Hayfever (Part 3)
Last week I discussed anti-histamine medication, this week I discuss other options.
Decongestants have a limited role in hay fever and should be reserved for periods of severe nasal congestion. Nasal decongestants sprays and drops such as Otrivine® should not be used for longer than three to five days because of the possibility of rebound congestion which makes the problem worse.
Nasal drops and sprays reduce inflammation and swelling of the nasal mucosa and in normal dosage side effects are minimal. It is best to start treatment a few weeks before the season begins. All corticosteroids nasal sprays appear to have similar efficacy. Fluticasone (Nasofan®), beclomethasone (Nasobec®) and Mometasone (Nasonex®) are the most regularly used. The once daily dosage regimen of Nasofan® and Nasonex® is convenient. Side effects are mild and transient and consist of nasal irritation and stinging, dryness, sneezing, sore throat, nose bleeds and fungal overgrowth. They should be avoided during nasal infections. Flixonase® and Beconase® are available over the counter in pharmacies. Oral steroids (eg) prednisolone or depot injections (eg) triamcinolone (Kenalog®) are only prescribed for certain groups of patients such as those doing exams or those with severe continuous symptoms despite standard therapies.
Ipratropium bromide nasal spray (Rinatec®) may be prescribed by your doctor where running nose is the predominant symptom. It does not relieve itching, sneezing or nasal blockage.
Azelastine (Rhinolast®) is a prescription only nasal antihistamine spray with a rapid onset of action. It may provide an effective and safe alternative to oral medications. Otrivine Antistin® eye drops are fast acting antihistamine eye drops available over the counter.
Immunotherapy is the use of allergen vaccines containing house dust mite, animal fur or extracts of grass or tree pollen. By gradually increasing the patient’s exposure to the allergen that causes the allergy, the patient becomes tolerant to it. Immunotherapy is only used in patients with severe symptoms and must be done by a specialist. Long term relief can be achieved. Grazex® is a grass pollen extract tablet available on prescription for patients who have failed to respond to other hayfever treatments. Grazex® must be started at least 4 months before pollen season and should be continued for up to 3 years.
Seasonal Vs Perennial Hayfever
Hayfever is most often seasonal, usually the summer months when pollen count is high. If allergen exposure is seasonal, the most likely culprits are tree, flower and grass pollen. Some people may have hayfever all year round. This is called perennial hayfever. Perennial allergic rhinitis is usually allergy to indoor allergens like dust mites and animal fur. Classic perennial allergic rhinitis is associated with nasal symptoms, which occur for more than two hours per day and for more than nine months of the year. In perennial allergic rhinitis, nasal congestion is common while itchy and streaming eyes is less frequent.
Disclaimer: Please ensure you consult with your healthcare professional before making any changes recommended