Hay fever and perennial allergic rhinitis

They are good at relieving sneezing, itching and runny nose and eye symptoms, but are slightly less effective at reducing a blocked nose.

There are two main types:

Many people prefer to use the newer medicines because they can usually be taken once daily and allow you to get on with your daily activities without problems.

Many antihistamines can be bought over-the-counter, but some, eg fexofenadine, are available on prescription only.

Antihistamine nasal sprays and drops
Antihistamines that are used directly in the nose are azelastine and levocabastine, both of which can be bought over-the-counter.

These can be used to provide rapid relief of sneezing, itching and runny nose, but have no effect on other symptoms such as itchy eyes.

They can also be used regularly to prevent nasal symptoms, but are less effective than nasal corticosteroids.

Nasal corticosteroids
There are two steroid nasal preparations that can be bought from pharmacies: beclometasone and fluticasone. Others are also available on prescription only.

Nasal steroids reduce inflammation in the nasal passages and are better than oral antihistamines at relieving most nasal symptoms, including a blocked nose. They also relieve eye symptoms.

Nasal steroids have to be used regularly to be effective. They are best started a couple of weeks before the pollen season begins.

Nasal cromoglicate
Nasal sprays containing sodium cromoglicate are also used to prevent nasal symptoms, ideally starting treatment a couple of weeks before the pollen season.

They are less effective than nasal corticosteroids, but are often the first choice for young children.

Nasal decongestants
Nose drops and sprays containing decongestants such as xylometazoline (eg Otrivine nasal spray, Sudafed nasal spray) can be bought over-the-counter to treat a blocked nose.

They should only be used for a few days, otherwise they can cause 'rebound congestion' when you stop using them.

Antihistamine eye drops
Antihistamine eye drops can be useful if eye symptoms are your biggest problem. They include antazoline, azelastine and levocabastine, which you can buy from pharmacies.

The drops provide rapid relief from itchy, red, watery eyes.

Cromoglicate eye drops
Drops containing sodium cromoglicate (eg Clarityn allergy eye drops, Optrex allergy eye drops) or nedocromil sodium should be used regularly, as with nasal cromoglicate products, to prevent the allergic reaction occurring.

Cromoglicate drops can be bought from pharmacies and are also suitable if eye symptoms prevail.

Immunotherapy (desensitising vaccines)
This treatment is only used when allergen avoidance and medicines have proved ineffective at treating a severe allergy.

Injections of small amounts of the known allergy-causing substance are given to create tolerance to the allergen and prevent the immune system producing too much histamine when it encounters it.

This treatment has to take place over a long time and requires strict adherence.

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