Treatments are all down to the severity

THE reason why there are so many different hay fever treatments, offering different results for different people, is largely a question of severity.

Patients with mild intermittent symptoms do well with antihistamines and the newer non-sedating tablets should be used.

Patients with more severe and persistent symptoms do better with a regular daily intranasal corticosteroid spray.

When they do not work, it is often that the patient does not have a correct diagnosis of allergic rhinitis or the spray technique may be wrong or the spray is not being used regularly.

About five to eight per cent of patients do not respond to these measures or get bothersome side effects such as drowsiness or nose bleeds.

They should seek a referral to an NHS allergy clinic for consideration for allergen immunotherapy desensitisation treatment.

This involves administration of allergen extracts of grass pollen, starting low but increasing to large doses weekly then monthly by injection.

Recently, immunotherapy by placing daily grass pollen tablets under the tongue has also been shown to be an effective and safe alternative.

Immunotherapy is practised widely in US and Europe but less commonly in the UK, largely because of lack of awareness and a lack of specialist NHS allergy centres.

When given continuously for three years, immunotherapy is the only treatment shown to provide long-term relief for at least several years after stopping the treatment.