Hayfever treatment

We review your treatment options for managing hayfever symptoms.
 
Learn more
 
 
 
 
 
 

01 .Hayfever medication

Hayfever or seasonal allergic rhinitis

The misery of hayfever is nothing to sneeze at – but help is at hand. Here, we cover tips for getting help, as well as the available medications such as corticosteroid nasal sprays, oral antihistamines and antihistamine sprays, and other treatments like immunotherapy.

What is hayfever?

It’s an inflammation or swelling of the nose lining which may cause congestion, a runny nose, itchy throat, watery or itchy eyes and/or sneezing. Seasonal allergic rhinitis, as it’s also known, tends to occur in spring and summer due to an allergy to pollen from grass, weeds and trees. Perennial allergic rhinitis has similar symptoms and may be triggered by dust mites, animal dander (particularly that of cats), or mould spores, and can occur throughout the year.

Affecting around three million Australians, hayfever can have a significant impact on sufferers, causing lack of sleep and reduced productivity at work or school. While it can’t be cured, the symptoms can be managed to some extent; the two mainstays of prevention and treatment are corticosteroid nasal sprays and antihistamines. An allergy test can determine the source of the problem, which in turn can help with prevention and treatment strategies – avoiding or limiting exposure, for example.

Getting help

  • If you’ve never taken hayfever medication before, or are trying a new drug, it’s a good idea to consult your doctor or pharmacist to make sure it’s safe for you.
  • If you’ve tried one type of antihistamine or corticosteroid and found it didn’t help, try another – people respond differently to different drugs.
  • All hayfever medications have side effects, could interact with other drugs, and shouldn’t be used by people with certain conditions or with allergies to ingredients.
  • If you’re pregnant or breastfeeding, ask your doctor whether the potential benefits of medication outweigh the risks.
  • Before giving hayfever medication to a child under 12, consult your doctor for advice – some medications aren’t suitable for young children, and some come in a child-friendly form such as drops or syrup.

Treatment options

Corticosteroid nasal sprays

Corticosteroid nasal sprays are the most effective preventative hayfever treatment. They act by reducing inflammation in the blood vessels of the nose, helping reduce runny nose, congestion, itching and sneezing. Most don’t help with eye symptoms (although there are corticosteroid eye drops) but Fluticasone furoate (Avamys) claims to relieve watery, itchy or red eyes.

Nasal spray

Many people think that a blocked or stuffy nose is caused by thick mucus, such as when you have a cold. In fact, nasal congestion results from the blood vessels in the lining of the nose becoming swollen, which affects breathing and gives that blocked-up feeling. Corticosteroids (and other decongestants) work by narrowing the blood vessels, which reduces inflammation and swelling, allowing you to breathe more easily.

How to use them

It’s important corticosteroids are used regularly, because their effectiveness depends on having a steady dose over time. However, if used over long periods of time (many products suggest six months) your doctor should check the lining of your nose for changes. They don’t work instantly, and it may take several days - or up to two weeks - for corticosteroid sprays to attain full effect. Your doctor may recommend using them before allergy season starts. If you need fast relief, antihistamines and short-term use of other nasal decongestants can help. If there is no improvement within a few weeks, see your doctor. Don’t increase the dose.


Side effects


The main potential side effects are headaches, nosebleeds and damage to the nasal passages, and a bad taste or smell.

Not recommended for ...

Corticosteroids inhibit wounds from healing, so shouldn’t be used if there are existing wounds or after nasal surgery. Nor are they recommended for people with a tendency to nose bleeding, people with a severe nose or sinus infection, or a history of tuberculosis.

Products

Some products are available over the counter, and your pharmacist may be able to suggest one. However, some are prescription only, so if you find the others are not helping, consult your doctor.

Over-the-counter
  • Rhinocort Hayfever (Budesonide 32mcg)
  • Flixonase (Fluticasone proprionate)
  • Beconase (Beclomethasone)
  • Telnase (Triamcinolone Acetonide)
  • Nasonex (Mometasone)
Get a prescription
  • Rhinocort Nasal Spray (Budesonide 64mcg)
  • Budamax (Budesonide)
  • Avamys (Fluticasone furoate)
  • Omnaris (Ciclesonide)
Bottom line

This is the most effective hayfever medication, it relieves existing symptoms, including congestion, and can prevent them from occurring. However, because it’s a nasal spray it may not suit people with nasal passage injury or who are susceptible to nose bleeds.

Oral antihistaminesAntihistamine tablets

Antihistamines work by blocking the chemical messenger histamine, the main trigger of allergy symptoms in the nose and airways. They can help with a runny nose, watery eyes, sneezing, and itchy nose and throat, but generally don’t relieve congestion (though azelastine, an antihistamine spray, does appear to help).

How to use them

If you take them regularly they build up in your system and can help prevent histamines being released, and your doctor may recommend you start taking them a couple of weeks before you normally start to get symptoms.

Side effects

The main side-effects include dry mouth, nose, or throat, hoarseness, headache, dizziness and nausea. These are generally mild and don’t last long. Unlike older antihistamines, these so-called second- or third-generation antihistamines claim to be non-drowsy. A possible exception is cetirizine (brands include Zyrtec and Alzene), which appears to have more of a sedative effect in some people than other antihistamines. The others list drowsiness symptoms as potential side effects, and warn that you should see how they affect you before taking them prior to driving or operating machinery.


Products

There are several different types of antihistamine on the market – see below for the main ones – and no one product is best for all people in all situations. Some drugs work better for some people than others, so if one hasn’t worked for you, or has stopped working, try a different one. And some stronger ones need a prescription, so consult your doctor if you haven’t found one that works.


Over-the-counter
  • Claratyne (Loratadine)
  • Allerdyne (Loratadine)
  • Lorano (Loratadine)
  • Xyzal (Levocetirizine)
  • Zyrtec (Cetirizine)
  • Zodac (Cetirizine)
  • Zilarex (Cetirizine)
  • ZepAllergy (Cetirizine)
  • Cetrelief (Cetirizine)
  • Alzene (Cetirizine)
  • Telfast (Fexofenadine)
  • Fexal (Fexofenadine)
  • Allerfexo (Fexofenadine)
  • Aerius (Desloratadine)

Generic versions of some of these are also available – look for the drug name.

Bottom line

Antihistamine tablets prevent and treat most symptoms except congestion, and some come in formulations suitable for children. Side effects are usually mild, but even non-drowsy formulations can make some people sleepy.

Antihistamine nasal spray


The only antihistamine sold in spray form in Australia is azelastine (brand name Azep), and, like its tablet counterparts, it helps with a runny nose, itching and sneezing. Unlike oral antihistamines, however, it has a decongestant effect as well.

Some studies have found it is as good as or better than oral antihistamines, and when used with the corticosteroid fluticasone propionate, the combined effect is greater than the effect of either used alone. Dymista contains both ingredients, and is available on prescription.

Side effects

The main potential side effects are bleeding nose, nasal irritation, nausea, headache and bad (bitter) taste in the mouth. A flavoured drink after the spray can reduce the bitter taste.

Products
Over-the-counter
  • Azep (azelastine)

Get a prescription

  • Dymista (azelastine + fluticasone propionate)
Bottom line

An antihistamine spray may be worth trying if you have congestion, and it’s less likely to cause drowsiness though it may cause nasal irritation or bleeding.

Antihistamine with decongestant tablets

Pseudoephedrine is a decongestant, and is found in cold, flu, and sinus relief tablets. It’s also sold combined with antihistamine in tablets for hayfever. Preparations such as Telfast Decongestant and Claratyne-D are sold behind the counter in the pharmacy because they contain pseudoephedrine, and you may need to show identification to buy them.

Side effects

In addition to the possible side effects from antihistamines, those related to pseudoephedrine include insomnia, nervousness, excitability, dizziness, fear or anxiety, rapid heartbeat, tremor and hallucinations.

Not recommended for ...

People with high blood pressure, heart conditions, diabetes, glaucoma, or prostate disease should consult their doctor before taking these products.

Products
Over-the-counter
  • Claratyne-D (loratadine + pseudoephedrine)
  • Telfast decongestant (fexofenadine + pseudoephedrine)
Bottom line

These offer the symptom relief of antihistamines, along with a decongestant. Pseudoephedrine is a stimulant and shouldn’t be used by people with certain medical conditions – talk to your doctor or pharmacist.

For more information on allergies or other conditions, see General health.

 
 

Sign up to our free
e-Newsletter

Receive FREE email updates of our latest tests, consumer news and CHOICE marketing promotions.

 

02.More treatment options

 

While antihistamines and corticosteroids are the mainstays of treatment, there are more options which may suit some, including immunotherapy:

Anticholinergic nasal spray

Ipratropium bromide blocks the action of the neurotransmitter acetylcholine, which when applied in a nasal spray acts on the mucus glands to reduce the secretion of mucus. So while it helps stop a runny nose, it may not help with congestion or other hayfever symptoms such as sneezing.

Products
Over-the-counter
  • Atrovent
  • Atrovent Forte
Bottom line

Helps stop a runny nose.

Decongestant nasal sprays

Decongestant sprays, such as Otrivin, Vicks Sinex, or Dimetapp, that help when you have a cold can also help with hayfever.

How to use them

Used for more than a few days they can make congestion worse, so their usefulness for hayfever is limited to short episodes only. Oral decongestants (pseudoephedrine) can be used for longer than the spray. On the other hand, sprays are faster acting than tablets because tablets need to be absorbed into the blood stream from the stomach and make their way to where they’re needed, whereas sprays are quickly absorbed into the blood vessels in the nose.

Bottom line

Can help relieve congestion when fast relief is required, but only for a few days.

Allergen immunotherapy

If your hayfever is so severe it dramatically impacts on your quality of life (if the symptoms are debilitating or keeping you at home, for example), your doctor may recommend immunotherapy. This means taking regular doses of the allergens that affect you, starting with very small doses and getting larger over time.

The doses are usually given by injection, though there are also drops or tablets that are placed under the tongue. Injections are less expensive, and may be more effective, but are less convenient: it means going to the doctor’s surgery once a fortnight (or possibly once a week, getting less frequent over time), having the injection and waiting around for 30 minutes or so to ensure there’s no severe reaction (such as anaphylaxis).

The therapy takes three to five years, and you may need maintenance injections at the beginning of allergy season thereafter. You’ll need to continue your other medications while taking it, and while it will make symptoms more manageable, it probably won’t completely resolve the problem.