Get hayfever? US guidelines confirm steroid sprays trump antihistamines
If you're familiar with the itchy eyes, runny nose and sneezing that go with hayfever, then you might want to ditch antihistamine tablets in favour of a nasal steroid spray.
That is the advice from United States researchers in new guidelines on how to treat allergic rhinitis (commonly known as hayfever) in the Annals of Internal Medicine.
The researchers say treating hayfever with a nasal steroid spray alone is a better option for those with seasonal hayfever, rather than adding antihistamine tablets to the mix, which don't seem to add extra benefit (and can make you drowsy).
- The guidelines recommend people aged 12–14 initially use only a corticosteroid nasal spray, rather than in combination with an oral antihistamine.
- The same goes for people aged 15 years and older, who are advised to use a corticosteroid nasal spray over Montelukast (and other leukotriene receptor antagonists).
- And for those with moderate to severe hay fever, a combination of a corticosteroid nasal spray and an intranasal antihistamine is recommended.
Hayfever affects nearly one in five Australians and there are a range of treatments available over the counter, including antihistamines (tablets and sprays), intranasal steroid sprays, and decongestants.
Connie Katelaris, professor of Immunology and Allergy at Western Sydney University, said the revised guidelines are in line with what Australian experts recommend.
"This is basically what we teach here, which is that intranasal steroids are superior to all the other forms of treatment for allergic rhinitis — seasonal or perennial," she said.
Nasal steroid sprays most effective
If you experience moderate to severe hayfever (that includes people who get it regularly), nasal steroid sprays should be your starting point, Professor Katelaris said.
"You need to be treating the inflammatory component, not just symptomatic relief, which is what antihistamines offer," she said.
When people with hayfever are exposed to particular allergens (such as pollen, dust mites or animal fur), they experience an allergic reaction, causing inflammation in their nose, ears, eyes, throat and sinus passages.
Nasal steroid sprays help to dampen down this inflammation.
"They address many of the pathway mechanisms, and that's why they're superior," Professor Katelaris said.
While intranasal sprays help to reduce swelling and mucus production, they do not provide immediate relief from symptoms.
That's because they are a preventative treatment: most effective when used daily, and ideally applied from the very beginning of hayfever season.
"If you have symptoms that are more than trivial, you should be treating the inflammation that is at the heart of this condition," Professor Katelaris said.
Antihistamines for occasional symptoms
Antihistamines are popular over-the-counter medications commonly used to alleviate allergy symptoms.
They come in nasal sprays and as tablets.
"If somebody has very trivial, intermittent symptoms, then just treating those symptoms on the occasional days with an antihistamine may be reasonable enough," Professor Katelaris said.
While some oral antihistamines can make you drowsy, there are newer types that don't.
So it's worth speaking to your pharmacist to find out which type is best for you.
Antihistamines can be useful if you know you're going to be exposed to an allergen, for example when mowing the lawn or sitting on the grass in springtime.
However, taking an antihistamine only relieves your symptoms, it does not resolve underlying inflammation.
"There's nothing wrong with antihistamines, it's just that they are not very effective for all the symptoms in anyone that's got more than intermittent and mild allergic rhinitis," she said.
Avoid decongestant nasal sprays
Decongestant nasal sprays can relieve your naval congestion almost immediately, but experts tend not to recommend them.
"In general, we discourage the use of decongestant nasal sprays," Professor Katelaris said.
"They have problems if they are overused and abused, which often, once patients try them, they do so — because there's no doubt that they'll give quick relief of nasal blockage."
But overusing these sprays can lead to longer-term problems with nasal blockage, so you should limit their use to a few days only.
"They are not designed for regular daily use, and so patients have to understand that they can't be used every day," she said.
If you have regular hayfever symptoms and your current treatment doesn't seem to be working, talk to your doctor.