Question: I suffer from terrible hay fever and this year it is almost unbearable. I have been taking antihistamines since March, and I use eye drops and a nasal spray that the chemist recommended, but it doesn’t seem to make any difference. I recall someone mentioning a shot they used to get that sorted out hay fever, but I can’t find any information on it. Are there stronger remedies that I could ask the GP for? Please don’t tell me about washing bedding and closing windows, because I do all that already.
Dr Grant replies: Hay fever is also known as ‘allergic rhinitis’ or ‘rhinosinusitis’ and treatment has come on leaps and bounds over the past decade or so. It is practically curable if you invest in the right treatment and give it time to work.
I think ‘the shot’ you refer to is probably a depot-steroid injection — as far as I am aware, it is not given for hay fever anymore as there are better treatments now available.
Hay fever can begin at any age. The risk is higher for those with a family history or people who suffer from asthma or eczema. Rhinosinusitis is a reaction to small airborne particles called ‘allergens’ that cause the lining of the nose and/or sinuses to swell, resulting in sneezing, rhinorrhoea (runny nose), and nasal obstruction, accompanied by itching of the eyes, nose, and palate. This can also cause fatigue, irritability, post nasal drip and cough.
It can be helpful to identify what exactly is causing your hay fever symptoms — an allergy specialist can do skin prick tests or blood tests to help identify your triggers. This may help you avoid them, and will highlight if you can seek immunotherapy, which can eventually reduce reliance on long-term medication use.
Antihistamine medication has been the gold standard of treatment for decades and can be bought in any pharmacy. Oral antihistamine tablets have good efficacy for reducing itching, sneezing and some runny eye/nose symptoms.
Some people with severe eye symptoms find topical antihistamine eye drops work well. The scientific data suggests topical steroid eye drops (not safe to use in the long term) or steroid nasal sprays (can be used for several months every year) are the most effective single maintenance therapy — they work within a few hours, though maximal benefit may take a few days or weeks to be seen. In general, patients tend to under-use steroid nasal sprays.
Thankfully, there are two highly effective new treatments. The first is called SubLingual ImmunoTherapy (SLIT) — it is given as either a dissolvable tablet or liquid extract and is taken daily for three years. SLIT not only treats your hay fever as effectively as steroids or antihistamines but also retrains your immune system to be ‘less allergic’, giving the potential to get rid of your hay fever symptoms for good.
The second treatment is called ‘Rhinolight’ intranasal phototherapy. It involves inserting a small nasal endoscope into the nostril that emits UV-A, UV-B, and visible light (safe ranges of light spectrum) to reduce inflammation, while partially desensitizing the nose and sinuses against allergies. It is painless and does not cause any tissue damage. What’s more, it is an effective treatment for the vast majority of allergic rhinitis triggers.
Dr Jennifer Grant is a GP with Beacon HealthCheck