Hayfever (seasonal allergic rhinitis) affects approximately 1 in 5 UK adults and is the most common allergic condition. Despite being so prevalent, it is frequently undertreated — many sufferers take only an antihistamine when the evidence clearly shows that a combination approach is significantly more effective. This guide explains the treatment ladder from first OTC step to specialist-level intervention.

Step 1: Non-Sedating Oral Antihistamine

Start with a second-generation (non-sedating) antihistamine: cetirizine, loratadine, or fexofenadine are all available OTC. Fexofenadine 120mg has the strongest evidence for hayfever with minimal sedation or performance impairment. Cetirizine and loratadine are effective and low-cost. Take daily throughout the pollen season, not just when symptomatic — antihistamines are more effective taken consistently than reactively. Antihistamines are best for: sneezing, itchy eyes, rhinorrhoea (runny nose). They are less effective for: nasal congestion.

Step 2: Add an Intranasal Corticosteroid Spray

For moderate-severe hayfever, or when antihistamine alone provides insufficient control, adding an ICS nasal spray is the most impactful step. Options include fluticasone furoate (Avamys, Pirinase Hayfever), fluticasone propionate (Flixonase), beclomethasone (Beconase, Pollenase), and budesonide — all available OTC. ICS sprays reduce nasal inflammation directly, improving all four nasal symptoms (congestion, rhinorrhoea, sneezing, nasal itch) more effectively than antihistamines alone for nasal symptoms. Crucial point: ICS sprays must be started 2 weeks before pollen season onset for maximum effect, and must be used daily — not only when symptomatic. Relief builds over the first 1–2 weeks; don’t judge effectiveness from the first few days. Correct technique (aim spray away from the nasal septum, toward the outer wall) prevents nosebleeds.

Step 3: Add Antihistamine Eye Drops for Ocular Symptoms

For significant eye symptoms (itching, redness, watering): sodium cromoglicate eye drops (Opticrom — mast cell stabiliser, requires regular dosing) or olopatadine/azelastine antihistamine eye drops (faster onset). Apply before pollen exposure and throughout the day as needed.

Step 4: Prescription Step-Up

If Step 1–3 with correct use and timing still provides insufficient control: see your GP. Options include: montelukast (LTRA — leukotriene receptor antagonist, particularly useful if asthma coexists); short courses of oral corticosteroids for severe seasonal flares; azelastine/fluticasone combination nasal spray (Dymista — significantly more effective than either agent alone); and referral to allergy clinic.

Step 5: Allergen Immunotherapy (AIT)

Sublingual immunotherapy (SLIT) — grass pollen tablets (Grazax, Itulazax) taken daily for 3 years — is the only disease-modifying treatment for hayfever. Reduces symptoms and medication use significantly, with lasting benefits after the 3-year course. NICE approved for adults with moderate-severe grass pollen rhinitis. Available from NHS allergy clinics on GP referral, or privately. The most effective long-term solution for significant hayfever.

Frequently Asked Questions

Browse antihistamines and nasal sprays at Huncoat Pharmacy. Related: Allergy Guide, Hayfever in Children.

At Huncoat Pharmacy: Pharmacy First, Browse hay fever treatments, Prescription antihistamines & nasal sprays.