Dr Thomas Stuttaford

When my hay fever is very bad I end up taking a whole cocktail of sprays, pills, eye drops and herbal supplements. Is my body becoming completely confused by this cocktail and should I just try one thing (which claims to fight all) at a time to see if that works? With the “cocktail” I am still getting severe symptoms anyway. Thank you. Katie Turner, London

Without knowing what goes into your cocktail it is hard to answer this question. I usually recommend a second generation anti histamine such as Neo Clarityn together with Flixonase nasal spray, two puffs into each nostril each morning. If necessary you can supplement the Flixonase spray with a Flixonase nasule. These nasal drops are usually used by people with nasal polyps, but they do ease congestion. Unfortunately to use the nasule as well as the spray is returning to relying, as you do now, on a medicating cocktail. When the hay fever is very severe, I have found that excellent treatment is provided by St. Mary’s Hospital in London who run, or ran, a clinic that provided a first class hay fever service for adults and children.

Due to hayfever, my eyes are very sore, red, itchy and are hurting a lot. Opticrom and Otrivine Antistin eye drops are giving me no relief. Could you recommend any other eye drops? H Ahmed, Bristol

Opticrom is an anti inflammatory, but non steroidal, eye drop similar to other preparations such as Hay Crom. Otrivine is an anti histamine. For various reasons, including its long term effects on the eye, doctors are reluctant to prescribe steroid drops. Among the problems they may cause are an exacerbation of any existing infection, or when given long term may damage the cornea, increase intra ocular eye pressure (and increase the risk of glaucoma) or encourage the production of cataracts. Even if patients only have eye symptoms they should also take a second generation anti histamine by mouth and if the trouble is still interfering with professional or social life. If the hay fever continues it would be worthwhile enquiring about a course of pre-season injections to desensitise you to the allergens you are known to react to. These injections now have to be given in hospital so as to avoid problems of a severe reaction. Don’t forget to always wear glasses to keep the pollen away from your eyes.

Last week me and my partner found out that we are expecting our fist child. My partner if now eight weeks pregnant. However, she suffers from hay fever, and given the present climatic conditions, this is worse than normal. Furthermore, we live in a rural area, so staying clear of grass pollen is impossible. Our GP is reluctant to prescribe any medication due to the early stages of pregnancy, but my partner is suffering terribly at present. Can you please advise on any “safe” medications that may help? Name and address withheld

We don’t usually comment about individual patient’s treatment but suffice to say that your doctor is quite right and every effort should be made to avoid any drugs in pregnancy when possible. It is not that many of them cause trouble but if anything does go wrong women will always blame themselves. Most manufacturers recommend that anti histamines should be avoided in pregnancy. Your partner is presumably taking the standard simple measures of having an evening bath to wash off the pollen before going to bed, wearing sunglasses to keep the pollen out of the eyes, keeping the house and car windows shut and of course, although living in a rural area, avoiding lying in the grass, cutting grass or even at some times of the year walking in the woods. The manufacturers of hay fever remedies recommend extreme caution in pregnancy even for instance when using a Flixonase spray.

My 13-year-old son suffers from terrible hay fever, and takes tablets and uses a nasal spray every day. Even so he is still in a very bad way. Could you possibly provide the generic names of the first and second generation antihistamines so that I can check which ones he is taking and maybe switch him over if necessary? Also, is he too young to be considered for the injections? Nicky Smith, Oxfordshire

The non sedating anti histamines (generic names listed second) commonly used are cetirizine (Zirtek), desloratadine (NeoClarityn), fexofenadine Telfast, levocetirizine (Xyzal), loratadine now available over the counter. The sedating first generation antihistamines (generic names listed first) that are commonly recommended are Piriton chlorphenamine maleate, Phenergan promethazine hydrochloride, Periactin cyproheptadine hydrochloride, Vallergan alimemazipine tartrate, and Sudafed Plus tiprolidedine. Your son is certainly not too young to attend a clinic for hayfever and to have prophylactic injections. St Mary’s makes a speciality of treating children with hay fever.

You implied in your article that all non-prescription antihistamines cause drowsiness. I am 65 and drive. I am taking one-a-day hay fever relief with the active ingredient Loratidine, because it claims to be non-drowsy. It seems to give me relief from most symptoms. Was Loratidine one of the second-generation antihistamines you were recommending? Ian Forsyth, Durham

Loratidine was one of, if not the, first of the second generation anti histamines. It was and is very effective. It was marketed as Clarityn but its patent has now run out and is sold an over the counter anti histamine by other names. The manufacturers have replaced it by NeoClarityn. This also contains a Loratidine type constituent that is said to be even more efficient than Clarityn. It is on prescription.

I am a severe asthmatic on long-term oral steroids (minimum 20mg) - despite this I still suffer badly from hay fever, which in turn affects my asthma control. I take certirizine, nasonex and opticrom, but I still feel “coldy” throughout the summer months and suffer from greatly increased breathlessness and wheeze. Is there anything else you can suggest? In the past I have had kenalog injections, but these seem less popular now than they used to be. Name and address withheld

Kenalog is triamcinolone, a very potent steroid. When given by injection in this form it acts as a depot and once buried it can’t be retrieved. If for any reason you needed to stop or cut down on steroids you would be left with this irretrievable supply still oozing out a potent steroid into your circulation. This is one reason why these are unpopular medically, and the other is that it is hard to determine the amount of the steroid that you absorb daily. This must vary from person to person. Although they are considered to have these disadvantages and are therefore now unpopular, even frowned upon, they can be very effective for those with severe symptoms. I have known several doctors who have been aware of the problems but have insisted on having this treatment. Having discussed it with them, and warned them annually, I have agreed to giving the injection.

I suffer serious hay fever every year. This year, I have noticed asthma-like symptoms, even though I am not asthmatic. Could this cause any permanent damage, for example lead to asthma? Suleman Shakeel, Birmingham

If you are wheezing and you have serious hay fever there is every chance that you have in fact developed asthma. You should discuss this with your doctor. Asthma and hay fever go together like a horse and cart, but unlike a horse and cart it is a bit of a toss up which comes first.

At the age of 63 I have suddenly developed hay fever for the very first time. Why? I sneeze constantly, my eyes water, my nose is congested and I have lost the taste of food and can’t smell anything. My doctor has given me anti histamine tablets but they are not working. Is there something better that will help me to feel normal again? Ann Furst, Glasgow

Either asthma or hay fever quite frequently start in the older age groups. The same standard treatments apply, but it is even more important to take a non-sedating anti histamine than when younger. Why now? This has been a particularly bad year for hay fever. The weather this year has led to many of the trees coming into flower at the same time. These periods coincided with a hot spell (or rather two hot spells). Humidity was also high so that pollution compounded the difficulties experienced. Only second generation anti histamines relieve nasal congestion, although both first and second ease the runny nose. Certainly it would be worthwhile buying a Flixonase or Beconase nasal spray.

I was very interested in the article Pop a pill for hay fever by William Little (T2, June 24) because I have many friends in Japan who suffer terribly from cedar pollen allergy. Do you think the pill mentioned could help them? Also, could you tell me what stage of development it is at and whether it will be available as an OTC remedy or not. Is it possible to let me know the name of the Danish company making the pill? Thank you very much. Alexander Cox, Tokyo, Japan

This new under the tongue pill is said to be so rapidly absorbed that it saves the need to injections. It is a very interesting idea, but I suspect that it will be some time before it can be shown to be absolutely safe. The concept is that the pill, as with the injections, will slowly desensitise the patient to the allergen. Without having had any experience of the pill it is impossible to pontificate but I would expect the problem to be that if it is as effective as they hope there would be some risk in some susceptible patients of a severe reaction and even anaphylactic shock. This is why in the UK these injections are given in hospital.

I am sorry that I don’t know the name of the Danish company or how long they will take them to perfect the pill. In the meantime I would suggest that your friends should discuss desensitising injections. It is worthwhile clearing up a single pollen allergy when possible. The spectrum of pollens to which a patient is allergic often increases over the years, so that what starts as an allergy to one pollen ends up by being an allergy to many different ones.