WITH DR JENNIFER GRANT My eyes react badly when I put on makeup — would antihistamines help?

QI have been working from home a lot and as a result very rarely wear makeup. When I do, I notice that my eyes go crazy — watery and hayfevery. My nose would run sometimes also. I don’t use out-of-date makeup, I have tried different brands and I wash my make up brushes after every use. I wonder if I took an antihistamine would that help? I am pretty sensitive to a lot of things but I can’t stop wearing makeup. What do you think of the antihistamine idea?

AI understand that your symptoms only occur when you put on your makeup, and if you have not changed any products recently, then it is unlikely to be an allergic reaction to your make-up, unless the manufacturer has changed the ingredients — but then they would usually also change the packaging. Like you said, it may be a hayfever-like reaction you are suffering, even though you have not mentioned any history of hayfever or that symptoms occur when outdoors. You should try going for a walk in a local park without any makeup on and see if you get symptoms.

The hayfever season runs from spring through to autumn. Eye allergy symptoms include red, swollen, itchy eyes, a burning sensation or excessively tearful/runny eyes, and lastly sensitivity to light. You might consider using a simple eye rinse/wash daily to remove any dust and pollen from the surface of the eyes. Sometimes having an eye lubricant/moisturising drop in the fridge and applying a cold, hydrating drop can help relieve milder symptoms. Certainly, a trial of oral antihistamine tablets is worthwhile as they have good efficacy for reducing itching, sneezing and to some extent symptoms of runny eyes/nose.

Antihistamine medication antagonises histamine activity at H1 receptors responsible for inflammation and allergic responses. The first-generation (first to market over 60 years ago) H1 antagonists, are also known as ‘sedating’ antihistamines (eg, diphenhydramine, chlorpheniramine) as they commonly cause drowsiness. They are often used as sleep aids due to this side effect. The second-generation H1 receptor blockers, also known as ‘nonsedating’ antihistamines (eg, loratadine, cetirizine) are less likely to cause drowsiness, fatigue or dry mouth. This is because the nonsedating antihistamines act as a selective antagonist of peripheral H1-receptors (versus central, which would cause drowsiness) and are relatively free of anticholinergic activity, therefore much less likely to cause dry mouth, blurred vision or difficulty passing urine.

As your symptoms are limited to your eyes, I also suggest trying topical antihistamine eye drops, either Over the Counter (OTC) or prescribed by your GP. In people with hayfever-like allergies, the body mistakes something harmless, such as pollen, for a threat. Anti-allergy eye drops (antihistamine or mast cell stabilisers or dual action) are used to help treat eye symptoms, as they target the site of inflammation directly. The scientific data suggests that short-term use of topical steroid eye drops (unfortunately, not safe to use in the long term) or nasal sprays (can be used for several months every year) are the most effective single maintenance therapy for hayfever. Steroid eye drops exhibit a very strong anti-inflammatory effect but can have serious side effects (ie, increased risk of glaucoma, cataract development and possible damage to the cornea). Steroid eye drops are only available on prescription, and treatment is closely monitored. They work within a few hours — however, maximal benefit may take a few days or weeks to be seen in patients with longstanding untreated symptoms.

After a few weeks, if these simple measure do not help, then I suggest attending a specialist allergy clinic to help assess the exact underlying cause of your eye allergies such as pet dander, dust, pollen, smoke, perfumes, or even food triggers. Attending an optician or eye doctor for an eye examination during a flare-up may also help firm up a diagnosis and treatment plan.