What Is Hay Fever (Allergic Rhinitis)?

Hay fever or allergic rhinitis is a common allergic reaction that causes sneezing, coughing and itchy eyes. It occurs when the body reacts to harmless substances (called allergens) such as pollen or dust. These allergens cause the immune system to release a chemical called histamine, leading to all the familiar symptoms.

Generally considered a seasonal allergy, hay fever may also be classed as perennial (lasting year-round) but is distinct from those that are truly perennial. True perennial allergies are triggered by constant exposures to outdoor allergens like dust mites, mould spores or pet dander(tiny flakes of skin), present throughout the year. In contrast, seasonal allergies such as hay fever are linked to fluctuating pollen counts that vary with the seasons.

Food allergies are another type of immune response involving proteins in specific foods such as nuts, shellfish or milk. There is a phenomenon called oral allergy syndrome (OAS), where people with hay fever may be more susceptible to food allergies due to similarities between pollen and food proteins.

True food allergies are a form of severe allergic reactions which, due to their life threatening nature, require immediate treatment with adrenaline auto injectors (Epi-pen).

Symptoms of Hay Fever

Common symptoms of hay fever can include:

• Sneezing or coughing

• Itchy, runny nose or blocked nose (nasal congestion)

• Watery/itchy or red eyes

• Sore throat

• Mucus dripping down the back of the throat is called postnasal drip

• Fatigue or trouble sleeping

• Headache

A patient may experience some of these symptoms, but usually not all together. These tend to be worse during high pollen season (between March and September), but may occur during other times as well.

For patients with asthma, hay fever can worsen symptoms. Since both conditions affect the airways, the allergic reaction to pollen can increase inflammation and aggravate asthma. Look out for a worsening of your condition, and speak to a medical professional to optimise your treatment during high pollen seasons.

When Should I Seek Urgent Help?

Whilst allergic rhinitis is usually a mild and manageable condition, it is important to know when to seek urgent medical attention, as in rare cases, severe allergic reactions can occur, which can be life-threatening.

Seek urgent medical attention if you experience:

• Difficulty breathing

• Wheeze, not relieved by your reliever inhaler (blue inhaler)

• Swelling of the lips, tongue, or throat

• Dizziness or fainting

• A sudden drop in blood pressure.

These are symptoms of anaphylaxis and happen very quickly. If you have adrenaline auto injectors such as Epi-pens, you should use these as prescribed and call 999 as immediate treatment in hospital is required.

Choosing a Treatment Plan: Step-By-Step

Management of hay fever is a combination of hay fever treatments and measures taken at home, summarised in the following steps.

Step 1: Identify Triggers

The best approach is to avoid the common allergens. Common allergies stem from tree pollen, grass pollen, dust mites, pet dander and mould spores. Once identified, steps can be taken to stop pollen exposure. Some allergens are classed as indoor, such as mould, whilst others are exclusive to outdoor environments.

Step 2: Match Symptoms to Treatments

I.e. if you have predominantly nasal symptoms such as a blocked or runny nose, a nasal spray may be more appropriate. Conversely, if your symptoms affect the eye, then eye drops are advised.

Step 3: Combine Treatments if Needed

Based on the duration of symptoms, it may be more appropriate to take a combination of treatments. I.e. a daily antihistamine tablet throughout high season, supplemented with a nasal spray/eye drops if required for localised symptoms. Ensure you speak to your healthcare provider, who can help determine safe combinations of treatment.

Step 4: Review After 2 to 4 Weeks

Some people find certain treatments work better for them. Reviewing treatment at this point can help adjust your treatment if required to keep your symptoms at bay.

Step 5: Consider Specialist Referral

If allergic symptoms continue, despite optimal treatment, a referral to a specialist may be necessary. Referral is also appropriate if symptoms occur throughout the year or if there is uncertainty about the type of allergies involved.

Treatment Options Available

Oral Antihistamines

Histamine is a signalling chemical released from the immune system, which has several functions but is mainly known for its role in causing hay fever symptoms. The main treatment option to relieve hay fever symptoms is thus antihistamines, which block the action of histamine.

Antihistamines are mainly of 2 types: drowsy and those less likely to cause drowsiness, and are available as tablets, capsules, liquids, sprays and eye drops.

Non-drowsy antihistamines are preferred, though there are specific administration instructions depending on which type you are using. The preferred treatment pathway is for susceptible individuals to take a non-drowsy oral antihistamine every day - this should ideally be taken first thing in the morning, before exposure to the allergen. Additional methods, such as nasal sprays or eye drops, could be used if required for breakout symptoms.

Whilst most over-the-counter antihistamines, such as Cetirizine, Loratadine, Fexofenadine, and Chlorphenamine, are generally safe, some patients may need to speak to a healthcare professional first. This includes the very young, the elderly, patients who are pregnant/breastfeeding, patients taking other medication or those who have an underlying health condition.

Steroid (Corticosteroid) Nasal Sprays

Steroid nasal sprays are useful in treating nasal symptoms of allergic rhinitis, such as sneezing, runny or blocked nose and itchy or watery eyes. They work by reducing swelling and irritation inside the nose and can work faster than tablets.

For best results, the sprays should ideally be started 1-2 weeks prior to the expected onset of symptoms and should be used daily, even if you're feeling better.

Side effects of the sprays include a stinging or burning sensation in the nose, a dry, irritated throat (caused by the fine powder within), unpleasant taste in the mouth and, rarely, nosebleeds.

Most people can safely use sprays though you should speak to a healthcare professional before using if you:

• Have had an allergic reaction to steroids in the past

• Have recently had surgery on your nose

• Have ever had tuberculosis (TB)

• Had an infection in the nose or sinuses

• Are taking or have recently taken other steroid medicines

• Are looking for a spray for a child

• Are pregnant or breastfeeding

Non-Steroidal Nasal Options

Non-steroidal sprays such as Azelastine is an option for those who cannot take steroidal sprays. This is an antihistamine and works for rapid local relief of nasal itching and sneezing.

In addition to this, barrier products such as petroleum jelly applied around the nostrils can help trap pollen from entering the nasal cavity in the first place.

Decongestants (Short-Term Only)

Decongestant sprays are another option which can help ease allergy symptoms. These work by reducing the swelling in blood vessels around the nasal cavity, which can help to open the airways. They have a minimal effect on other symptoms of hay fever, but can prove useful if a blocked nose is an issue.

These sprays should only be used as a short-term treatment, as using them for too long can cause rebound congestion. They may also interact with other medications, so they should be used with caution in individuals who are taking other medicines. As they affect blood flow, extra care should be taken in conditions where blood flow is particularly sensitive, such as high blood pressure, glaucoma or heart disease.

Eye Drops

Eye drops are useful for when allergic symptoms are localised to the eyes, such as watery, red or itchy eyes. Mast-cell stabilize drops, such as Sodium cromoglicate prevent mast cells from releasing histamine that cause the allergic reaction. Antihistamine drops, such as Azelastine don't prevent the release of histamine but blocks its action, again helping to relieve symptoms.

For Sodium cromoglicate to work properly, it must be used regularly for 2 weeks. Ingredients in some eye drop preparations may interact with contact lenses. For this reason, you should avoid the drops unless it clearly states 'for use with contacts' on the label.

Saline Sprays and Rinses

Saline sprays are a drug-free option which are generally safe for all patients, including during pregnancy. Essentially a saltwater solution, saline sprays are used to clear pollen and other allergens from the nasal passages.

Most saline sprays are isotonic (same saline concentration as in the body), but some are hypertonic (higher salt concentration than in the body). Hypertonic solutions may do a better jo,b but these may also cause mild irritation and other side effects.

Combination Therapy

A suitable combination therapy would include an oral antihistamine, taken prior to allergen exposure, preferably early morning upon waking. This should prevent most of the symptoms of allergies from occurring, even if the allergen is encountered. Importantly, this must be taken regularly for most benefit. Additionally, patients can benefit from an eye-drop or nasal spray formulation to settle localised symptoms if needed.

When considering multiple therapies, ensure that you first follow the advice of your healthcare provider, who can advise on whether the combination can be suitably taken. Secondly, ensure you read the product leaflets for advise on how to take/use and expected side effects.

Immunotherapy (Allergy Shots or Sublingual Tablets)

Immunotherapy, also known as desensitisation, is a process where increasing doses of a specific allergen are administered to a patient with the aim of reducing its reactivity. This is conducted in a carefully monitored environment using a skin prick test or patch test and is an emerging option available for those who have had moderate to severe allergic reactions despite optimal treatment.

This process is initiated by an allergy specialist, where an initial test (skin prick test, patch test and/or blood tests) reveals allergic antibodies. A physical examination follows to ensure you are at optimal health. The allergen would then be introduced in increasing doses usually over a period of time. This is a generally lengthy procedure and may be a multi-year procedure based on the severity of your allergy and other medical factors.

Self-Care to Reduce Exposure and Relieve Symptoms

Check Pollen and Plan Your Day

Practical tips to reduce exposure to allergens involve:

• Applying petroleum jelly around the nostrils to trap pollen

• Wearing wrap-around sunglasses

• Keeping windows and doors shut as much as possible

• Vacuuming and dusting with a damp cloth.

Ensuring both your vacuum cleaner and if applicable air conditioning units are fit with HEPA(high efficiency particulate air) filters to trap tiny particles and a pollen filter in your car.

It is advised not to:

• Cut grass

• Spend too much time outside

• Keep fresh flowers in the home

• Smoke or be around smoke

• Dry clothes outside

• Let pets inside

Allergies in Children, Pregnancy, and Long-Term Conditions

For children, commonly used treatments are liquid formulations. Cetirizine and Loratadine are preferred over Chlorphenamine as they are non-drowsy and licensed for children aged 2 years and above. These preparations suffice for most allergy symptoms in children but for severe reactions, onward medical care must be sought.

For children under 1, there are no over-the-counter licensed options, so parents should seek advice from a GP. Medical advice is also recommended if over-the-counter treatments are ineffective, symptoms are severe, or if the child has asthma.

During pregnancy and breastfeeding, it is essential to seek medical advice before starting treatment, as not all medicines are suitable. In most cases, non-drug approaches such as saline nasal sprays and practical steps to reduce pollen exposure are preferred.

For patients with asthma, hay fever can make symptoms worse. It is important to continue using prescribed inhalers and to review asthma management regularly. If hay fever is not well controlled, speak to your GP, as treatment may need adjustment.

For individuals with long-term conditions such as high blood pressure, glaucoma, or heart disease, decongestant-containing products should be avoided, as they may raise blood pressure, affect heart rhythm, or increase eye pressure. Safer alternatives include antihistamines, steroid nasal sprays, and saline sprays.

Allergy Testing and Specialist Clinics

Testing for allergies is recommended where the trigger is unclear, or if symptoms are persistent, occurring throughout the year, suggesting a perennial allergy. This can be done through a number of different methods such as:

• A skin test, where a small amount of allergen is placed on the skin to check for an allergic reaction

• Specific IgE blood tests - which measure how the immune system response to particular allergens

• Patch testing - used when contact dermatitis is suspected.

A specialist allergy clinic can use results from this to tailor treatment based on your history and symptoms. This plan would include allergen avoidance strategies, medication optimisation and immunotherapy for patients with severe allergic rhinitis.

How Quick Meds Can Help

At Quick Meds, we are a GPhC-registered pharmacy, so you can be confident you’re in safe hands. Our clinicians are well-placed to provide tailored advice on managing your symptoms. All medicines are sourced from MHRA-approved suppliers, ensuring a safe and reliable supply.

To get started, simply complete our online consultation form. A clinician will review your answers, provide personalised recommendations, and if suitable, approve your treatment. Your order will then be sent via discreet, tracked delivery straight to your door to most UK-based addresses.

We offer a wide range of treatments to meet the needs of many patients. However, in some cases, onward referral may be necessary, for example, to NHS urgent care for severe reactions, or to a GP for ongoing asthma symptoms or suspected food allergies.