What is hay fever?
Hay fever is an inflammation or swelling of the nasal lining, which may cause congestion, a runny nose, itchy throat, watery or itchy eyes and/or sneezing. Hay fever has two forms:
- Seasonal allergic rhinitis 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, hay fever can have a significant impact on sufferers, causing lack of sleep and reduced productivity at work or school. Although it can't be cured, the symptoms can be managed to some extent. 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.
Hay fever treatment options
Antihistamines and corticosteroids are the mainstays of treatment, but there are several other treatments which may suit some sufferers.
Corticosteroid nasal sprays
Corticosteroid nasal sprays are the most effective preventative hay fever treatment. 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 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) has - it's been claimed - provided relief for watery, itchy or red eyes.
How to use corticosteroid nasal sprays
It's important that 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 their full effectiveness. Your doctor may recommend using them before allergy season starts. If you need fast relief though, 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 of corticosteroid nasal sprays
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 toward nose bleeding, people with a severe nasal or sinus infection, or a history of tuberculosis.
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.
- Rhinocort Hayfever (Budesonide)
- Flixonase(Fluticasone proprionate)
- Beconase (Beclomethasone)
- Telnase (Triamcinolone Acetonide).
- Rhinocort Nasal Spray (Budesonide)
- Budamax (Budesonide)
- Avamys (Fluticasone furoate)
- Nasonex (Mometasone)
- Omnaris (Ciclesonide).
Prevention is better than cure, so corticosteroid nasal sprays are the most effective treatment option available provided they're used consistently. They relieve existing symptoms, including congestion, and can prevent them from occurring. However, nasal sprays may not suit people with nasal passage injury or those who are susceptible to nose bleeds.
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 an itchy nose and throat, but generally don't relieve congestion (though azelastine, an antihistamine spray, does appear to help).
How to use oral antihistamines
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 of oral antihistamines
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 as a potential side effect, and warn that you should see how they affect you before taking them prior to driving or operating machinery.
There are several different types of oral antihistamines 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.
- Claratyne (Loratadine)
- Allerdyne (Loratadine)
- Lorano (Loratadine)
- 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.
Antihistamine tablets prevent and treat most symptoms except congestion, and a few come in formulations suitable for children. Side effects are usually mild, but even non-drowsy formulations can make some people sleepy.
Antihistamine nasal spray
You can reduce some of the side effects associated with antihistamines by using a nasal spray, which acts in the nasal passages. Azelastine (brand name Azep) is available as a nasal spray and, like its tablet counterparts, it helps with a runny nose, itching and sneezing, and also has a decongestant effect as well.
Some studies have found it's 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. A product called Dymista (made by the same company as Azep) which contains both ingredients by prescription only.
Another type of antihistamine spray is levocabastine.
Side effects of antihistamine nasal spray
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.
- Azep (Azelastine)
- Zyrtec (Levocabastine)
- Livostin (Levocabastine)
- Dymista (Azelastine + Fluticasone)
An antihistamine spray may be worth trying if you have congestion as well as other nasal symptoms, 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 hay fever. 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. Phenylephrine, which is sometimes used instead of pseudoephedrine, isn't effective for hay fever.
Side effects of pseudoephedrine
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, anxiety, depression or prostate disease should consult their doctor before taking these products.
- Claratyne-D (Loratadine + Pseudoephedrine)
- Telfast decongestant (Fexofenadine + pseudoephedrine).
These medications 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.
If your hay fever 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.
Anticholinergic nasal spray
When applied in a nasal spray, ipratropium bromide acts on the mucus glands to reduce the secretion of mucus. So although this treatment option helps stop a runny nose, it may not help with congestion or other hay fever symptoms such as sneezing.
- Atrovent (Ipratropium bromide)
- Atrovent Forte (Ipratropium bromide).
Helps stop a runny nose. That's about it.
Decongestant nasal sprays
Decongestant sprays, such as Otrivin, Vicks Sinex, or Dimetapp - which help when you have a cold - can also help with hay fever.
How to use decongestant nasal spray
Used for more than a few days they can make congestion worse, so their usefulness for hay fever 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.
These sprays can help relieve congestion when fast relief is required, but should only be used for a few days.
While antihistamine tablets and liquid are useful for treating red, itchy, watery eyes, if you'd rather avoid taking them for symptoms you don't have, or you're using a nasal spray instead of tablets, medicated eye drops can help.
The two main choices are antihistamine eye drops (levocabastine or azelastine), or combination antihistamine-decongestant drops (naphazoline hydrochloride + pheniramine maleate).
- Zyrtec (Levocabastine)
- Eyezep (Azelastine)
- Visine-A (naphazoline hydrochloride + pheniramine maleate)
- Naphcon A (naphazoline hydrochloride + pheniramine maleate)
If your main concern is eye irritation, medicated eye drops may be all you need. Eye drops containing decongestant should only be used for a few days at a time.
Tops tips for taking hay fever medication
- If you've never taken hay fever 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.
- People respond differently to different drugs, so if you've tried one type of antihistamine or corticosteroid and found it didn't help, try another.
- All hay fever medications have side effects, can 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 hay fever 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. For more information on managing your child's symptoms, see our article on treating hayfever in children.