Greater Knox Pharmacy
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Hay fever, also called allergic rhinitis, is caused by an allergic response to outdoor or indoor allergens, such as pollen, dust mites, or tiny flecks of skin and saliva shed by cats, dogs, and other animals with fur or feathers (pet dander).
When you have hay fever, your immune system identifies a harmless airborne substance as harmful. Your immune system then produces antibodies to this harmless substance.
In Australia, up to 21% of the population is affected by hay fever, most commonly between the ages of 25 and 44 years.
Rhinitis is a major risk factor for developing asthma; effective management of rhinitis is associated with better asthma control. Patients with rhinitis due to pollen allergy have an increased risk of asthma exacerbations during thunderstorms coinciding with high pollen season.
The following can increase your risk of developing hay fever:
Hay fever signs and symptoms can include:
Signs and Symptoms | Onset | Duration | |
---|---|---|---|
Hay Fever | Runny nose with thin, watery discharge; no fever | Immediately after exposure to allergens | As long as you're exposed to allergens |
Common Cold | Runny nose with watery or thick yellow discharge; body aches; low-grade fever | One to three days after exposure to a cold virus | Three to seven days |
Hay fever can be classified by severity and chronicity and is usually described by both adjectives, for example 'intermittent, severe' or 'persistent, mild'. This classification is useful for choosing management options.
Intermittent
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Persistent
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MildNormal sleep and:
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Moderate or SevereOne or more of:
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It is extremely hard to avoid getting hay fever. The best thing to do is to lessen your exposure to the allergens that cause your symptoms and take allergy medications before you are exposed to allergens.
Reducing allergen exposure can be often difficult especially for house dust mites and outside pollen, but it can be beneficial to reduce the severity of hay fever symptoms.
Many people only find relief when using a combination of hay fever medications. This depends on severity, frequency and type of symptoms.
When symptoms improve doses may be reduced.
Itch/Sneeze | Nasal discharge | Nasal blockage | Eye symptoms | |
---|---|---|---|---|
Intranasal corticosteroids | +++ | +++ | ++ | ++ |
Oral/intranasal antihistamines | ++ | ++ | +/- | ++ (oral) - (intranasal) |
Antihistamine eye drops | - | - | - | ++ |
Oral/intranasal decongestants | - | - | + (oral) +++ (intranasal) | - |
Decongestant eye drops | - | - | - | +/- |
Intranasal Chromones | + | + | +/- | - |
Cromoglycate eye drops | - | - | - | + |
Ipratropium | - | +++ | - | - |
Montelukast* | - | + | ++ | ++ |
+++ very effective, ++ moderately effective, + marginally effective, +/– little or no effect, – ineffective | ||||
* Requires prescription |
Should be used 10-15 minutes before other medicated nasal sprays. They help to clear nasal congestion, wash away dust, pollen and other irritants.
For many people these are often the most effective medication, and should be the option to try first. They are most effective to relieve itch, sneeze, and nasal discharge, and have good efficacy to relieve nasal blockage and eye symptoms.
The maximum benefit can take up to 2 weeks, and they are best started before the allergy season and continued throughout. Some symptoms can improve within hours however.
There are several you can buy without a prescription, including:
Pregnancy | Breastfeeding | Children | |
---|---|---|---|
Budesonide (e.g. Rhinocort) | A - safe | safe | > 2 years |
Mometasone (e.g. Nasonex) | B3 - probably safe | safe | > 3 years |
Beclomethasone (Beconase) | B3 - probably safe | safe | > 12 years |
Fluticasone (Flixonase) | B3 - probably safe | safe | > 2 years |
Individual response to an antihistamine varies widely; it may be necessary to try a number to see which is best tolerated and most effective. Even though they are typically tried first, they may not offer the best results. They can improve most symptoms of hay fever, and they can be used along with other options for better symptom control.
Advantages
Pregnancy | Breastfeeding | Children | |
---|---|---|---|
Loratadine (e.g. Claratyne) | B1 - probably safe | safe | > 1 year |
Fexofenadine (e.g. Telfast) | B2 - probably safe | safe | > 6 months^ |
Cetirizine (e.g. Zyrtec) | B2 - probably safe | safe | > 1 year |
Desloratadine (e.g. Aerius) | B1 - probably safe | safe | > 6 months* |
Bilastine (e.g. Allertine) | B3 - consider alternative | consider alternative | > 12 years |
Usually require multiple daily doses. More likely to cause side effects than the less sedating options. Examples include:
They have similar efficacy to oral antihistamines (except on eye symptoms). Examples include:
Work quite quickly, usually within 15 minutes. Can be used alongside other medications for symptoms of itchy and watery eyes. Examples include:
Rarely used on their own for hay fever, and have limited benefit when used with other medications. Benefit is mostly restricted to relieving nasal blockage when nasal sprays are used.
Offer only a slight benefit in improving nasal blockage, compared to their potential side effects. They do not feature in any hay fever treatment guidelines.
Very effective for relieving nasal blockage, but are not recommended to be used for more than 3-5 days in a row. If prolonged use is required, take a break every 3-5 days to avoid rebound congestion.
Not recommended for the following reasons:
May be an option when a runny nose is the dominant problem. Examples include:
Only available in eye drops. They are not as effective as other options and take longer to work.
May be beneficial for patients who suffer from both hay fever and asthma. However, it is less effective than intranasal corticosteroids and requires a doctor’s prescription.
Link1
If medications don't relieve your hay fever symptoms or cause too many side
effects, your doctor may recommend allergy shots (immunotherapy or desensitisation therapy). Usually started by an allergy specialist.2