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by Shilpa Patel Lead Clinical Practice Pharmacist @ BHWC

You are not alone! We have had so many patients request a change in their usual hayfever medication and many have found it difficult to alleviate the symptoms of dry throat, blocked or runny nose and itchy eyes. I did some quick research to find out why this is the case and found the same was claimed last year and the years before and various reasons given for each pollen season. Whilst I cannot explain why we seem to be getting worse symptoms this year, I can give you some advice on what you can do to help cope during this period.

Hayfever is an allergic reaction to pollen, typically when it comes into contact with your mouth, nose, eyes and throat. Pollen is a fine powder from plants. It is a condition that can usually be managed without having to contact the practice. The NHS has classified hayfever as a “self care” problem. This means that where possible it should be treated using over the counter preparations. I will guide you through the symptoms and offer treatments.

What is Hayfever?

As well as sneezing, coughing, a runny or blocked nose, itchy, red or watery eyes, itchy throat, mouth, nose and ears, symptoms of hayfever can include loss of smell, pain around your temples and forehead, headache, earache and feeling tired. If you have asthma, you might also have a tight feeling in your chest, be short of breath or have a wheeze and cough. Hay fever will last for weeks or months, unlike a cold, which usually goes away after 1 to 2 weeks.

Pharmacological Treatments

Over the counter treatments available to purchase from your pharmacy:
There are 4 antihistamines available to purchase from your community pharmacy. Each of these works completely different, so if you have tried one, try the next and so forth. You are likely to find that one works for you and another works for someone else.

Loratadine (usual brand name is Clarityn but may be in some own brand products) – label says causes drowsiness, but most people find this less drowsy, once daily administration, cheap as comes as own brand
Cetirizine (usual brand name is piriteze or zirtec but can be in own brand products) – label says causes drowsiness, but most people find less drowsy, once daily administration, cheap as comes as own brand
Acrivastine (brand name is Benadryl) – non-drowsy, can be taken up to 3 times a day – only comes as brand so is expensive – benefit is that you can take one in the morning and if you get more symptoms you can take in the evening too
Chlorphenamine (usual brand name is piriton but can be in some own brand products) – Drowsy. lasts 8 hours, so can be taken upto 3 times daily

Try one of the above tablets and it should alleviate most of your hayfever symptoms. Once you have found an antihistamine which works for you it is advisable to take this every day during the hayfever season to prevent the symptoms starting.

Eye drops: If you have runny eyes, try sodium cromoglicate eye drops – this comes as own brand but is also an ingredient in opticrom and optrex allergy eye drops. These are safe to use in addition to the tablets.

Nasal symptoms: If you have a runny nose you could add pseudoephedrine to dry the nose, for this reason I often recommend Benadryl plus, which contains acrivastine (an antihistamine) and pseudoephedrine (a nasal decongestant). Benadry Plus should only be used for 3-4 days and then you can switch to Benadryl Acrivastine.
If you have a blocked nose you could try a nasal spray. Popular nasal sprays are beconase, flixonase and otrivine (otrivine should only be used for max 7 days).

Non medical tips and advice

Vaseline on around nasal area
Keep windows closed early evening
put Vaseline around your nostrils to trap pollen
wear wraparound sunglasses to stop pollen getting into your eyes
shower and change your clothes after you have been outside to wash pollen off
stay indoors whenever possible
keep windows and doors shut as much as possible
vacuum regularly and dust with a damp cloth
buy a pollen filter for the air vents in your car and a vacuum cleaner with a special HEPA filter
do not cut grass or walk on grass
do not spend too much time in high pollen areas such as fields and parks
do not keep fresh flowers in the house
do not smoke or be around smoke – it makes your symptoms worse
do not dry clothes outside – they can catch pollen
do not let pets into the house if possible – they can carry pollen indoors

What next?

If you have tried all the above and are still suffering fill out an eConsult. We can prescribe a stronger antihistamine (fexofenadine) although this does not always work and better it may be worth trying as it can work for some patients, or you may need steroids. If steroids and other hayfever treatments do not work, we may refer you for immunotherapy. This means you will be given small amounts of pollen as an injection or tablet to slowly build up your immunity to pollen. This kind of treatment usually starts in the winter about 3 months before the hay fever season begins.

We do not endorse steroid injections, often referred to as the hayfever injection by patients. This is due to known complications associated with steroids. Oral steroids can be stopped and so are often prescribed for various conditions but if you have a serious side effect with an injection, this cannot be stopped.

I hope you find this article helpful and are able to find a product to alleviate your symptoms. I am aware this can be a tedious and painful process, but it is worth trying different medications until you find the right one for you.