The potential of new prescription hayfever treatment formulations coming onto the market would suggest that if you haven’t seen a medical professional about your condition recently, you could be out of date.

Hayfever Sprays and Tablets

Decongestants

These come in two forms:

Topical which means ‘onto surface’ such as decongestant nasal sprays,

Systemic which means ‘acting from inside the body system’ such as decongestant tablets.

Relief from congestion or blocked nose can commence in under 1 minute (with a decongestant spray), and decongestant relief can last for a few hours.

However, continued use of a topical decongestant for two or three days may cause a decrease in effectiveness, called tachyphylaxis, and after 5-7 days of use what may result is called rhinitis medicamentosa, also known as ‘rebound congestion’.

This means the swelling of your nasal passages could ‘rebound’ back to its previous state, possibly becoming even more blocked than before the use of the decongestant.

So you can imagine someone increasing the number of sprays to clear their nose, which in turn keeps returning the nose to a worse condition, and you have a rather unhappy hayfever sufferer.

If used correctly on the first day of someone’s hayfever suffering for example, a topical decongestant can bring welcome relief on that day as the person waits for other medication to start working.

For more information on all things ocular see our section on Eye Drops & Rinses here.

Antihistamine Nasal Sprays

Antihistamine direct to the nose is still relatively unknown on the hayfever scene in many countries.

Much to the delight of an increasing number of sufferers, these non-addictive sprays can start working in under 15 minutes and continue working for up to 12 hours.

People who don’t like other spray products may reject the benefits of what they might think is “just another nasal spray”.

There is an antihistamine nasal spray containing azelastine (pictured below as its Australian brand ‘Azep’) that in addition to relieving hayfever symptoms, also has anti-inflammatory properties and provides a decongestant effect 1.

Azep, for which Australian guidelines recommend one spray per nostril twice daily, is suitable for adults and children 5 years and over.

Important

Always consult a doctor or local pharmacy about dosage levels before using any medication. If symptoms persist do not increase dosage beyond recommended limits, seek further medical advice.

See here for more information on azelastine antihistamine spray.

The most common side-effects of antihistamine sprays are headache, nasal complications and a brief bitter taste.

Corticosteroid Nasal Sprays

This treatment is generally used for more moderate-severe hayfever sufferers, and is regarded in some countries as the most effective treatment option for those sufferers.

It can take up to 2 weeks before the drug becomes fully effective, and dosing needs to continue for the duration as advised by a healthcare professional.

The most common side-effects of corticosteroids include nasal complications, nose bleeds and damage to the lining of the nose, headaches and increased susceptibility to infection.

Due to the suppression of the immune system brought about by corticosteroids, those with unhealed wounds should exercise caution before using, wound healing is impaired by this medication, and ulcer formation is also possible6.

Always seek medical advice and only take as directed.

Corticosteroid tablets are also an option, as are injections which may be available in some countries.

If you are using corticosteroids it is safe to use other hayfever medications, though only in line with medical advice from your doctor or pharmacist.

Oral Antihistamines

Antihistamine in tablet or syrup form makes its journey via the gut obviously, so relief takes a little longer to arrive.

Relief from hayfever symptoms usually commences within a few hours and can last up to 24 hours from when the tablet was first ingested.

Although they appear similar, keep in mind that the different types of antihistamine tablets, like all antihistamine medications, are quite different from each other.

Fexofenadine tablets for example are not to be taken with fruit juice as this will reduce absorption, as will antacids containing magnesium.

The possible side effects across the most common antihistamine tablets (including cetirizine2, fexofenadine3, loratadine4) include headache, nausea, dizziness, drowsiness, sleepiness, nervousness, nightmares, frequent coughing, dryness of the mouth/nose/throat, urinary retention, blurred vision and gastrointestinal disturbances.

Some oral antihistamines come with pseudoephedrine5 as a decongestant, which has the advantage of not causing rebound congestion like topical decongestants.

However, due to pseudoephedrine being a stimulant, additional side effects may occur including hypertension, sweating, insomnia and anxiety.

Combination Antihistamine and Corticosteroid Nasal Spray

For people who suffer from moderate-severe hay fever symptoms, including both nasal symptoms and ocular symptoms, a combination nasal spray is available that contains an antihistamine and a corticosteroid. This type of treatment is only available through a prescription therefore it is recommended to contact your healthcare professional for advice.

Sources:

  1. AZEP Nasal spray Australian product information. MEDA Pharmaceuticals, January 2014.
  2. Cetirizine, Zyrtec Australian product information. UCB Pharma, February 2006. Accessed at https://gp2u.com.au/static/pdf/Z/ZYRTEC-PI.pdf, July 2014.
  3. Fexofenadine, Telfast Australian product information. Sanofi, July 2010. Accessed at http://products.sanofi.com.au/aus_pi_telfast.pdf, July 2014.
  4. Loratadine, Claratyne Australian product information. Merck Sharp and Dohme, April 2014. Accessed at http://secure.healthlinks.net.au/content/msd/pi.cfm?product=mkpclard, August 2014.
  5. Wikipedia. Pseudoephedrine. http://en.wikipedia.org/wiki/Pseudoephedrine, July 2014.
  6. Wikipedia. Corticosteroid. http://en.wikipedia.org/wiki/Corticosteroid, accessed July 2014.