Hay Fever & Allergy Treatment

Treatment can include prescription antihistamines, nasal corticosteroid sprays, combination sprays and eye drops. Starting before the season rather than during it makes a substantial difference.

Book if

• Pharmacy antihistamines are not controlling it
• Symptoms are affecting sleep, work or exams
• You want treatment in place before the season starts
• Eye symptoms are the dominant problem

Needs assessment first

Wheeze, chest tightness or breathlessness may indicate asthma rather than hay fever alone. Allergic rhinitis and asthma frequently coexist, and treating only the nose leaves the more serious half untreated.

Practical note

Sedating antihistamines affect driving and concentration. If exams or work are the reason you are treating this, the non-sedating options matter.

1. Start before the season

Nasal steroids take one to two weeks to reach full effect. Starting when symptoms arrive means spending the first fortnight of every season miserable.

2. Combine, do not substitute

Antihistamine plus nasal steroid works considerably better than either alone. Most people who say antihistamines have stopped working are missing the second half.

3. Spray technique

Aim outward, toward the ear on the same side, not up the middle. Aiming at the septum causes nosebleeds and delivers the dose to the wrong place — which is why most people conclude the spray does not work.

4. Escalate if needed

Combination sprays and eye drops for symptoms not controlled by the above.

Start before the season, not during it

Nasal steroids take one to two weeks to reach full effect. Starting when symptoms arrive means spending the first fortnight of every season miserable for no reason.

• Tree pollen — start late February to March
• Grass pollen, the commonest — start late April
• Weed pollen — start June

Then use it every day through the season, not on bad days only. These sprays work by suppressing inflammation continuously; used intermittently they barely work at all, which is what most people conclude about them.

Spray technique — the single commonest reason treatment fails

• Aim outward, toward the ear on the same side. Not up the middle
• Use the opposite hand — right hand for left nostril — which makes the angle happen naturally
• Do not sniff hard. A gentle breath in; sniffing sends it straight down your throat
• Aiming at the septum causes the nosebleeds people blame the spray for, and delivers the dose to the wrong place

Review after two to four weeks

• Technique, demonstrated rather than described. Almost everyone believes they are doing it correctly
• Whether it is being used daily or only on bad days
• Whether an antihistamine and nasal steroid are being combined — which works considerably better than either alone
• Whether eye symptoms need separate treatment

What needs a different assessment

• Wheeze, chest tightness, breathlessness or a night-time cough. Allergic rhinitis and asthma frequently coexist, and treating only the nose leaves the more serious half untreated
• One-sided symptoms, bleeding, facial pain or loss of smell — not typical hay fever and needing assessment
• Year-round symptoms, which suggest dust mite, pets or mould rather than pollen — a different management plan entirely

Practical things that help

Check the pollen forecast; keep windows shut in the early morning and evening when counts peak; shower and change clothes after being outside; and do not dry washing outdoors during the season. Wraparound sunglasses genuinely help eye symptoms.

Most of what works is available without a prescription

• Non-sedating antihistamines — cetirizine, loratadine, fexofenadine — all over the counter, and supermarket own-brand is the identical drug at a fraction of the branded price
• Nasal corticosteroid sprays, several available over the counter. The most effective single treatment for hay fever, and the one most people are missing
• Sodium cromoglicate eye drops, over the counter and effective for eye symptoms
• Saline nasal rinses, cheap and genuinely useful before the steroid spray

If you have not combined an antihistamine with a properly used nasal steroid, that is the first thing to try — and it costs a few pounds.

Where a prescription adds something

• Combination nasal sprays — antihistamine and steroid together, more effective than either, and prescription-only
• Prescription-strength antihistamines, and options in pregnancy
• Montelukast, sometimes used where asthma coexists — though it carries a warning about mood and behaviour changes that should be discussed before starting
• A short course of oral steroid for exam or wedding week, used sparingly and never as a routine seasonal approach

What we will not prescribe

Depot steroid injections — Kenalog and similar — for hay fever. They are no longer recommended in the UK: the dose cannot be withdrawn once given, and it suppresses the adrenal system for months.

Private clinics do still advertise them, and we would rather explain why we do not.

The treatment that changes things long term

Immunotherapy — desensitisation with tablets or injections over about three years — is the only treatment that modifies the allergy rather than suppressing symptoms. Available on the NHS through allergy clinics for severe hay fever not controlled by everything else, and worth asking about if you dread every summer.

When testing is worth it

Only where the result would change something. Seasonal symptoms in May and June do not need a test to confirm grass pollen. Year-round symptoms are worth testing, because dust mite and pet allergy are managed quite differently.

What you pay us

• £40 for the consultation, including nasal spray technique taught properly
• Allergy testing where it would change something, quoted first — and often it would not

Be honest with yourself before booking

Almost everything that works for hay fever is available over the counter for a few pounds: antihistamines, nasal steroid sprays, and eye drops.

Supermarket own-brand cetirizine or loratadine is the identical drug to the branded version at a fraction of the price, and a nasal steroid spray from a pharmacy costs very little.

If you have not tried a nasal steroid, used daily and sprayed correctly, alongside an antihistamine — try that first. We would rather say so than take your money.

What the appointment is actually worth

• The technique. Most sprays fail because of how they are used, and being shown properly is worth more than another prescription
• Combining rather than substituting. Most people who say antihistamines stopped working are missing the second half of the plan
• Checking it is hay fever, and not asthma hiding behind it
• Prescription-only combination sprays where over-the-counter treatment genuinely has not worked

Where not to spend money

• Branded antihistamines when the generic is identical
• Depot steroid injections, still advertised privately and no longer recommended in the UK
• Air purifiers, nasal filters and supplements, none of which has evidence approaching that for a nasal steroid
• Allergy testing that will not change anything — if your symptoms are in June, you do not need a test to name grass pollen

The one worth asking the NHS about

Immunotherapy — three years of desensitisation — is the only treatment that alters the underlying allergy, and it is available on the NHS through allergy clinics for severe hay fever that everything else has failed to control.

My antihistamines have stopped working. What now?

Usually they have not stopped working — they were never enough on their own.

A nasal corticosteroid spray is the most effective single hay fever treatment, and combining it with an antihistamine works considerably better than either alone. Most people missing control are missing that second half.

Am I using the spray correctly?

Probably not — almost nobody is, and it is the commonest reason sprays "do not work".

• Aim outward, toward the ear on the same side, never up the middle
• Use the opposite hand — right hand, left nostril — which produces the correct angle naturally
• Breathe in gently. Do not sniff hard, which sends it down your throat

Aiming at the septum causes the nosebleeds people blame the spray for.

When should I start treatment?

Before the season, because nasal steroids take one to two weeks to work fully.

Tree pollen: late February. Grass pollen: late April. Weed pollen: June. Starting in the first bad week means a fortnight of unnecessary misery.

Can I use it only on bad days?

No — that is why it seems ineffective. Nasal steroids suppress inflammation continuously and need daily use through the season.

Antihistamines can be taken as needed. The spray cannot.

Which antihistamine is best?

Fexofenadine, cetirizine and loratadine are all non-sedating and all effective, and people respond differently — if one does little, try another.

Avoid the older sedating ones (chlorphenamine, promethazine) if you are driving, working or sitting exams. Buy own-brand: it is the identical drug at a fraction of the price.

Could it be something other than hay fever?

Worth asking, particularly if:

• Symptoms are year-round — suggesting dust mite, pets or mould, which are managed differently
• Only one side is affected, or there is bleeding, facial pain or loss of smell — not typical, and needing assessment
• There is wheeze, chest tightness or a night-time cough — which raises asthma

Why does hay fever matter for asthma?

Because they frequently coexist, and treating only the nose leaves the more serious half untreated. Uncontrolled hay fever makes asthma harder to control.

Any wheeze or breathlessness needs assessing properly rather than being treated as hay fever alone.

Can you give me a steroid injection for my wedding?

No. Depot steroid injections such as Kenalog are no longer recommended for hay fever in the UK — the dose cannot be withdrawn once given, and it suppresses the adrenal system for months.

Some private clinics still offer them. For a specific occasion, a short course of oral steroid alongside optimised treatment is the safer approach.

Do I need allergy testing?

Only where the result would change something. Symptoms every May and June do not need a test to identify grass pollen.

Testing is worth it for year-round symptoms, where identifying dust mite or a pet changes the plan considerably.

Is there anything that cures it?

Immunotherapy comes closest — desensitisation with tablets or injections over about three years, which modifies the allergy rather than suppressing symptoms.

Available on the NHS through allergy clinics for severe hay fever not controlled by anything else, and worth asking about if every summer is a write-off.

What can I take in pregnancy?

Several options are considered safe — certain antihistamines and nasal steroids among them — and saline rinses are entirely safe and genuinely useful.

Do not simply endure it. Tell the GP you are pregnant and the plan will be built around it.