If shop-bought antihistamines are not working, there is a great deal more available.
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Hay fever is an allergic reaction to pollen. The immune system treats a harmless protein as a threat, releases histamine and other mediators, and the result is the sneezing, itching, streaming and congestion that makes a British summer miserable for around one person in four.
The single most useful thing on this page is about timing. The most effective treatment for moderate or severe hay fever is a steroid nasal spray — and it takes days to a couple of weeks to reach full effect. So the people who start one when symptoms are already unbearable conclude it does not work, when in fact they started it a fortnight too late.
Begin your nasal spray two weeks before your season starts, and continue it daily through the season rather than using it when you feel bad. That one change transforms results more than any change of drug.
The second most useful thing is technique. A large proportion of people use nasal sprays in a way that delivers the dose to the back of the throat rather than the nasal lining — detail below.
Knowing which season affects you tells you exactly when to start treatment.
Pollen seasons in the UK have lengthened and intensified. Warmer springs bring tree pollen earlier, and higher carbon dioxide increases pollen production. This is not imagination — people genuinely are experiencing longer, heavier seasons than a generation ago.
Untreated hay fever measurably worsens asthma control. If you have both, treating the nose properly is part of treating the chest — and this connection is routinely overlooked. A summer deterioration in asthma is very often untreated hay fever.
If your mouth or lips itch when eating raw apple, stone fruit, celery, carrot or nuts — but the same foods are fine cooked — that is pollen food syndrome. Proteins in those foods resemble birch pollen closely enough to cross-react. It is usually mild and confined to the mouth, but tell us: rarely it is more significant, and it is frequently mistaken for a straightforward food allergy.
Hay fever is diagnosed from the history, and the history is usually conclusive. Itchy eyes and nose, sneezing and clear discharge that recur at the same time each year, worse outdoors and on dry windy days, make the diagnosis without any test.
Not routinely, and testing without a clear question produces positives that reflect sensitisation rather than clinical allergy — which leads to pointless avoidance.
Specific IgE blood testing or skin prick testing is genuinely useful where:
Hay fever assesses well remotely and prescriptions reach your pharmacy within minutes. Most treatment is available over the counter, and a consultation is worth it when what you are buying is not working.
For anything beyond mild symptoms this does more than antihistamines. Two things determine whether it works:
Timing. Start two weeks before your season, use it every day, and do not stop and start according to how you feel.
Technique. This is where most people go wrong:
Aiming at the septum in the middle is also the commonest cause of nosebleeds from these sprays.
Non-sedating antihistamines — cetirizine, loratadine, fexofenadine — work well for sneezing, itch and runny nose, less well for congestion. They can be taken daily through the season.
Avoid sedating antihistamines such as chlorphenamine. They impair concentration, reaction times and driving — including the morning after — and they are still widely sold for hay fever. If you are sitting exams or driving, this matters considerably.
We do not give steroid injections for hay fever. A single depot injection of triamcinolone was once common and is no longer recommended — it delivers a high, uncontrollable systemic steroid dose over weeks, and safer treatments exist. Some private clinics still offer it; we do not, and we would advise against it.
For severe hay fever that does not respond to full treatment, desensitisation — daily tablets or injections over three years — can produce lasting improvement. It is specialist-initiated and we can refer.
Call 999 for:
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Start your nasal spray two weeks before your season. For grass pollen — which affects most people — that means starting in early May. Tree pollen sufferers should start in mid-March.
Local honey has no credible evidence — the pollen in honey is from flowers, not the wind-borne grass and tree pollen that causes hay fever. Most "natural" remedies marketed for hay fever have nothing behind them.
Hay fever treatment is almost entirely over the counter, and cheap. Antihistamines, steroid nasal sprays, eye drops and saline rinses are all available from any pharmacy for a few pounds, and buying a season's supply at once costs considerably less than a packet at a time. Your NHS GP treats hay fever free.
We would not charge you for a prescription you can buy today, and for most people that is the honest answer.
What is worth twenty minutes is hay fever that is not responding — because the reason is almost never that the antihistamine is too weak. Four things account for most failures: the steroid nasal spray is missing entirely; it is being aimed at the middle of the nose rather than outwards; it was started in May instead of two weeks before the season; or it is being used on bad days rather than every day. Each is fixable in a single conversation.
The other thing worth paying for is the assessment behind the symptoms — specific IgE testing to establish what you actually react to, and an honest view on whether immunotherapy referral is justified.
What we will not prescribe is a Kenalog injection. Depot steroid injections for hay fever are no longer recommended in the UK — the systemic steroid load is disproportionate to a seasonal allergy, and it cannot be withdrawn once given.
BSACI (British Society for Allergy and Clinical Immunology) guidelines for the management of allergic and non-allergic rhinitis are the principal UK reference, establishing intranasal corticosteroid as the single most effective treatment, the value of starting before the season, and the stepwise addition of antihistamines and eye drops.
NICE Clinical Knowledge Summary, Allergic rhinitis — seasonal, covers primary care management including nasal spray technique.
The position on depot corticosteroid injections follows RCGP and BSACI guidance, which do not support their use for seasonal allergic rhinitis given the risk-benefit balance of systemic steroid for a self-limiting seasonal condition.
BSACI guidance on allergen immunotherapy defines the threshold for referral: severe symptoms unresponsive to optimal medical treatment with confirmed sensitisation.
ARIA underpins the severity classification and the recognised association between allergic rhinitis and asthma control.
Almost always one of three things. You started it too late — it needs two weeks to take full effect, so begin before your season. You are using it intermittently rather than daily. Or the technique is wrong — aiming up the middle and sniffing hard sends the dose down your throat. Fix those three and most sprays work.
Itch is the giveaway. Colds do not make your eyes, nose and palate itch. Colds also clear within about ten days, may cause a mild fever and aching, and produce discharge that thickens. Hay fever runs for weeks, recurs at the same time each year, and stays clear and watery.
Yes. Non-sedating antihistamines are designed for continuous use through a season and are safe taken daily for months. Taking one only when symptoms are already bad works considerably less well than taking it consistently.
We do not offer one. The single steroid injection some private clinics still provide delivers a large uncontrolled dose of systemic steroid over several weeks and is no longer recommended, because safer and equally effective treatments exist. Immunotherapy — a proper desensitisation course over three years — is a different thing entirely and we can refer for it.
Pollen food syndrome. Proteins in raw apples, stone fruit, celery, carrots and some nuts closely resemble birch pollen, so your immune system reacts to them. It is usually confined to the mouth and the foods are typically fine cooked. Worth mentioning, since occasionally reactions are more significant.
No. It is a persistent and appealing myth, but the pollen in honey comes from flowers pollinated by insects — not the wind-borne grass and tree pollen that causes hay fever. There is no credible evidence of benefit.
Because untreated hay fever worsens asthma control — the upper and lower airways behave as one system. Treating the nose properly is part of treating the chest, and a summer asthma deterioration is very often uncontrolled hay fever underneath.
Yes. It most often begins in childhood or adolescence, but it can appear at any age — including after moving to a new area with different vegetation. New symptoms in an adult are worth confirming rather than assuming, particularly if they are year-round or one-sided.
August 23, 2026
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Call 999 or go to A&E — do not book an online appointment and do not wait for a reply to an email. For urgent problems that are not emergencies, NHS 111 is available 24 hours a day, online or by phone, and can direct you to the right service.
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