How do different hay fever treatments work and which one should you pick?

Melbourne’s apocalyptic spring is back. Nearly one in five Australians will be subjected to the misery of hay fever.

Characterised by watery, itchy red eyes, a runny or congested nose, and incessant sneezing, hay fever, or allergic rhinitis, occurs when allergens enter the nose or eyes.

These allergens get trapped in the tiny hairs inside your nose, often triggering an allergic reaction. Your immune system thinks it’s under attack. Nasal cavities become inflamed, causing your body to create more mucus in an attempt to flush out the irritating particles.

Common seasonal allergens include tree, grass, and weed pollens, while year-round allergens comprise dust mites, mold, and pet dander. In many parts of Australia, pollen season is in full swing!

So, what treatment options are available to prevent or alleviate hay fever symptoms, and how do they work? Let’s break it down.

1. Antihistamines

Given that histamine release is a key contributor to hay fever symptoms, it’s no surprise that antihistamines are among the most commonly recommended medications for treating hay fever. Antihistamines function by blocking histamine from binding to histamine receptors in the body, thereby reducing symptoms.

In Australia, two main categories of antihistamines are available: older sedating versions (introduced in the 1940s) and newer, less-sedating options (introduced in the 1980s). 

Notable less-sedating antihistamines used for allergic rhinitis include bilastine (Allertine), cetirizine (Zyrtec), loratadine (Claratyne), and fexofenadine (Telfast). Bilastine, a newcomer to the Australian market, is only accessible through pharmacies with a pharmacist’s recommendation. Research has indicated that bilastine epitomises the evolution of research on antihistamines concerning both efficacy and safety

On the other hand, older sedating antihistamines like promethazine can cross the blood-brain barrier, causing drowsiness and cognitive impairment. They are associated with numerous side effects and potential drug interactions, making them less suitable for hay fever management.

Antihistamines are typically administered orally in tablet or liquid form, although there are also topical options such as nasal sprays (azelastine) and eye drops. Nasal sprays containing antihistamines are just as or even more effective than oral antihistamines.

Important note: Individual responses to antihistamines can vary significantly, you may have to try several types to determine which works best for you. Increasing the antihistamine dosage or combining oral and topical antihistamines does not provide added benefits.  It is important you obtain advice in relation to all these products, to help you make the right choice.

2. Steroid Nasal Sprays

When antihistamines alone fail to improve symptoms, healthcare providers often recommend nasal sprays containing corticosteroids. Corticosteroids function by inhibiting the release of several key chemicals responsible for inflammation. 

Corticosteroids and antihistamines have distinct mechanisms of action. Research has shown that corticosteroid nasal sprays are more effective than antihistamines in managing symptoms like an itchy, runny, congested nose. Additionally, when applied to the nasal passages, corticosteroids can also alleviate watery and itchy eyes.

Various corticosteroid nasal sprays with different active ingredients are available, but a recent large-scale study indicates that they are all equally effective and work best when used consistently over several days.

3. Sodium Cromoglycate

Sodium cromoglycate is another medication used to address hay fever symptoms. It is available in the form of eye drops and can be obtained over-the-counter at pharmacies. This medicine is categorised as a mast cell stabiliser, preventing them from breaking down. When mast cells break down, they release histamine and other inflammatory chemicals, contributing to the allergic response.

Sodium cromoglycate eye drops serve both preventive and treatment purposes, typically used before the onset of allergies. Evidence supports their effectiveness in reducing the symptoms of allergic conjunctivitis, which is inflammation of the eyes due to allergies.

4. Decongestants

Decongestants (such as Sudafed and Demazin) work by constricting blood vessels. They are available in oral form, as nasal sprays, or as eye drops. When applied as eye drops, they reduce redness, while nasal application stops a runny nose. 

Important note: Decongestants should only be used for short durations and are not suitable for long-term use. In fact, prolonged use of nasal spray decongestants (beyond five days) can lead to a condition called “rebound congestion” which is basically severe nasal congestion.

5. Saline

Saline, or saltwater, nasal sprays are also available to alleviate hay fever symptoms. Although there is limited research in this area, evidence suggests that saline can help flush out allergens from the nasal passage to reduce hay fever symptoms. Saline is considered safe and is not associated with adverse effects.

6. Supplements like quercetin

Quercetin is a plant flavonol found in many fruits, vegetables, leaves, seeds, and grains such as capers, red onions, and kale. It’s said to have anti-allergic functions that are known for inhibiting histamine production. Quercetin also functions as an anti-inflammatory. What this means is that it can help manage the severity of itchy throats, watery eyes and runny noses. Research so far suggests that it is a good candidate as a supplement to help the management and treatment of allergic diseases, especially rhinitis

Since medicinal plants have a low price, natural origin, and fewer side effects, quercetin seems to be a good therapeutic nominee for allergic diseases in further clinical trials.

If you’re grappling with hay fever symptoms and are uncertain about which option to try from the multitude of options available, consult with your healthcare provider or our friendly pharmacists Jenny, Gavin, Michelle, Maria, Amy, or Jill. 

They are available for a chat on (03) 9509 7912 or in person at 153 Burke Rd, Glen Iris, VIC 3146. They can provide guidance on the available choices and help you identify the one that best suits your specific symptoms, medical conditions, and medications.

Opinions or facts expressed within the content have been sourced from various news sources. While every effort has been taken to source them accurately, the pharmacy, its owners, staff or other affiliates do not take any responsibility for errors in these sources. This article does not constitute individual health advice. Patients should not rely on the facts or opinions in the content to manage their own health, and should seek the advice of an appropriate medical professional. Further, the opinions or facts in the content do not reflect the opinions and beliefs of the pharmacy, its owners, staff or other affiliates.

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