Midsummer’s Day, 21st June, is the worse day of the year for hayfever sufferers, as it falls during the height of the grass pollen season, and hot sunny days cause pollen counts to soar. As a doctor I’ve prescribed, used and recommended many hay fever treatments and formed strong views on which are the most effective natural, herbal and pharmaceutical brands. Below, I’ve reviewed what I believe are the best hay fever medicines, pollen filters, eye drops, nasal barriers, nasal sprays and antihistamine tablets, as well as herbal medicines and drug-free methods such as light therapy and acupressure. I’ve also shared my best tips to help minimise your hay fever symptoms this year.
Pollen and hay fever
Hay fever – also known as seasonal allergic rhinitis and pollinosis – makes life a misery for one in five people who are sensitive to grass and tree pollens. These pollens are essentially the sex seed of male plants, with a single flower releasing anything from a few hundred pollen grains (eg the mallow) to several million at a time (eg pine tree).
As pollens from different species of plant are all mixed in the air together, they secrete special recognition factors to ensure they pollinate the right flowers. It is these protein factors that are believed to trigger the allergic reactions of hay fever.
Different pollens are implicated in different countries, with ragweed being a common problem in the US, birch tree pollen in Scandinavia and cedar pollen in Japan. Some flower pollens can also cause problems – especially the bright yellow, oil-seed rape.
When pollen lands on the delicate mucus membranes of the nose, mouth and eyes, it is normally flushed away without causing a problem. In people who are sensitised, however, the immune system wrongly identifies the pollen’s unique recognition factors as a potential threat. Immune cells secrete an antibody known as IgE to respond to the ‘invader’ by triggering the release of histamine.
Histamine acts as an alarm signal that heightens your immune response. It causes blood vessels to dilate and speeds the arrival of other immune factors into the area. The resulting irritation, inflammation and swelling produces the usual symptoms of hay fever with runny nose, stuffiness, sneezing and itchy conjunctivitis. Only one in 20 people with hay fever escape eye symptoms altogether – usually those allergic to the pollen of oil-seed rape. Conjunctivitis tends to be worse in those allergic to tree pollens.
That’s why simple pollen barriers can provide such an improvement in symptoms by stopping the pollen coming into contact with your eyes or nasal lining.
Women get worse hayfever than men
New research shows that women have a higher sensitivity to irritants and a stronger immune response against pollen than men. As a result, women experience worse seasonal allergic rhinitis symptoms with greater airway ‘hyper-responsiveness’ than males. This effect appears to relate to the way oestrogen stimulates the release of histamine from mast cells. This makes barriers that trap pollen before it comes into contact with the sensitive linings of the eyes and nose even more important.
Wrap-around glasses for hay fever
You can minimise hayfever eye symptoms with wrap-around sunglasses – as long as you put them on before you step outdoors. You need protection against ultraviolet light, too, so check the label specifies ‘100% UV protection’, ‘Lenses block UVA and UVB rays’, or ‘Full UV400 protection’. Avoid those that do not state any level of protection or that vaguely claim they are ‘UV absorbing lenses’ or ‘Blocks most UV light’.
Pollen filters for hayfever
Face masks are increasingly trendy essentials for people who cycle, jog or simply walk through built-up areas. Designed to control the quality of air you breathe, these masks can filter out pollen as well as traffic fumes.
Nasal barriers for hay fever
Nasal barriers work on the simple principle that stopping pollen from touching the lining of your nose prevents symptoms by blocking the trigger that releases histamine. As the nose is an efficient, self-flushing organ, scientists have had their work cut out finding solutions that work within minutes yet stay within the nose for a useful length of time.
Rinse away hayfever allergens with nasal douching
Saline douching to cleanse the nose is recommended by ENT doctors to irrigate nasal passages, reduce congestion and wash away allergens such as pollen. This helps to reduce nasal inflammation (rhinitis) and sinusitis and is safe enough for use during infancy, pregnancy and breast-feeding when other prescribing options are limited.
Saline douching is recommended as a first-line approach by the British Society for Allergy and Clinical Immunology (BSACI) guidelines as a Grade A, evidence-based recommendation for treating hay fever (allergic rhinitis). The National Institute for Health and Care Excellence (NICE) also recommend nasal douching with saline as an alternative or add-on treatment for allergic rhinitis.
Nasal irrigation with physiological seawater can also help other nasal treatments work better by cleansing the nasal lining before using a medicated hay fever spray. For example, it maintains the effectiveness of intranasal steroids used to treat hay fever (alelrgic rhinitis) at a lower dose, resulting in fewer side effects.
NB Use an isotonic spray for treating allergies. The hypertonic sprays are for short-term use to help dry up a cold.
Best hayfever medicines
Whether or not to take an oral antihistamine, or to use a nasal corticosteroid spray, comes down to personal choice. Some people prefer the convenience of using a one-a-day oral tablet, while others prefer the localised effects of a once-a-day nasal preparation. You can, of course, use both if necessary. The National Institute for Health and Care Excellence (NICE) state that non-sedating oral antihistamines and nasal corticosteroids may be used regularly to treat hay fever (allergic rhinitis) without fear of adverse side effects.
A head-to-head trial involving 682 people with hay fever symptoms found that using either an oral antihistamine (cetirizine) or a nasal corticosteroid spray (fluticasone propionate) for two weeks was equally effective for improving eye or nose symptoms and quality of life. Note the trial only lasted two weeks, however. When it comes to treating frequent or persistent symptoms, ‘most experts agree that intranasal corticosteroids are the more effective treatment for controlling symptoms of hay fever and other forms of allergic rhinitis when used on a regular basis’, according to NICE.
As a general guideline, if your main symptoms are sneezing or nasal discharge, either an oral antihistamine or an intranasal corticosteroid will help. If your main symptoms are nasal blockage/congestion, or if you have nasal polyps, then a nasal corticosteroid spray is likely to be more effective.
Best hay fever tablets
Oral antihistamines, as their name suggests, are taken by mouth to stop the effects of histamine in the body. They are excellent for reducing symptoms of a runny nose and sneezing, but tend to be less effective against a stuffed up nose, for which a decongestant spray (reviewed below) usually works best.
Antihistamines (eg acrivastine, astemizole, loratadine, terfenadine) help to prevent release of histamine from cells or stop histamine from producing its actions in the body. Some older antihistamines, such as chlorphenamine, are sedating which may be useful if you need to use them at night.
During the daytime, select a non-sedating version, such as loratadine or cetirizine, which is less likely to make you feel drowsy. This is especially important if you want to drive or operate machinery at work. Some people are more sensitive to these sedating effects than others, however. Don’t drink alcohol while taking an antihistamine or you may literally end up lying in the road (like a friend of mine who was celebrating Padstow May Day in traditional style!)
A study by the Drug Safety Research Unit found that the least sedating over-the-counter oral antihistamine tablet was loratadine which was 3 times less likely to cause sedation than cetirizine, so this is the antihistamine tablet I usually recommend.
|Claritin Reditabs (known as Clarityn Rapide in the UK) fast-dissolving dispersible tablets melt in your mouth with no water needed should symptoms strike while you are out and about. Each one-a-day dispersible tablet provides 10mg loratadine.
| Boots One-A-Day Allergy Relief tablets provide 10mg loratadine.
Check price from Boots.com
A similar product in the US is value-size Claritin one-a-day 10mg loratadine.
View offers on Amazon.com
Best hayfever nasal sprays
Many people find that nasal corticosteroid sprays offer better relief of hay fever symptoms overall than antihistamine tablets. There is no clear evidence to suggest one nasal corticosteroid spray is more effective than another. As some sprays are more expensive, it’s worth trying a cheaper one first. These are the ones I usually recommend first-line. Stronger versions are available on prescription from your doctor.
|Beconase Hay fever Relief nasal spray contains the corticosteroid, beclometasone dipropionate.
Dose: adults over 18, use two sprays into each nostril twice a day (morning and evening). Once your symptoms are under control reduce the dose to one spray in each nostril twice a day.
Always use the lowest dose necessary to relieve your symptoms, and read the Patient Information Leaflet provided.
Boots Hayfever Relief contains the same drug and own-brand, tends to be cheaper.
In the US, you have more choice as three leading pharmacy brands contain medicines that are only available on prescription in the UK.
Antihistamine sprays for hay fever
Nasal antihistamine sprays are not usually recommended as a first-line treatment as, on their own, they are less effective than the above nasal corticosteroid sprays, and only improve nose symptoms – they have little effect against allergic conjunctivitis.
However, if your nose symptoms persist, an antihistamine nasal spray containing azelastine is available on prescription to help control breakthrough symptoms.
A combined antihistamine/corticosteroid spray containing azelastine plus fluticasone propionate (brand name Dymista) is also available. This really is the ‘big gun’ against hay fever and is highly effective but only available on prescription from your GP.
Best eye drops for hayfever
Numerous soothing eye drops are available to treat hay fever. These contain either an anti-inflammatory agent (eg sodium cromoglycate which stabilises mast cells to prevent histamine release) or an anti-histamine plus, sometimes, a decongestant to relieve redness. Usual dose is 1 or 2 drops in each eye, 4 times a day.
Sodium cromoglycate works by stopping the release of inflammatory chemicals from cells, so it’s most effective when used before symptoms start, rather than once your eyes start to itch or sting. Anti allergy drops containing ketotifen fumarate work quickly and provide relief for up to 12 hours.
For a totally natural approach, I’ve found it helps to lie down for 20 minutes with a cool compress over your eyes made from cotton pads soaked in cold, camomile tea.
Salt therapy for hay fever
Spending time in subterranean salt mines is a traditional treatment for hay fever, asthma and other respiratory problems in Central and Eastern Europe. Known as speleotherapy, this allows you to breathe air that is free from common dusts and pollen, and which is saturated with beneficial negative ions released from Himalayan salt. Modern trials have shown that speleotherapy has beneficial effects on lung function, with clinical effectiveness estimated at 97.3%.
Salt cave therapy is now available in many towns and you can obtain similar benefits at home by inhaling salt-laden air through a porcelain salt pipe for just 15 minutes a day. Simply place your mouth over the spout to breathe in and exhale through your nose. This helps to moisturise, cleanse and stabilise your respiratory passages, as well as thinning mucus to relieve congestion.
You can even treat the atmosphere in a whole room using a salt therapy air purifier. The unit gently disperses microparticles of salt and trace elements into the atmosphere while filtering out allergens. In the lungs the salt-diffused air gently reduces inflammation, has an anti-bacterial action, promotes airway dilation and reduces mucus build-up.
Vitamin C for hay fever
Vitamin C acts as a natural antihistamine to damp down inflammation. Taking 2g daily vitamin C has been shown to reduce airway reactivity to histamine, to reduce histamine levels by over a third. There is some evidence that vitamin C may help to reduce symptoms linked with pollen allergy, including mucus production, but this has not been well-studied. Researchers believe that vitamin C neutralises histamine and reduces the influx of immune cells (neutrophils) that ramp up inflammation and make symptoms worse. Vitamin C is often combined with bioflavonoids such as quercetin which have a similar antihistamine action.
If you want to trial vitamin C to see if it helps you, doses of 1 gram per day are safe for long-term use as supplements. Doses of 2g to 3g per day are fine for short-term use to reduce allergic symptoms. As a water-soluble vitamin, excess is safely flushed away via the kidneys. The dose you can tolerate may be limited by indigestion or by bowel looseness (which is why the upper safe level was set at 1g per day). If you experience these side effects, cut back the dose or switch to the ‘body-ready’ form known as ester-C which is non-acidic but does tend to be more expensive.
NB If you are a known kidney-stone former, do not take vitamin C supplements. Some urine tests are affected by high dose vitamin C supplements – tell your doctor if you need any urine/stool tests, and if you have diabetes and use urine glucose tests check you are using a kit that is not affected.
Herbal remedies for hay fever
A number of herbal remedies are used to prevent and treat hay fever. I’ve found two that are particularly effective.
Luffa Complex contains extracts from seven tropical herbs: Sponge Cucumber (Luffa), Heartseed, American Spikenard, Golden Thryallis, Chapparal, Okoubaka and Toothpick Weed. It is available as a tincture or tablets. Research shows that Luffa Complex relieves hay fever symptoms in 75% of cases.
Pycnogenol is a blend of powerful antioxidants derived from the bark of the French maritime pine. Laboratory studies show these block histamine release from mast cells exposed to airborne allergens such as pollen. Clinical trials have found that pycnogenol has an antihistamine action that is as effective as the commonly used hay fever drug, sodium cromoglicate, but is best started 7 to 8 weeks before the onset of the hay fever season for best effect.
Light therapy for hay fever
Because hay fever symptoms develop as the sun starts to shine, it seems surprising that nasal exposure to specific light wavelengths can improve symptoms. Known as rhinophototherapy (nasal light therapy), research published in The Journal of Allergy and Clinical Immunology shows that certain wavelengths suppress over-active immune responses and prevent the release of histamine from nasal mast cells.
Forty-nine people with hay fever used the therapy three times a week, for three weeks, during the height of the ragweed allergy season. Those receiving the real nasal light treatment for hay fever had a significantly greater improvement in sneezing, runny nose, itchy nose and total nasal symptoms, while those using a control light showed no improvement. When the volunteers’ nasal secretions were analysed, they showed a significant reductions in the number of inflammatory cells and chemicals present.
Another study, involving 31 people with hay fever, compared the effects of intranasal light therapy (three times a week for 2 weeks) with taking an antihistamine tablet (180mg fexofenadine) for two weeks. In the nasal light therapy group, all symptoms improved. In antihistamine group, only sneezing improved significantly. The researchers concluded that intranasal phototherapy is more efficient than fexofenadine HCl in reducing clinical symptoms of seasonal allergic rhinitis.
In another study, involving 65 people with persistent allergic rhinitis, all received a combination of inhaled steroid spray plus antihistamine tablets, and one-half also received rhinophototherapy. Adding in the nasal light therapy significantly improved symptoms and quality of life compared with using the medications alone.
|Sneezer Beam is the original hay fever nasal red light device that my husband swears by.
Just insert the probes for 3 minutes, three times a day, while symptoms persist. Your nose will light up like Rudolf the Reindeer, so sit or lie down somewhere quiet and private for three minutes during use. The benefits are worth it!
Laser acupuncture for hayfever
In Japan, laser therapy is popular to vaporise parts of the nasal lining (inferior turbinates) that swell to produce hay fever symptoms. Although this may seem a drastic approach, some studies suggest that 60% of people undergoing the procedure experience complete relief of nasal obstruction with no further need for nasal sprays. You obviously don’t want to be doing this at home, but more gentle, low-frequency, painless and non-destructive versions are now available that combine intranasal laser stimulation with acupoint stimulation.
A study involving 24 people with allergic rhinitis received either true laser acupuncture treatment or sham laser treatment (using a deactivated device beaming normal red light). Symptoms significantly improved in those receiving the true treatment but worsened in those receiving the false treatment.
Intranasal laser acupuncture is safe enough for use in children. One study divided 40 children and adolescents (aged 7 to 18 years) with hay fever into two groups. One group received nasal light therapy, and one received intranasal laser acupuncture. Both groups showed similar improvements in symptom scores and both treatments were found to be equally safe, reliable, non-invasive and successful.
|HailiCare CR-912 Rhinitis Allergy Reliever is a low-frequency laser therapy that combines soft light laser with acupoint impulses. This has been shown to relieve nasal congestion, nasal itching, sneezing, runny nose and snoring with 15 minutes use.
Acupressure tip When nasal symptoms start, try self-acupressure: Press on the top end of the web between your thumb and index finger – at the highest point of the muscle, just before you can feel the bones meet. Press and rub firmly for one minute, then repeat on the other side. I’m never quite sure whether it’s mind over matter, distraction, or because acupoint stimulation is really effective. Either way, it works more often than not!
Which pollen is causing your hay fever?
Symptoms will vary from month to month, depending on which plants you are sensitised to and where you live. Hay fever tends to develop earlier in the year as you travel south, and later as you travel north.
Early spring – you are probably sensitive to hazel, elder and birch pollen
Late spring – plane tree pollen is one of the main culprits
Early to mid-summer – grass pollens are usually to blame, especially when counts exceed 50 grains per cubic metre of air
Late summer and autumn – mould and fungal spores are a common problem in damp weather.
Rhinitis can also be caused by other airborne allergens and, if you are sensitive to dust mites or certain animals, for example, nasal discharge, sneezing, congestion and itching can occur all year round (perennial rhinitis). Symptoms that occur for less than 4 days per week, or less than 4 weeks at a time, are defined as intermittent, while those occurring for at least 4 days a week, or for at least 4 weeks at a time, are described as persistent. Most of the approaches described below will help, whatever underlying allergy is causing your symptoms.
These allergic responses can also cause sinusitis with pressure pains and headache, may make asthma and eczema worse and cause difficulty sleeping. All in all, it makes what should be a pleasant time of year an exhausting misery.
Avoiding hay fever
The simplest way to reduce hay fever symptoms is to avoid heavy exposure to pollen, but this is easier said than done when you have to work or want to continue living a normal life. Where practical, aim to avoid:
- Going out when pollen forecasts are high – check the UK MetOffice pollen forecast here and the US National Allergy Forecast here
- Going out when pollen counts peak between 7 – 9 in the morning, and between 3 – 7 in late afternoon/early evening
- City streets during the afternoon as hay fever symptoms are made worse by exposure to traffic fumes
- Working at the top of a tall building as pollen rises – try to work at ground level rather than on the first floor or above
- Hanging clothing outdoors to dry as pollen can cling to them
- Pets that have been outdoors and will carry pollen on their fur/hair
- Gardening and mowing the lawn, barbecues and picnics – or try wearing a dust mask during these activities.
- Keep your bedroom window shut to avoid sleeping in a pollen trap at night, or use an air-filter or ioniser in your room.
I hope you found this overview of hay fever treatments helpful
If you continue to suffer problems despite trying the above over-the-counter treatments, always consult your doctor as some medicines are only available on prescription.
If you’ve tried any of the products I’ve recommended, or found anything else that helps, please let me know using the comments box below.
Click here to find out if taking locally produced honey can prevent hay fever.
Image credits: christine/flickr