As a doctor I’ve prescribed, used and recommended many hay fever treatments and have formed strong views on which are the most effective natural, herbal and pharmaceutical brands.
I’ve reviewed what I believe are the best pollen filters, eye drops, nasal barriers, nasal sprays and antihistamine tablets below, starting with drug-free methods before reviewing herbal and pharmacy medications. 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 the 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.
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.
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.
Overcoming 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.
Wrap-around glasses for hay fever
You can minimise 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’.
Filters for hay fever
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.
|Respro’s Cinqro comfortable face mask features two exhalation valves to expel heat and water vapour. Available in Gold, Camouflage, Pink, White or Yellow, the mask is fitted with a Hepa-Type particle filter that removes submicron particles such as pollen, diesel fumes, dust and other airborne allergens. Sizes medium, large and extra-large.
Check current cost on Amazon.co.uk or on Amazon.com
|If a full-on face mask is too much for you, WoodyKnows Ultra Breathable Nasal Filters will reduce your exposure to pollen, dust, molds and other airborne allergens to relieve hay fever, allergic asthma, rhinitis and sinusitis.
Select the filter size according to the natural size and shape of your nostrils. When in place, they are hardly visible as the electrostatic filter efficiently removes airborne particles before you can breathe them in. The disposable mesh is replaced every 3 days.
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.
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, 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 treatment 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 rhinophototherapy 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 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!
View current price on Amazon.co.uk or from Amazon.com
Laser acupuncture for hay fever
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) into two groups. Once received rhinophototherapy, 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!
Rinse away hay fever 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. 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 spray. For example, it maintains the effectiveness of intranasal steroids 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.
|Stérimar Isotonic nasal hygiene spray has an Allergy UK, Allergy friendly endorsement.
The sterilised sea water microdiffusion spray may be used long-term, 2 to 6 times a day, to rinse the nose, for as long as needed.
View current cost on Amazon.co.uk and on Amazon.com (NB ships from France, here are English language instructions if you need them)
Also available from Boots.com
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 and 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.
|Vitamin C that is encapsulated in liposomes has maximum bioavailabilty and is rapidly absorbed to get to work quickly. Each sachet of Lypo-Spheric or Altrient Vitamin C supplies a 1,000mg dose.
View products on Amazon.co.uk
Check price on Amazon.com
|Solgar’s Ester-C Plus provides a non-acidic, highly absorbable form of vitamin C to prevent digestive irritation. Each capsules contains 500mg, and each tablet 1000mg of vitamin C plus bioflavonoids.|
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 of seven tropical herbs that relieve 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 its antihistamine action 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.
|Luffa Complex is a tincture containing extracts from seven tropical herbs: Sponge Cucumber (Luffa), Heartseed, American Spikenard, Golden Thryallis, Chapparal, Okoubaka and Toothpick Weed.
Dose: adults: 20 drops, 2 to 3 times a day in water. Children: 1 drop twice a day in water.
|Solgar’s Pycnogenol is made to pharmaceutical standards and supplies 100mg French Maritime Pine Bark extract per capsule.
Dose: 1 or 2 a day.
Check price on Amazon.co.uk
View offers on Amazon.com
Nasal herbal sprays for hay fever
If you prefer to use herbal products before moving on to a pharmaceutical decongestants or steroid nasal sprays, the following products have helped many of my patients.
Pharmaceutical Medications for hay fever
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 ‘Expert opinion in a published review article suggests that non-sedating oral antihistamines and nasal corticosteroids may be used regularly without fear of adverse consequences.’
A recent head-to-head trial involving 682 people with allergic rhinitis/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 allergic rhinitis when used on a regular basis’, according to NICE.
As a general guideline, if your predominant symptom is sneezing or nasal discharge, either an oral antihistamine or an intranasal corticosteroid will help. If your main symptoms is nasal blockage/congestion, or if nasal polyps are present, however, an intranasal corticosteroid spray is likely to be more effective.
Oral antihistamines for hay fever
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, however, it’s best to select a newer 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 close 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 was loratadine which was 3 times less likely to cause sedation than cetirizine, and this is the version 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.
A similar product in the US is value-size Claritin one-a-day 10mg loratadine.
View offers on Amazon.com
Corticosteroid nasal sprays for hay fever
Many people find that nasal corticosteroid sprays offer better relief of symptoms overall than oral antihistamines. There is no clear evidence to suggest one nasal corticosteroid spray is more effective than another. As some sprays are more expensive, it is 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.
Check offers on Amazon.co.uk
Boots Hayfever Relief contains the same drug and, as an own-brand, tends to be cheaper.
| In the US, you have more choice with two leading pharmacy brands which contain medicines that are only available on prescription in the UK.
Nasacort Allergy contains triamcinolone acetonide.
View price from Amazon.com
Flonase Allergy Relief contains fluticasone propionate. View current cost from Amazon.com
If you are in the UK and are unable to visit your own doctor for a prescription, you can obtain the prescription-only Flixonase Aqueous nasal spray via an on-line consultation with a registered GP using the Pharmacy2U link below.
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 hayfever and is highly effective but only available on prescription – either from your own GP, or from the Pharmacy2U online doctor service above.
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.
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.
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.
|Opticrom Hayfever eyedrops contain sodium cromoglycate.
Dose: 1 or 2 drops in each eye, 4 times a day.
View offers on Amazon.co.uk
Boots own-brand Allergy Relief eye drops tend to be cheaper.
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