What is hay-fever?

Hay fever is caused by an allergic reaction to pollen which comes from plants when it comes into contact with your eyes, nose and throat (1). 

In the UK, hay fever symptoms are at their peak between late March and September. Hay fever affects around 13 million people in the UK (1).

There is currently no ‘cure’ for hay fever, and you cannot prevent it.

What are the symptoms?

The symptoms of hay fever include (1):

• sneezing

• itchy eyes, nose and throat

• runny nose

• feeling tired

• red and watering eyes

Hay fever will only occur seasonally, so if you have symptoms in the winter for example, this is unlikely to be hay fever. 

What can you do to help with hay fever?

• Local weather reports have information about pollen counts. If the pollen counts are due to be high or very high, you can consider your activities on those days, for example. This might involve staying home if possible, or keeping windows and doors closed. Some people believe that rain helps to reduce hay fever symptoms, this is true for light rainfall, but heavy rainfall is felt to have the opposite effect (2).

• Wearing sunglasses can help to protect your eyes from the direct hit of pollen.

• Putting vaseline around your nostrils can help to trap pollen.

• If you do spend time outside, when you come into the home it is best to try and change your clothes, and if you are able to, wash your hands and face.

• In terms of cleaning, using a damp cloth or a vacuum with a HEPA filter can help. You may be able to attach a pollen filter to your car.

• Where possible, avoid cutting grass and keeping flowers indoors. If you do suffer badly with hay fever, try not to dry clothes or bed sheets outdoors as this can trap pollen, similarly, pets can also bring in pollen.

• It can be helpful for symptom relief to use a cold flannel over your eyes if they are irritated, or shower including washing your hair where pollen may be trapped.

• There is some discussion with regards to whether honey can be helpful for hay fever, however, the outcomes of studies do not reveal a benefit from ingesting honey. There was a pilot in Finland which showed honey with birch pollen did help, however, this was a pilot study and should not be used as medical advice.

Why do some people suffer more than others?

People with other conditions, such as asthma may suffer with more severe symptoms such as chest tightness and coughing (1). 

What treatments are available?

Antihistamines are the mainstay treatment and can be purchased Over-The-Counter or on prescription. These come in two main classes, drowsy and non-drowsy. It is worth noting that antihistamines impact individuals differently, and hence it is worth trying different types of antihistamines, particularly if one isn’t working. It is best to speak to your pharmacist/GP first to find the best for you. You can take them as required or you can take them as a preventative measure (I.e. if you know there’s a high pollen count that day). If your symptoms are not controlled with that, your GP may prescribe corticosteroids. Nasal decongestants and eye drops are also often used. In very severe cases of allergy, your GP may refer you onward to an allergy specialist who may consider immunotherapy (1).

There is a ‘hay fever injection’ which is available privately. This injection is a steroid injection into a muscle, which is released slowly over a number of weeks. This helps to reduce inflammation in the body and hence hay fever sufferers can benefit by getting longer lasting relief than once daily medications. Although the treatment is helpful to some, it is no longer available on the NHS due to lack of robust evidence (4).

Alternative therapies that claim to treat hay fever include acupuncture, but study results have not confirmed significant improvements. No herbal remedies are recommended. 

What is the best antihistamine?

GPs are often asked to prescribe ‘the strongest’ antihistamine. There is no such thing, unfortunately. If one antihistamine hasn’t worked for you, do try another, as they affect individuals differently. Previously, fexofenadine (5) was only available on prescription, however, this was only as it did not have as much safety data as the other medicines. Now, fexofenadine 120mg is available to buy from pharmacies. 

What research is being done into hay fever?

There are several studies ongoing into treatments for hay fever. A sublingual tablet called Grazax is a type of sublingual immunotherapy which is being researched. The GRADUATE (6) study is looking into a treatment which has helped with other conditions such as allergic eczema and if this has a role in hay fever. If you are interested in participating in a hay fever study, you can find more information here 

Summary

Hay fever is an incredibly common condition in the UK and can severely impact an individual’s quality of life and ability to engage with school, work or recreational activities. If you are suffering, please do speak to your pharmacist in the first instance, thereafter, if you still need help, then do speak to your GP.