For sufferers of seasonal allergies, treating hay fever can feel like a never-ending battle. When you’re not locking yourself indoors on scorching summer days, you’re having to constantly carry a bevy of eye-drops, nasal sprays, and tablets on a daily basis.
Even then, there’s a smorgasbord of different brands and medications on offer, each promising to hold pollen and other allergens at bay.
Hay fever typically starts around April, although it can be earlier - in February and March. It depends on what you react to as a sufferer of hay fever: tree pollen is from late March to mid-May, whereas grass pollen is mid-May to July. Weed pollen comes at the end of June, right through until September.
“There's two aspects of treatment,” says Mr Pavol Surda, Consultant ENT Surgeon at London Bridge Hospital and hay fever expert. “There's the medication and the counselling of the patient.”
And while doctors are great at prescribing the former, judging by Surda’s experience, they’re not always the best at handling the latter. This, he says, has led to vast numbers of hay fever sufferers taking all manner of medications and not really understanding why or what their medications do.
If that sounds like you, look no further. Here’s everything you need to know about hay fever medication and treatment.
How do antihistamines work?
Antihistamines are the most common form of hay fever treatment and as you might gather from the name, they simply block the release of a chemical called histamine. Ordinarily, histamine would be a very beneficial chemical. It’s a part of the immune system responsible for opening up blood vessels and increasing blood flow into infected or damaged areas of the body. This allows the quick distribution of chemicals and white blood cells into the area to fight off illness.
In allergy sufferers, the immune system mistakes allergens like pollen, pet hair, or household dust for infections and starts to release histamine. This binds to receptors, causing swelling and the symptoms of an allergic reaction.
Think of the receptor as a lock and histamine as the key which releases the immune response. Antihistamines get to the lock first and block histamine from unlocking the door, holding the immune reaction at bay.
Read more: Hay fever vs coronavirus symptoms
What antihistamines are out there?
The two you’ll find over the counter are Loratadine and Cetirizine Hydrochloride. “Both are newer, non-drowsy antihistamines that have been designed to minimise the risk of making you feel sleepy and give good symptom control,” says Surda.
However, there are differences which might impact which one you use. “Loratadine is a bit older and not as strong as Cetirizine but the action is quicker and it's less likely to cause any sleepiness,” explains Surda, going on to say that about one in ten people who use Cetirizine experience drowsiness. “In contrast, the older first-generation antihistamines (containing chlorphenamine) are also strong in symptom relief but cause strong sedation and have been associated with poor school performance, impaired driving and work injuries.”
Are antihistamines the only treatments for hay fever?
In short, it depends how much you suffer. Doctors tend to start people off with antihistamines but if these don’t bring relief, there are more options.
“There is also a very novel treatment called immunotherapy, I think this is something which is worth talking about because it's literally the first treatment which treats the root of the problem, rather than the symptoms,” explains Surda. “Immunotherapy is administered as monthly injections or daily pills which you put under your tongue over a period of time. These contain a tiny amount of a specific substance which triggers your allergic reaction, that we call allergens. This will stimulate your immune system but not enough to result in a full-blown allergic reaction. The amount of allergen progressively increases to a certain level so your body will build up a tolerance to the allergen, causing your symptoms to fade over time. You'll stop being allergic which helps treat the root of the problem.”
Immunotherapy takes a few months, but according to Surda, the most recent studies show its effects last for three to five years.
How often should I take hay fever medication?
Again, this depends on how intense your symptoms are. Surda recommends that those who experience occasional or mild allergy symptoms should use Loratadine as and when needed for quick relief which fades quickly, while those who experience allergies for an extended period should take a Cetirizine Hydrochloride pill every day for 24 hours of relief.
He also recommends nasal spray. Again, there are two varieties. Antihistamine sprays and corticosteroid sprays. “Corticosteroid sprays have been shown to be superior to ones containing antihistamines in the treatment of nasal symptoms,” explains Surda, though they do have to be used every day for four or five days.
“When it comes to nasal spray, it accumulates in the lining of the nose and will start to work within eight hours but the full effect will take 4-5 days, so regular treatment is essential.”
When should I start taking my hay fever medication?
Do you wait until symptoms start or, if you’re used to getting symptoms around the same time every year do you try to get the jump on it? Well, a bit of both. Surda recommends that you should “definitely” start using nasal spray about a week before your symptoms normally start, and maybe Cetirizine if that’s your medication of choice. If you’re a Loratadine user, just wait until you have symptoms.
Surda also points out that due to climate change, your symptoms may start occurring at different times of the year as plants bloom earlier or for longer. He notes studies have found that people are sometimes affected by weed pollen all the way through to December.
Are brand name hay fever medications better than generic ones?
Most supermarkets and pharmacies offer their own versions of hay fever medication, alongside branded versions such as Clarityn, Allacan and Piriton. These branded versions are often sold at a much higher price.
“The branded version is usually the original which is usually more expensive because the pharmaceutical company has to pay for the research and development to create it, but really there's no difference,” says Surda. “The generic one has to be tested against the original and found to have no difference.”
What about natural remedies? Does eating honey reduce hay fever symptoms?
There are many myths about treating hay fever, but most are utter hogwash. One of the most pervasive examples is the honey theory. The idea is that if you eat lots of honey made by bees in your local area, you’ll get used to the pollen that they’ve made the honey from.
“It works on the same principle as immunotherapy,” admits Surda. “It's about repeated exposure to allergens in the raw honey. And raw honey does contain a small amount of pollen and by eating it you should be regularly exposing yourself to pollen.”
However, there is an important difference: in immunotherapy the dose of allergen you’re exposed to is carefully controlled and increased in opportune increments, but a local beekeeper has no way to control this. “The studies which have been reported, usually based on anecdotal evidence, do show some reduction in symptoms, but they're very inconsistent. Based on the knowledge and based on the literature and everything else that's out there, I'd say it probably isn't helpful.”
Does putting Vaseline under your nose help reduce hay fever symptoms?
The idea with this one is that the sticky Vaseline traps the pollen and catches it before it enters your nose, preventing symptoms before they even begin. And it does work, says Surda, but there’s a catch. “When you use the Vaseline too much you end up inhaling small particles which might end up in your lungs and can cause various problems. But if you were to only use Vaseline for a couple of days when it was peak season and you were really suffering, I think you'd be completely fine.”
Covid vs hay fever symptoms
According to Allergy UK, symptoms of runny, itchy nose and sneezing which are typical of hay fever are not typical of coronavirus.
One of the main symptoms of coronavirus is a high temperature of 37.8C or greater. Again, according to Allergy UK, this is not typical for hay fever sufferers.
If you do have these symptoms, it is likely hay fever will respond to antihistamines and nasal sprays. The Allergy UK website recommends that people treat “hay fever proactively” to minimise symptoms and reduce “the tendency for you to touch your face due to itch, and prevent unintentional spread of coronavirus by sneezing.”
Their website also says that hay fever, otherwise known as allergic rhinitis, can feature a “a runny nose, blocked nose, cough, and sneezing. In some people, hay fever can trigger allergic asthma, causing a tight chest and difficulty breathing.”
It is the cough and feeling of being tight-chested that cause one of the key crossover symptoms between covid-19 and hay fever.
According to Amena Warner, Head of Clinical Services at Allergy UK, it is "often the runny nose is a clear fluid, like somebody has turned on the tap. “The itchiness is also very significant in finding out if you have a cold or the flu as opposed to an allergy. Itchy eyes, nose, throat and palette are all typical of hay fever symptoms.”
With hay fever, you get a post nasal drip and that will often cause irritation at the back of the throat where people will start to cough to clear it. In hay fever you would often get a persistent new cough, which is where the symptom may crossover with coronavirus.
"It will be new and continuous this season, but many people with hay fever symptoms will know that last year they had it, and the year before, and the year before that,” she added. “But now they will start suspecting its covid-19 rather than their returning cough, which may confuse people and make them anxious.”
She also states that the “pollen induced asthma” which can occur in people with hay fever can be confused with the symptoms of covid-19, which can give people a feeling of breathlessness.
“Pollen induced asthma can feel like a tightness on the chest, difficulty breathing and a wheeze,” she said. “People can also feel fatigued and lethargic during the pollen season as their body tries to deal with the high pollen load on their system.”
