How to survive hay fever: the ultimate guide

    26 July 2016

    A lot of patients have come to see me of late all saying the same thing: ‘I don’t usually have hay fever, but…’

    Whatever is going on this year, it seems to be affecting a lot of us, myself included. Over-the-counter medications seem to be not as effective as they have been previously in relieving the symptoms, so patients come to their GP for help. And yes, in the short term, there are a few things that we can do.

    For hay fever, where you live matters. A prominent allergy specialist recently advised that sufferers, in severe cases, tended to move areas. London, where I live, has a particular issue. Vehicle emissions are high and particles from exhaust fumes tend to amplify allergies. It is in a valley, too, where pollutants tend to pool and aggregate until the rain comes.

    Timing is important. If you suffer from February to June, tree pollens are probably the culprit, whereas May to July it’s grass pollen and June to September it’s likely to be weeds.

    For children, it is useful to know that hay fever has been identified as an explanation for underperformance in exams. I ordinarily advise patients a year of two away from their GCSEs to plan their approach to exam season and perhaps consider a referral to an allergy specialist the year before.

    There is plenty you can do before it gets to this stage, however. Here is my list, in order of priority. For some patients the first two actions may be enough to reduce symptoms. Others, like me, should be doing the whole lot.

    1. Shower before bed to wash the pollen off. This is the first place to start. Pollen is sticky: if we are bathed in it during the day we don’t want to lie in it overnight. It makes no sense to sleep in the very thing that you are allergic to.

    2. While in the shower, rinse the inside of your nose. This may sound abhorrent but it works. Products to use are Sterimar, NeilMed or Neti Pot. Sterimar sprays a fine mist; Neti Pot is more like a watering can that you pour into one side of your nose while tilting your head.

    3. If you are still suffering, a steroid nasal spray should be added to the routine. This should be applied just before bed. The idea is that once the steroid is applied and you start to fall asleep, it will actually stay there. If you spray in the morning, it will likely come out as soon as you blow your nose… which is likely as soon as you leave the house. The products to try are Beclomethasone, then Fluticasone, and then Mometasone (in order of increasing potency).

    4. The next thing to consider is nasal decongestants. Some people have frontal sinus issues and sinus pressure and can develop an ear condition called Eustachian tube dysfunction — this is because fluid is trapped in the small aerated canals around your face, or behind your ears. There are a range of over-the-counter nasal decongestants available. I recommend using these at night again, as it will improve their effectiveness. Warning: they can taste awful as they drip down your nose.

    Only use nasal decongestants for about five days at a time. If used for longer you can become dependent on them. In its worst form, you can have a change in your nose called rhinitis medicamentosa.

    Oral decongestants can be quite stimulating, so best avoided at night. Coffee works for some in the day.

    5. Antihistamines. Medicines to try in order of increasing potency: Cetirizine, Loratadine, Fexofenadine. Again, best used at night. Some people get the extra benefit of increased sleepiness from the medication and it should last you through most of the next day. Plus, you’re more likely to keep taking it at night.

    6. A smear of vaseline on the inside of your nose before leaving the house. I don’t know how effective this really is, but I have been told it helps to catch the pollen before it moves further up your nose.

    7. Ocular/eye antihistamines: sodium cromoglicate eye drops are available over the counter. If your eyes are really playing up, and itching you terribly, this can help.

    8. If your airways are affected, it is perhaps worth visiting the GP for help. Prescribed medications to make breathing easier include montelukast and salbutamol. Salbutamol, your first choice, is most commonly taken via an inhaler. Montelukast, which reduces the effect of the immune system, is taken in tablet form.

    If this isn’t working so well, and the symptoms are particularly severe, consider a referral to an allergy specialist. Hay fever can be significantly debilitating to the point where specialist immune therapies are required to keep it to a tolerable level, and a GP can facilitate a referral to an allergy centre easily.