Understanding Hay Fever & Antihistamines

Hay fever is a common allergy which strikes so many of us, especially in springtime. The symptoms of hay fever can make life miserable and cause us to avoid having fun outdoors. That’s why it is essential to understand what causes hay fever and the benefits antihistamines can have on a person’s quality of life during allergy season. For more information on accessing antihistamines, Medmate can help. 

Treatments include hay fever tablets, hay fever eye drops, or even hay fever nasal sprays. Each has their own benefits to ease your suffering. In this article, we’ll go through what hay fever is and which remedy is best for you and then we will dive into the way antihistamines work.  

What is hay fever?

Hay fever is an allergic reaction to pollens, dust mites, skin, and saliva shedding from animals (most often cats and dogs). Like other allergies, hay fever is caused by your own immune system treating a substance that is safe (like pollen) as though it were dangerous, causing an immune reaction. So, when dust or other triggers get into the nose, the immune system attacks the area, causing inflammation and increased mucus production. Hay fever is more likely to occur during spring when plants release pollen. It can also happen due to contact with animals or dusty environments. It is most likely to affect people who are atopic. Atopic individuals have an increased sensitivity to allergens, and their immune system may react more strongly to these substances compared to others without this genetic predisposition. People who are atopic are also more likely to suffer from asthma and eczema.  

And yes, for many people, the symptoms of hay fever are getting worse year by year. You can blame climate change and other factors for that. There is a complex relationship between weather and pollen concentration that plays a key role in modulating allergen levels. This, combined with the continued spread of introduced species of plants such as grasses like rye grass grown for livestock feed and other weeds such as ragweed are all contributing to the rising incidence of hay fever in Australia.  

What are the symptoms of hay fever?

Hay fever can include some or all of the following symptoms:

• Red, itchy, and watery eyes (allergic conjunctivitis).
• Sneezing and a runny nose/nasal congestion (allergic rhinitis)
• Coughing
• Itchy nose, mouth and/or throat.
• Dark bags under the eyes.
• Headache and fatigue.

Peak hay fever season in south-east Australia is around October to November.

How to get rid of hay fever

Unfortunately, there is no cure for hay fever at the present, although desensitisation can possibly assist with symptoms. There are several different options which can be used individually or concurrently to help alleviate hay fever symptoms. These include tablets, eye drops, nasal sprays, prescriptions and natural remedies. You can read more about these options below or get a fast online prescription for hay fever medication with Medmate’s telehealth service here.

Hay fever tablets

Hay fever tablets are antihistamines (see below for more information on antihistamines). They are available in sedating and non-sedating varieties, allowing the relief of symptoms during the day, and assistance with symptoms and sleeping at night.

Sedating varieties include (brand names in brackets):

• Cyproheptadine (Periactin)
• Dexchlorpheniramine (Polaramine)
• Pheniramine (Avil)
• Promethazine (Allersoothe, Phenergan)

Non-sedating varieties include:

• Cetirizine (Alzene, Zilarex, Zyrtec) 
• Desloratadine (Aerius) 
• Fexofenadine (Allerfexo, Telfast, Fexo varieties, Fexotabs, Tefodine, Xergic, Fexorelief) 
• Levocetirizine (Xyzal) 
• Loratadine (Claratyne Loratadine varieties, Allerdyne, Allereze, Lorano) 
• Bilastine (Allertine) – newest on the market in Australia 

*Antihistamines do have the potential to interact with some medications. Always check with your pharmacist first before purchasing if you take other regular medications.  

Hay fever eye drops 

Hay fever eye drops are available in two varieties: antihistamines and mast cell stabilisers. They can help alleviate symptoms such as itchy, red, and watery eyes and often work better than antihistamine tablets for these persistent ocular symptoms.  

Varieties of antihistamine hay fever eye drops include:

• Antazoline and Naphazoline (Albolon-A, Antistine-Privine)
• Azelastine (Eyezep)
• Levocabastine (Livostin, Zyrtec Levocabastine eye drops)
• Naphazoline and Pheniramine (Naphcon-A, Visine Allergy with Antihistamine)
• Olopatadine (Patanol)
• Ketotifen (Zaditen)

Varieties of mast cell stabiliser eye drops include:

• Sodium Cromoglycate (Opticrom)
• Lodoxamide (Lomide)
• Ketotifen (Zaditen)

Hay fever nasal spray

Nasal sprays also come in two basic forms; antihistamine and corticosteroid nasal sprays. Antihistamine nasal sprays are used for immediate symptom relief, whereas steroid nasal sprays are used to prevent the onset of symptoms or as an add on to make the symptoms less severe. Often, steroid nasal sprays are used as preventers (much like the preventers used for asthma sufferers). Chronic hay fever sufferers are best to use both; antihistamine for immediate relief and steroid for prevention.  

Varieties of antihistamine nasal sprays include:

• Azelastine (Azep)
• Azelastine and Fluticasone (Dymista)
• Levocabastine (Livostin)

Varieties of corticosteroid nasal sprays include:

• Azelastine and Fluticasone (Dymista)
• Beclomethasone (Beconase)
• Budesonide (Rhinocort, Budamax)
• Ciclesonide (Omnaris)
• Flutiscasone (Avamys, Flixonase)
• Momentasone (Nasonex, Sensease, Momentasone varieties)

Natural Hay fever Medication

Natural remedies for hay fever include three different types: vitamins, nasal sprays, and immunotherapy. 

Vitamin supplements containing vitamin C, horseradish, garlic, and ginger may be able to assist the immune system and help with the treatment of hay fever symptoms.

Unmedicated nasal sprays, usually a saline preparation, can assist in reducing the buildup of mucus in the nose and therefore help with runny nose or congestion.

Immunotherapy is a long-term treatment option where the patient is gradually exposed to allergens, such as pollen, to help the immune system learn that it is not a threat. This is best undertaken with the oversight of a medical health professional.

What is an antihistamine?

Antihistamines are a class of medications that interrupt the body’s histamine response. When a person is exposed to allergens, the body releases histamines to fight them, which gives us the allergic response. Histamines are signalling molecules and are useful for some bodily functions, such as sleep and digestion, but they can become problematic when too many of them are present, which is how allergic responses occur.

What does an antihistamine do?

Histamines cause symptoms of allergy. In the instance of hay fever, these symptoms include runny nose, itchy eyes, and general cold-like symptoms. Antihistamines work by blocking histamine receptors and thereby prevent the symptoms they cause.

Antihistamine side effects

As with any medication, side effects can occur, whether they be pain killers, anti-depressants, or antihistamines. If you experience any side effects, you should consult a health professional as soon as possible. Common side effects of antihistamine use can include: 

• Drowsiness (particularly with sedative type antihistamines)

• Stomach pain or discomfort

• Dizziness

• Dry mouth, nose, and/or throat

• Increased appetite

• Changes in vision

• Thicker mucus

• Feeling anxious, excited, or irritable.

So… which treatment option is best for you? 

The symptoms of hay fever are different between individuals. Therefore, the most effective treatment option for you might take some trial and error. Hay fever is generally treated in a step-wise manner. Starting with an antihistamine tablet, then adding in a steroid and/or antihistamine nasal spray if rhinitis and sinus congestion is still present and then finally adding an eye drop if ocular symptoms are persisting. As we have already listed above, there are many options within each treatment class. For antihistamines in particular, the biggest decision is whether to choose a sedating or non-sedating one. In general, the non-sedating anhistamines have a much lower potential for side effects and drug interactions than the sedating ones. Usually, the best option is to choose a non-sedating one to try first unless your hay fever is disrupting your sleep. You may still need to trial a number of different antihistamines in the same class before you find the one that works best for you. They all block the same histamine receptors, but one will be more effective for one individual than another. If symptoms still persist, the next option is to add in a steroid nasal spray. Some work over 12 hours (such as Beconase) and some last for 24 hours (such as Nasonex). Again, a little trial and error might be necessary. Finally, an allergy eye drop is essential to add to the regimen if ocular symptoms are persisting. Of the eye drops on the market, the mast cell stabilisers such as ketotifen (Zatiden) have proven to be among the most effective.  

Can I buy antihistamines over the counter in Australia?

Yes, antihistamines are available over the counter in Australia. A pharmacist, whether online at Medmate or in person, can help you determine the right antihistamine for you. If you have further questions, a health professional such as a general practitioner can help you determine which course of treatment is best for you. In some instances, a prescription may be required and Medmate’s Virtual Care service can help with this too.

Key Takeaways

Antihistamines and the other treatment options mentioned in this article are a valuable tool in the arsenal against hay fever. So rather than spend springtime locked inside the house with a box of tissues, you can go out and live your best life without being weighed down by hay fever.