You may be a hay fever veteran or new to the season of sneezing and streaming. There’s an array of hay fever products available, so let our resident pharmacist take you through where to start and how to choose between them.
Oral antihistamines are a good place to start, especially if you have multiple symptoms. They aim to reduce the overall immune response, which is driven by the release of histamine from mast cells. Starting antihistamines early is key to controlling symptoms, ideally a couple of weeks before your pollen season.
Once-daily antihistamines are available to buy and contain loratadine (Claritin, Alavert), levocetirizine (Xyzal), fexofenadine (Allegra), or cetirizine (Zyrtec). They are similar in effectiveness, but you may find one works better than another. They get to work within 1 to 3 hours and peak in effectiveness after 8 to 12 hours but last for 12-24 hours. These formulations are unlikely to make you drowsy. Carefully follow the directions and the cautions on the label.
Older antihistamines are more likely to cause drowsiness – this may be an advantage if symptoms are worse at night, but not if you need to operate heavy machinery or drive long distances. Those containing chlorpheniramine or diphenhydramine are older types. They work for a shorter amount of time, typically 4 to 6 hours, so you might need to take them several times a day or just when the pollen count is higher, typically early mornings and evenings. Despite this, some people think they work better for their particular hay fever – it's a question of trial and error on what works for you.
You may want to treat a single symptom, such as a stuffy or runny nose or just itchy or streaming eyes.
Cromolyn sodium 4% products, such as Opticrom eye drops, are available by prescription for those aged 4 and above. This active ingredient is not classed as an antihistamine but works to reduce the release of histamine in the eyes and suppress allergy symptoms there. It’s applied four times daily and can be used as a standalone treatment or alongside oral antihistamines.
Cromolyn sodium is available in a nasal spray (NasalCrom) over-the-counter.
Antihistamine eye drops such as ketotifen (Zaditor, Alaway) are available over-the-counter. They only need to be applied twice a day and are safe in children 3 years of age and older. Olopatadine (Pataday) is available twice a day and has two strengths of a once a day formulation. They are safe for children as young as 2 years of age. Other ophthalmic antihistamines are available by prescription.
Just recently, azelastine nasal spray (Astepro) was made available over-the-counter. It can be used once or twice a day and also comes in a formulation safe for children 6 years of age and older.
Steroid nasal sprays are available over-the-counter and contain either fluticasone (Flonase), triamcinolone (Nasacort), or budesonide (Rhinocort). They can be dosed in children less than 12 years of age after consultation with a doctor.
Steroid nasal sprays have similar effectiveness and potential for side effects. They are often used once a day instead of twice a day. The choice of a product is based on personal preference and cost.
Steroid nasal sprays take one to two weeks to build up to maximum effect, and they need to be taken regularly. You can start them a couple of weeks before you anticipate the pollen season starting, and they can be taken throughout for up to 3 months. They are considered safe for adults, and only a minute amount of steroid is absorbed into the body, so they do not carry the risks of taking steroid tablets.
While you wait the few days for a steroid nasal spray to get to work, you may seek short-term relief. A nasal decongestant spray such as Sinex or Afrin can relieve a blocked nose or sinuses within minutes. Nasal decongestant sprays don’t reduce the immune response like steroids do, but instead they temporarily shrink blood vessels in the nasal passages, relieving the feeling of a stuffy nose. These should not be used for more than 7 days, as continual use can cause rebound congestion once you stop.
A decongestant tablet such as pseudoephedrine (Sudafed)) can also rapidly clear the nasal passages. However, a tablet is more likely to interact with other medicines, and some may experience a racing pulse or palpitations, or increased wakefulness, as it has an adrenaline-like effect on the body.
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