Ep 48 – Hay fever management

In this episode, Dr Roger Henderson discusses the treatment pathway for people suffering from hay fever. This comprises options ranging from simple measures for allergen avoidance to the treatments to consider for specific symptoms and when to refer for specialist advice and consideration of immunotherapy.

Key references discussed in the episode:

1. BMJ Best Practice. Allergic rhinitis. 13 January 2022.
2. Dykewicz MS, et al. J Allergy Clin Immunol. 2020 Oct;146(4):721-767. doi: 10.1016/j.jaci.2020.07.007.
3. Bousquet J, et al. J Allergy Clin Immunol. 2020 Jan;145(1):70-80.e3. doi: 10.1016/j.jaci.2019.06.049.
4. Scadding GK, et al. Clin Exp Allergy. 2017 Jul;47(7):856-889. doi: 10.1111/cea.12953.
5. Lipworth B, et al. NPJ Prim Care Respir Med. 2017 Jan 23;27(1):3. doi: 10.1038/s41533-016-0001-y.
6. Walker SM, et al. Clin Exp Allergy. 2011 Sep;41(9):1177-200. doi: 10.1111/j.1365-2222.2011.03794.x.

Patient information:

• Hay fever (NHS).
• Allergy UK.

Key take-home points:

• Allergen avoidance is a key part of all hay fever treatment.
• Intranasal steroids are the preferred first-line treatment for symptom management, although many patients prefer to start with an oral antihistamine.
• Antihistamines are good for as-needed use because of their speed of action. Always use a non-sedating type when possible and remember that intranasal antihistamines are useful.
• If symptoms persist despite allergen avoidance measures, intranasal steroids and oral antihistamines, then check patient technique and consider saline nasal irrigation. This has been shown to decrease symptoms and improve nasal treatment efficacy.
• The nasal anticholinergic ipratropium is helpful for rhinorrhoea, and an antihistamine spray is helpful for sneezing and nasal itch.
• Should asthma symptoms be triggered by hay fever, consider adding in oral montelukast.
• Should symptoms remain uncontrolled and seriously affect quality of life, a short course of steroids can be considered for 5–10 days.
• If symptoms remain persistent and troublesome, refer to an allergy specialist for testing and possible subcutaneous or sublingual immunotherapy treatment.