Are all hay fever treatments the same?

Thankfully there are plenty of treatments available to ease hay fever symptoms, but are all treatments for hay fever the same? And how can you pick the right treatment for your allergies and symptoms?

Dr Deborah Lee of Dr Fox Online Pharmacy explains the differences between hay fever medications, and how to pick the right one for you.

Up the ante

Hay fever is an allergy to pollen. When you breathe in pollen particles they get trapped in your nasal passage and airways and are recognised by the body as a foreign substance.

"This sets off the cascade of inflammation, in just the same way as it does if your body meets any other foreign organisms - such as influenza, or respiratory viruses, for example," Dr Lee explains.

"Histamine is one of many molecules your body releases when it mounts a local inflammatory reaction. Histamine is a cell-signalling molecule that causes small blood vessels to dilate, which increases blood flow to the area.

"Blood vessels also become leaky, to facilitate white blood cells quickly reaching the site. In hay fever, histamine is the major cause of itching and irritation, as well as runny eyes and a runny nose."

There are three main types of hay fever treatment, Dr Lee says, all working in different ways to tackle the telltale symptoms. They include:

• Antihistamines - which block the release of histamine.

• Corticosteroids - powerful anti-inflammatories.

• Nasal decongestants - which reduce the swelling of blood vessels in the nose.

Pick of the bunch

So, how can you pick the right treatment for you? That depends entirely on your symptoms.

"When choosing a hay fever treatment, it's important to choose products that are most likely to benefit your specific symptoms," Dr Lee says. "However, as the central cause of hay fever is due to histamine release, most hay fever sufferers would be offered an antihistamine tablet to take by mouth."

Let's take a closer look at each medication and how they work.

Antihistamines

"Antihistamines generally benefit all hay fever symptoms, apart from nasal blockage. However, for best effect they need to be taken before symptoms develop," Dr Lee explains.

"You may choose to take them as and when. For example, if you know the pollen count is forecast to be high that day, you take the tablet before you go outside. However, most hay fever sufferers will take an antihistamine every day during the hay fever season to try to keep on top of their symptoms."

Dr Lee suggests looking for antihistamines that include acrivastine, bilastine, cetirizine, desloratadine, fexofenadine, loratadine, mizolastine or rupatadine.

If you are pregnant or breastfeeding, you will not be able to take antihistamines.

Corticosteroids

If your symptoms aren't controlled by an oral antihistamine, you may benefit from a steroid nasal spray.

"These products are often better than antihistamines if local symptoms are a problem, but they need to be started preferably before the hay fever season begins and used regularly," Dr Lee adds.

"Occasionally, if your symptoms are very severe, your GP may prescribe a short course of oral steroids in order to give you symptomatic relief.

"A combination antihistamine and steroid nasal spray can be very effective." Dymista is an example of this.

Some nasal sprays should not be used for more than 2-4 weeks, including those containing betamethasone and fluticasone.

Nasal decongestants

As the name suggests, nasal decongestants are medicines you inhale up into your nose.

"These cause the blood vessels lining your nose to shrink, relieving swollen nasal passageways. They should only be used for up to seven days at a time as with longer-term use you can develop a rebound, persistent nasal discharge," Dr Lee says.

Eye drops can also be used to ease runny, itchy eyes.

"A specific type of eye drops, called sodium cromoglycate, can be very effective for hay fever. These prevent the release of histamine and must be used regularly," Dr Lee adds.

"Otherwise, antihistamine eye drops are also very effective. These contain azelastine and olopatadine."

Plagued by pollen

If you find your hay fever treatment isn't working, there could be several reasons why.

Firstly, it's important to make sure you start using treatments before your hay fever actually kicks in, Dr Lee says.

"For best results start treatment at least two weeks before the pollen count starts to rise. The hay fever season usually runs from March to September, but you may do best to start treatment in mid-February," she adds. However, it's worth pointing out that many people's hay fever is only triggered by grass pollen and levels of this are highest from May to July.

"This may seem an alien concept, but the idea is to prime your body, so it is ready for action when the onslaught comes on."

You also need to make sure you are taking your treatment consistently - taking a 'once-a-day' antihistamine every couple of days isn't going to help your body keep your histamine levels under control.

Sometimes though, things are just out of your control. A bad pollen year can mean that while hay fever treatments have some impact, they're just not as effective.

"Some years the pollen count is particularly high. At present the pollen count is high, and many hay fever sufferers are having an especially bad time," Dr Lee says. "Tree pollen is high in the spring, grass pollen is high in the summer, and weed pollen is high in the autumn."

If you're struggling with your symptoms and your treatments aren't working as effectively, there are several other steps you can take to help ease hay fever.

• Wear a mask that fits snugly over your nose and mouth when you go outside - luckily, we're already doing that because of COVID.

• Wear wraparound sunglasses to keep pollen out of your eyes.

• Put a rim of Vaseline just inside your nose to trap pollen when you breathe in.

• Stay indoors with doors and windows closed as much as you can.

• Vacuum and dust at home regularly to get rid of pollen and other allergens.

• Buy a pollen filter for the air vents in your car.

• Change your clothes when you come in from outside and wash them, shower, and wash your face and hair.

• If you wear contact lenses, consider giving your eyes a break and wearing glasses for the time being to avoid eye irritation.

Snuff out the sniffles

If you're not sure which treatment is right for you then you can speak to your local pharmacist about your symptoms. They will be able to advise on, and supply, a range of anti-hay fever options that are right for you. Some medications otherwise only available on prescription, such as Dymista, are available from pharmacists through Patient Access.

But if your symptoms are still not going away then you may need to consult your GP.

"You may need to consult the doctor if your hay fever isn't responding to treatment. This might be because the diagnosis is wrong, or because there are hay fever complications," Dr Lee says.

"A differential diagnosis for hay fever could be a different type of rhinitis, or an upper respiratory tract infection. Complications might include sinusitis, a middle ear infection, conjunctivitis or, in some people, be associated with a flare-up of asthma symptoms.

"If hay fever is extreme and severe, the pharmacist may suspect you might need a course of oral steroids."