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The correct name for hay fever is 'seasonal allergic rhinitis'. The term 'hay fever' originated in the 19th Century when it was assumed that it was just grass pollens that caused irritation, but tree and weed pollens cause it too. Because of the release of the different pollens, the hay fever season stretches from early spring to late summer, although not all sufferers will be allergic to all of the pollens.

Hay fever doesn't raise the temperature of the sufferer, and so a fever is not one of the recognised symptoms.

When grass, tree and weed pollens travel up the nasal cavity of a hay fever sufferer, they trigger an immune response. One of the chemical compounds released by this is histamine, which causes sneezing, runny nose, itchy, watery eyes and, sometimes, nasal congestion.

Grass, tree and weed pollens trigger hay fever in sufferers

Flowers don't give you hay fever

While tree, grass and weed pollens are small enough for the wind to pollinate, the pollens collected by insects from flowers are larger and heavier and are not released into the wind. Some people mistake an allergic reaction to a flower's perfume to be hay fever.

Another common misconception is that local honey can be a hay fever remedy. However, because of the way flower pollens behave in the wind, this cannot be the case.

There's no cure, but there are multiple treatments

There is no cure for hay fever but there are now three generations of antihistamine tablets that block the histamine and most side effects.

The first generation includes chlorphenamine, branded as Piriton. As with other first-generation antihistamines, Piriton has a sedative action and may cause drowsiness.

Second and third generation treatments such as cetirizine (hydrochloride), loratadine, fexofenadine and acrivastine are generally less likely to cause drowsiness, although cetirizine can cause this in 10% of users. Cetirizine is noted to work faster but loratadine's effects last longer. But they come at a higher cost.

There's a big difference between branded and non-branded tablets when it comes to price

The price differential between different generations of antihistamines and branded and non-branded options is wide.

Acrivastine, which is sold under the brand name Benadryl Allergy Relief, claims to be active in 15 minutes, costs 41p per tablet and the user is directed to take three a day.

Meanwhile, other second-generation products fall to 35p a tablet for the cetirizine product Piritize and 26p a tablet for Claritin, a loratadine product. "However," notes Greg, "the Boots-own version for the same dose is 18 per tablet, Tesco's 10p a tablet, and Asda's is under 7p a tablet."

As well as a wide range of tablets, and even balms, masks and wraparound glasses, there are a plethora of nasal sprays including antihistamine and corticosteroid sprays and ones that combine both. Acting clinical director of Allergy UK, Margaret Kelman says that the steroid-based sprays are particularly effective at relieving congestion, but that their use should be supervised by a healthcare professional. Meanwhile, the antihistamine sprays are good for itchy and runny noses.

Saline sprays can be useful in helping antihistamines work more effectively by washing allergens out of the nasal passages.

Margaret cautions against reliance on decongestant nasal sprays, mainly used for colds, because prolonged use can mean symptoms will return and be more virulent after this method is finally stopped.

The hay fever jab is no longer a thing… but immunotherapy offers hope

A corticosteroid injection (brand name Kenalog) to reduce inflammation has previously been used for hay fever but is mainly for arthritis and joint pain. Its side effects include more susceptibility to infection and raised blood pressure, and this has prompted the NHS to discontinue its use for hay fever.

For those suffering from severe hay fever, immunotherapy, could offer a better route. Requiring a medical referral, this long-term treatment creates a tolerance by gradually increasing the dose of the relevant allergen over a period of three years.

Nasal microbiome could offer a new frontier for hay fever treatments

Research suggests that diversity of nasal microbiome could be as useful to us in raising immunity levels as happens with gut microbiome. Dr Sam White, lecturer in genetics and immunology at Nottingham Trent University, advises that oral probiotics with bacteria types lactobacillus acidophilus and lactobacillus rhamnosus GG "can actually help to reduce hay fever symptoms such as congestion, itching and sneezing".

Key to the efficacy of probiotics is whether they have an encapsulation formula to ensure most of the bacteria makes it through the body to the gut.

Find what treatment works for you

As with painkillers, the right hay fever treatment is about finding what works for you.

"All medications are metabolised differently for everybody," says Margaret, "and the antihistamines will work differently on different people."

"You've got to take into account the age of the person, their body weight, medications and the kind of conditions they may have. These will all have an impact on how quickly the antihistamine will work. I wouldn't say any one particular antihistamine is better than the other. It just depends on what kind of works for you."

Finally, Margaret also advises to take care over what non-active ingredients are in a tablet in case there are other allergens involved.

But what will listeners Lisa and Richard make of Greg's hay fever findings? Find out by listening here.

The information contained in this article was correct at the time of broadcast on 25 May, 2023.