Hay fever: Nine tips for coping with pollen and seasonal allergens - BBC

The Sun is shining, the flowers are blooming – and, if you're like millions of other people around the world, you may be a sniffling, hacking, runny-eyed mess.

Globally, some 400 million people suffer from allergic rhinitis: a condition that occurs when the nasal passages are irritated by airborne allergens, including pollen. When this occurs seasonally, it's called hay fever. In North America, it's known as seasonal allergies (partly because the symptoms can be caused by an allergy to a wide range of different types of pollen or other allergens).

Making matters worse, it seems that both the number of hay fever sufferers and the severity of symptoms are on the rise, thanks in no small part to the consequences of climate change. ( Read more about how climate change is supercharging pollen and allergies.)

Luckily, you don't have to suffer in silence (if one punctuated by coughs and sneezes). In just the last few years, a number of treatments have become available to everyday hay fever sufferers that are more effective than ever before, while a wealth of research has fed into guidance about exactly how and when these treatments work best.

Here are nine tips for how to suffer less this allergy season – and when to head to your doctor.

1. Opt for a nasal corticosteroid or antihistamine spray – or combined version – over a pill

At the first sniffle, many of us tend to reach for an oral antihistamine like Claritin or Benadryl. But these pills tend to be less effective than intranasal options, because they work differently: like all oral medications, they have to be digested and distributed throughout the body. This means that the amount that actually reaches the nasal tissue, where it's needed, is limited.

Nasal sprays, on the other hand, are applied right where they need to go. And, unlike oral versions, they target inflammatory pathways themselves, helping them to address nasal obstruction, sneezing, and other symptoms more comprehensively.

All of this is why nasal spray s are now usually the recommended first-line treatment for both children and adults.

Within nasal sprays, the most effective tend to be corticosteroids, followed by antihistamines. But the best option, developed in the last decade or so, packs a one-two punch: a combined corticosteroid-antihistamine spray – which has proven most effective of all, with no worse side effects.

Nasal sprays will often clear eye symptoms on their own. However, if itchy eyes persist, eyedrops with olopatadine can be helpful, says Stephen Durham, emeritus professor of allergy and respiratory medicine at Imperial College London and Royal Brompton Hospital in the UK.

2. Avoid nasal decongestants

Not all nasal sprays are the same – and while many of us turn to decongestant sprays for relief from a blocked nose, this can backfire.

Decongestant sprays (which use ingredients like oxymetazoline, phenylephrine or xylometazoline) work by constricting the blood vessels, shrinking nasal tissue so you can breathe better. But with prolonged use – generally speaking, more than five days – blood vessels can become dependent on this effect and, when the drug isn't applied, swell too much. That leads to even more congestion (" rebound congestion ") and, often, the unsuspecting patient starts using even more. There is even a danger of long-term damage and dependence.

3. If you do take an oral antihistamine, make sure it's a 'second-generation' version

If you decide to take a pill, opt for a "second-generation" option like certirizine (Zyrtec), loratadine (Claritin) or fexofenadine (Allegra). These newer medications work better and have less of a sedative effect than first-generation options like diphenhydramine (Benadryl), chlorpheniramine or doxylamine.

While it can be tempting to take both an oral antihistamine and a nasal spray, it's usually "a waste of money", says Glenis Scadding, vice president of the non-profit E uforea, which focuses on research and education around allergies, and honorary consultant allergist and rhinologist at University College Hospital London in the UK. "Oral antihistamines make very little difference to a nasal corticosteroid," she says.

4. Start your treatment before allergy season begins