How is hay fever managed?

Like with all allergies, the best treatment is simply to avoid the allergen. However, it may be extremely difficult to avoid pollen. You can get pollen count data from many online weather forecasts (BBC weather, for example, will display pollen count). Avoid going outside in the early evenings, as this is when hot air is beginning to fall again and pollen is around nose level. If you go out during the day, wearing sunglasses (especially wrap-around sunglasses) can help by stopping pollen getting into your eyes, and by rubbing a small amount of vaseline around each nostril, you can catch pollen before they get inside your nose. You may need a separate set of outdoor clothes, which you might need to take off when you get inside and wash, and change into a set of indoor clothes. Obviously, keeping windows closed when you are in the house or in the car will stop pollen getting inside. Do not mow the lawn yourself and do not walk over freshly mown grass – there will be large amounts of pollen in areas of freshly cut grass.

There are also several drugs which you can use to alleviate symptoms of hay fever. The most widely used are antihistamine tablets. Older formulations are known as first generation antihistamines, and these include drugs like promethazine, chlorphenamine, or doxylamine. These can interfere with alpha-adrenergic receptors and 5-hydroxytryptophan receptors as well (which are receptors in the nervous system), and can lead to side effects, including drowsiness. Nowadays first generation antihistamines are only really used for sleeping preparations. Second generation antihistamines, such as cetirizine, loratadine, desloratadine, and fenoxifenadine are much more specific for histamine H1 receptors, and do not cross the blood-brain barrier and cause drowsiness. Antihistamine tablets are effective at reducing sneezing, but less effective at reducing eye symptoms, a runny or blocked nose, and itching in the roof of the mouth.

Eye drops are particularly useful at reducing eye symptoms. Some are also relatively painless and easy to take. Eye drops can include antihistamines such as cetirizine hydrochloride. Antihistamine eye drops can be effective within 10 – 15 minutes. You can also find eye drops which are used for rehydrating the eye and providing relief from itchy or dried eyes. These are more expensive and should not be used too often, as you may get a rebound reaction where the eye ends up drier than what it was before you used these eye drops. Sodium cromoglicate and nedocromil act by stabilising the mast cells (these cells release histamine) and can stop histamine being released. These drugs can be extremely effective. It is important that you do not wear contact lenses while you are using eye drops.

You can also find nasal sprays. Beconase (beclometasone dipropionate) is a commonly found and effective nasal spray. Beclometasone dipropionate is a corticosteroid, meaning that it suppresses the immune system in the area it is applied to (in this case, the nose). This can reduce inflammation and can help with a blocked nose. It might make you cough when you breathe it in. You can also buy decongestant nasal sprays, such as Sudafed (phenylephrine hydrochloride) and Vicks (which includes various ingredients). These can clear the nose and can allow corticosteroid nasal sprays like beclometasone dipropionate to penetrate deeply into the nose. If you overuse decongestant nasal sprays, you may get rebound nasal congestion, which is where your blocked nose becomes worse that it was originally. Other side effects include headaches, stinging sensations, sneezing, or a dry nose, as well as possible changes in how you taste food. Antihistamine sprays such as loratadine and desloratadine are very effective at warding off nasal symptoms, but their effects are short lived and do not target eye symptoms.

Leukotriene antagonists are a type of drug which act against leukotrienes, which are chemicals released by cells to attract other immune white blood cells to the area. These chemicals can also cause narrowing of the airways (bronchoconstriction), which is a more significant problem in asthma. Leukotriene antagonists are less effective than corticosteroids, but have fewer side effects, so are suitable for children. Examples of leukotriene antagonists are zafirlukast and montelukast.

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