The nasal symptoms are best treated with a nasal steroid spray. A recent review in an American medical journal states that “there is no evidence that one intranasal corticosteroid is superior to another.” However, the cost can vary considerably, some are not licensed in young children, they look and feel different, have different applicators, and some are twice daily rather than once per day.
The dose of the once daily nasal sprays is 1-2 puffs each nostril oncer per day - so that's up to 4 sprays a day; some bottles have 120 doses and some 60. I recommend a once daily generic formulation - have a word with a pharmacist. Fluticasone and budesonide nasal sprays are examples. Just remember, though, that you can buy the 120-dose bottles for a lot less than two of the 60-dose bottle.
Using the sprays correctly is important; so follow the simple instructions in the pack. Don't “sniff it” or it will just end up in the back of the throat. Also, pointing the nozzle away from the middle of the nose (septum) will reduce the risk of nose bleeds. The longer the steroid sprays are used the better they work, and preferably start them a week or two before your hayfever season, and should be used every day.
For persistent nasal symptoms, or additional eye symptoms, you can add an oral non-sedating antihistamine. It's important to check they don't make you drowsy, though, because even the “non sedating” antihistamines can still cause drowsiness in a few people (especially important if driving).
The common “non-sedating” antihistamine are loratadine, desloratadine, levocetirizine and fexofenadine. Interestingly, cetirizine has been identified as more likely to cause drowsiness although it is traditionally put in this “non sedating” group. The difference in cost can be considerable so have a chat with a pharmacist or check prices from an online Australian pharmacist first to get an idea.
Eye symptoms also respond to the antihistamine tablets, or can be treated with anti-allergy eye drops such as sodium cromoglycate (is cheap and effective but needs to be used for a few days to work properly) or an antihistamine eye drop (eg eyezep) that's more expensive but works quicker.
So, it all depends on your symptoms (eye and/or nose). Typically, start with a nasal once daily steroid, add in eye drops if you need them; and you can use one of the non-sedating antihistamines as well as all 3 if you need this - these tablets don't work for nasal congestion. Most people use antihistamines “breakthrough” symptoms (as-required basis) because they work within 30 minutes.
There are other treatments some people try (nasal cromoglycate spray, nasal decongestants for strictly very short term use, nasal irrigation some people say is very effective) but the above is the mainstay. A nasal antihistasmine is also available over the counter (eg. azep) but it does need using four times a day and is more likely to cause nasal side effects than the nasal steroids; it's well worth considering adding with the nasal steroid, though, if you get breakthrough symptoms and don't want to use an oral antihistasmine.
The word “Hayfever” suggests it is trivial but those people who suffer hayfever will know its not. Indeed, hayfever has been shown to impair performance and cause fatigue. You really can't function normally with poorly controlled hayfever, so do use your treatments properly and regularly, and see a doctor if it's still not controlled.
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