are not very good at controlling severe nasal blockage and dribble. The advantage of antihistamines is their flexibility; you can take them when you have problems, and avoid them when you are well. Examples, include Claratyne, Aerius, Telfast, Zyrtec, Xylal, Lorastyne, Fexotabs, Xergic and so on. Combination drugs containing both an antihistamine and pseudoephedrine are also available. Examples include Clarinase and Telfast Decongestant.

Medicated nasal sprays can also help. It is important to avoid the regular use of decongestant sprays. Those available can contain antihistamines (good for sneeze and itch- Azep, Livostin, Rhinolast), ipratropium bromide (good for drippy noses), cromoglycate (to reduce inflammation) or topical steroids (with an even more potent action on inflammation). Examples of nasal steroid sprays include  Beconase, Nasonex, Rhinocort,  Flixonaseor Telnase. Many need to be used regularly and with careful attention to the way in which they are used. Most of these are now across the counter but more potent ones are on prescription - Avamys, and Dymista.

Cortisone injections are best avoided. They only offer relief for a week or two and can't be repeated frequently because of side-effects. It is much safer to use a cortisone spray !

Medicated eyedrops may contain soothing lubricants, antihistamines (eg. Livostin, Naphcon A, Zyrtec, Zatiden or Patanol) or drugs to reduce inflammation (eg. Opticrom, Lomide,) with regular use.

Newer medications such as antileucotriene tablets (Singulair/montelukast) have been found to be useful treatment in some cases.

Choice of medication when pregnancy or breast-feeding
The overriding principle when using medication during pregnancy or breast feeding is that "all drugs are potentially poisons, but some are more poisonous than others". Ideally, all drugs will be avoided where possible, but some patients get miserable symptoms and need something to take. Which medicines are recommended is based on human and animal research, clinical experience and theoretical concerns. Your doctor is in the best position to give you appropriate advice if this is an issue.

Complications of hay fever
Severe hay fever can also:

-make asthma more difficult to control

-make people more prone to sinus infections (sinusitis)

-impair learning and performance in children

-result in bad breath, a husky voice and sore throats

-make people tired and run down due to poor quality sleep

-worsen snoring and the tendency to sleep apnoea in adults

-cause abnormal development of the mouth and teeth from chronic mouth breathing. The result is often in a high arched palate crowded teeth and high dental bills!

-Result in eye infections because people rub itchy eyes. Some will even become allergic to eyedrops or the preservative in the bottle.

Immunotherapy (desensitization) to switch off the allergy
The medicines that we use only reduce the severity of symptoms. Treatment for hay fever can be likened to weed-killer. When you stop the treatment, the symptoms may return unless the cause is removed. Another option is allergen immunotherapy whereby one tries to switch off the allergic reaction by repeatedly by either injecting small doses of allergen extracts, or allergen taken by mouth (sublingual oral immunotherapy - liquids or tablets). This topic is discussed in greater detail in another article.

References

Mannan S. Allergen immunotherapy. Immunotherapy. 2017 Nov;9(15):1199-1200. doi: 10.2217/imt-2017-0157.

Dhami S et al. Allergen immunotherapy for allergic asthma: A systematic review and meta-analysis. Allergy. 2017 Dec;72(12):1825-1848. doi:10.1111/all.13208.

Roberts G, et al. EAACI Guidelines on Allergen Immunotherapy: Allergic rhinoconjunctivitis. Allergy. 2018

Apr;73(4):765-798. doi: 10.1111/all.13317.

Rael E. Allergen Immunotherapy. Prim Care. 2016 Sep;43(3):487-94. doi: 10.1016/j.pop.2016.04.004. PMID: 27545737.

Pfaar O, Lou H, Zhang Y, Klimek L, Zhang L. Recent developments and highlights in allergen immunotherapy. Allergy. 2018 Dec;73(12):2274-2289. doi: 10.1111/all.13652.

Passalacqua G, Bagnasco D, Ferrando M, Heffler E, Puggioni F, Canonica GW. Current insights in allergen immunotherapy. Ann Allergy Asthma Immunol. 2018 Feb;120(2):152-154. doi: 10.1016/j.anai.2017.11.001.

Last reviewed 11 June 2020