Hayfever: the treatment

If you can work in an air conditioned building this may help a lot.

If you drive a lot, putting an electrostatic air filter in the car's ventilation system will probably help. This is simply a felt-like cloth with special fibres which have an electrostatic charge. I am told that all cars now being made have provision for putting such a filter into the air intake. An air-conditioned car may also be very good because of the air filtering which it provides.

Even preschool children should not have the older antihistamines in our opinion, again unless there is a specific reason why a doctor prescribes them in order to cause sedation or sleepiness. One reason for doing so is to reduce scratching in children with eczema.

The newer low-sedating antihistamines are at least as effective for hayfever. They cost more, but are still on the whole reasonably priced.

Examples of the newer and safer antihistamines

Are antihistamines safe if you are pregnant?

Two main medicines, cromoglycate and nedocromil, both of which work and have very good safety. Like the antihistamine sprays and drops they are used especially when people do not want to use steroid sprays or drops which do cause serious side effects.

Eye drops STING a bit if your eyes are inflamed. Don't worry about this; it soon goes away. The reason for the stinging is not the medicine, but the germ-killing antiseptic which has to he in the drops to make sure that they are safe to use even for people who have other eye problems as well as allergy. After you have been using the eye drops for some days they should be working, and your eyes should be less sensitive to this. If you really can't stand the stinging, then probably no eye drops will suit you and you'll probably prefer tablets.

Nose sprays may sting as well. This may vary from product to product, so it is worth experimenting. It is not specially a problem with the 'antiallergic' nose sprays.

Examples of 'antiallergic' drops or sprays

Work about as well as the antiallergic sprays and drops, and have about the same advantages and disadvantages. Of course they also work only in your nose or eyes.

If they work for you, fine. You're getting a good result without taking tablets which get to your whole body. You may like that aspect. You're also using a medicine which is not a steroid. In your nose, the steroid sprays really are tremendously safe and work like no other spray, but you might still prefer not to use a steroid if an antihistamine or antiallergic spray suits you.

But steroids in your eyes really are a bad idea if there is another medicine which will do the job.

So there is definitely a place for the antiallergic and the antihistamine drops and sprays.

No other kind of spray is so effective in the nose. Particularly, steroid sprays seem to work better against blockage of your nose from allergy than antihistamines do.

But the nose is a complicated thing. Inside, it looks a little bit like the inside of a walnut. Since you're trying to cover the lining with spray through two little holes, your nostrils, you may not be very successful in covering the whole of the lining. There's a way round this problem; we hope to describe it with pictures.

Meanwhile, A USEFUL TIP FOR USING ANY NASAL SPRAY which is a watery liquid. It could help if you've found sprays not much use in the past.

• Blow your nose first if necessary

• Tilt your head forward rather a lot: look at your feet

• Hold the spray so that the spout points straight up

• Spray one or two puffs into each nostril whilst sniffing for each puff

• Immediately get into a position so that your head is truly UPSIDE DOWN. Either kneel with your head between your knees, or lie across your bed with the edge of the bed behind your shoulder blades and your head tipped backwards until it is upside-down. You may need some practice and the help of a family member watching from the side to make sure your head really is truly upside down.

• Stay in this position for at least 30 seconds, sniffing in and out briskly and repeatedly to really spread the drops around inside your nose.

• That's it. You can get up now.

But don't make life complicated if you don't need to. If the ordinary way works, stick with it.

How did you get on? OK, you can try it tomorrow.

'STICKY' SPRAYS: Nasacort is a steroid spray which is formulated to stick to the lining of your nose instead of just running out. It is liquid when sprayed, but becomes jelly-like when it stops moving so fast. This should make it work better, and it is more convenient than the gymnastics I have just been describing. Other manufacturers claim that their steroid sprays also do this. Our suggestion: find out what works for you.

And now YET ANOTHER USEFUL TIP FOR STEROID SPRAY USERS. If your nose has been really badly affected by hayfever before, START USING YOUR STEROID SPRAY BEFORE YOU EXPECT YOUR HAYFEVER SEASON TO START.

Why? Well, it's to do with the way steroids work. Over a period of days, they prevent a build-up of inflammation in your nose which starts even before you notice any serious trouble. An inflamed nose is a sensitive nose, which will make you sneeze when you look into the sunlight or when you're trying to impress someone. So don't let it get inflamed in the first place. Keep the thing under control, and keep your cool.

There's a lot of scientific stuff behind this advice, but you don't want to be bothered with all that right now, do you? It works.

Steroid eye drops are very effective but can have serious side effects. So we don't like prescribing them for hayfever. But sometimes they are a good choice for a short time. What side effects? Increased pressure in the eyes (glaucoma), cloudiness of the lens in the eye (cataracts), and damage to the cornea, the transparent front covering of the eye. Blindness is a possible result of all three.

Can help a lot over a short period of up to a few days, but cause worse trouble than you started with if you use them for longer.

What happens is that they give you marvellous relief of the blockage in your nose. Only when they wear off, not all that long afterwards, your nose is blocked again. If anything, it's a bit more blocked than before you used the decongestant. This goes on, and if you carry on long enough you will have a worse blocked nose than you have ever had before, and it will seem that you have to use the spray all the time to be able to breathe at all through your nose.

The only remedy is to stop using the decongestant, put up with a very badly blocked nose, and get back to the state you would have been in if you had never used it. This will be better than the state you got yourself into with the decongestant spray.

All this does not happen with steroid or antiallergic or antihistamine sprays. They are safe. Only the decongestants make you worse than before.

Scuba divers may be tempted to use decongestant sprays to prevent pain in their ears during the descent. This has been considered potentially dangerous, as the spray may be wearing off by the time you return towards the surface, trapping compressed air in the middle ear where it might cause burst eardrums. There is also the argument that if you think you need such a spray you are not medically fit to dive. Scuba diving without adequate training and information is dangerous; consult a doctor expert in the medical aspects of diving if in the least doubt.

Decongestant sprays may help you get started with a steroid spray which would otherwise just not get into your nose. Don't be afraid of them if your doctor recommends them for short periods.

Work very well but have side effects. Should be used only for short periods when all else fails and it is really important to suppress symptoms, e.g. for exams, weddings, interviews.

Definitely worth using, under a doctor's supervision, if hayfever would otherwise interfere with your ability to function at a critical time in your life.

Our preference, quite definitely, is for tablets, not injections. Why inject something if taking small tablets works just as well? With tablets the dose can be adjusted and kept to a minimum. If it suddenly starts to rain for days on end, you won't need much or any. Steroids do have side effects. When your crisis or important event is over, you can stop taking the steroid tablets. The injections which doctors usually use are so-called 'depot steroids' which are supposed to stay around for a long time, whether you still need them or not.

Steroid injections sometimes cause 'fat atrophy', making a dent in your buttock which may look odd if you wear a swimsuit. Rarely they can cause an abscess. Though rare, this is extremely unpleasant. Another rare side effect of injections is anaphylaxis, an allergic reaction which may be life-threatening. Although tablets have caused anaphylaxis too, that is vastly more rare still and is likely to be less serious. Tablets are safer on all counts.

The argument for the injections is that some people find them convenient. But frankly, if tablets are too inconvenient for you, do you seriously need this treatment?

If your doctor is not sure what dose of steroid tablets to prescribe, we suggest two ways of looking at this.

The first is that short courses of steroid tablets are often prescribed for asthma which has temporarily become worse; a similar course would do for you. You could be treated as if you had a moderate worsening of asthma requiring a moderate dose of steroid tablets.

The other is to start with 20 or 30 milligrams of prednisolone daily for one to three days and then reduce to 20, 15 or 10 mg daily in the morning. Keep dose at the minimum which gives adequate control, but increase again if control is not adequate. It is unusual to need this treatment for more than 2 or 3 weeks. Once the need has passed, stop without bothering to reduce the dose gradually.

Remember, use steroid tablets only to enable you to function normally in an important part of your life. The aim is not to remove every last symptom unless that is really important for you, e.g. if you are an actor or singer and hayfever during filming or singing would ruin a critically important performance. Stop the steroids when the important event is over, or when the worst part of the pollen season subsides, whichever comes earlier. Refer to a pollen count graph to see when the bad part of the pollen season is. For the middle of the UK you will find a good one on our hayfever page.

Widely used throughout the world but hardly used in Britain. They do work, however, and can help hayfever when the best you can do with other treatments is not good enough.

You really should have advice from an allergy specialist before you embark on this. It is a time-consuming treatment, especially the way we do it in Britain, and there is a very small risk of death from the treatment. But then lots of other things we do, like travelling by car, have a small risk of death. You do however want to be driven by a good driver, and likewise, desensitisation should be prescribed and supervised by an expert.

The other thing the expert may be able to do for you is to help you really get the best out of all the other treatments, and you may find that you then don't want desensitising injections.

Desensitising injections are not a cure. They make the symptoms less, which may well mean they are perfectly bearable or easily treated with the other medicines.

In Britain most specialists would not desensitise with a mixture of things you are allergic to. For grass pollen hayfever they would only give you grass pollen injections, for example. Also, in Britain we insist on giving the injections in a hospital environment so that you can have swift and efficient treatment if you have a life-threatening allergic reaction. This and the one-hour wait after each injection makes it even more time-consuming.