Allergy and hayfever symptoms & management

Helping patients to manage the symptoms of hayfever

The symptoms of hayfever (or allergic rhinitis) may be seasonal but can have a wide-ranging impact on patients’ eyes, nose and even the skin.

The British Society for Allergy and Clinical Immunology have issued guidance for the management of allergic rhinitis.¹

First line recommendations for hay fever management

Mild-to-moderate intermittent and mild persistent - Antihistamines

First line recommendations for mild symptoms according to national clinical treatment guidelines are antihistamines^1,2

Effective on symptoms of itch, sneeze and rhinorrhea and have modest effects on nasal congestion
Improve histamine driven symptoms at sites other than the nose
Regular therapy is more effective than ‘as needed’ use in persistent rhinitis

Moderate to severe persistent - Topical INS

A first line recommendation for moderate/troublesome symptoms is topical intranasal corticosteroids (INS)^1,2

Act by suppression of inflammation at multiple points in the inflammatory cascade

The role of INSs in the treatment of AR

INSs are recognised as the most effective class for controlling symptoms of long-term anti-inflammatory treatment for AR, as they:^3,4

Relieve nasal symptoms
Are active in both early and late phases of the allergic cascade
High concentrations at receptor sites are achieved with a single dose

According to the 2008 Rhinitis Updated Practice Parameter from the AAAAI, INSs are the most effective first-line medication class for controlling symptoms of AR.³

In the treatment of SAR, INSs have been shown to be more effective than the combined use of an antihistamine and a leukotriene (LT) antagonist.³

INSs may provide significant symptom relief for patients with SAR, whether they’re used on a regular basis or on an as-needed basis.³

Advice on how to avoid allergies

In addition to oral antihistamines and intranasal corticosteroids, first‐line treatment for allergies also involves the avoidance of triggers that may cause an allergic reaction.⁵

Avoidance strategies for allergic rhinitis include:⁵

The use of allergen‐impermeable covers for bedding
Keeping relative humidity in the home below 50% to inhibit mite growth
Reducing pollen exposure by keeping windows closed, using air conditioning, and limiting the amount of time spent outside during peak pollen season
Avoiding exposure to, or ownership of, pets

Allergy management: in summary

Although each treatment option will help to reduce a person’s AR symptoms, clinicians should tailor the treatment option. Each of the following are common clinical scenarios, which would have different considerations:⁶

Person with nasal congestion as the primary complaint
Person with intermittent or episodic nasal AR symptoms
Person with mild AR symptoms
Person with moderate to severe AR symptoms

Product Information - Pirinase Allergy

Pirinase Allergy 0.05% Nasal Spray (fluticasone propionate). Uses: Prevention and treatment of allergic rhinitis. Dosage and method of use: Adults: Two sprays into each nostril once or twice a day if required. Maintenance: one spray per nostril once a day if possible. Use lowest possible maintenance dose. Max 4 sprays a day in each nostril. Children under 18 years: Not to be used. Contraindications: Hypersensitivity to ingredients. Precautions: Seek medical advice if: improvement is not seen within 7 days, relief is inadequate after 7 days, or more than 3 months continuous use is required. Seek medical advice before use with: other corticosteroid products, fever, nasal/sinus infection, recent nasal injury/surgery, nasal ulceration. Caution due to interactions with cytochrome P450 3A4 inhibitors may increase systemic exposure to fluticasone. Caution commencing in those withdrawing from systemic steroids, particularly if impairment of adrenal function suspected. Systemic effects of nasal corticosteroids may occur, particularly at high doses prescribed for prolonged periods. May cause visual disturbance. Contains benzalkonium chloride which may cause bronchospasm. Side effects: Very Common: epistaxis. Common: Dryness and irritation of the nose and throat, unpleasant taste and smell, headache. See SPC for full details. Legal category: P. PL number: PL 44673/0099. Product licence holder: Haleon UK Trading Limited, The Heights, Weybridge, Surrey, KT13 0NY, UK. Package quantity and MRSP (excl. VAT): 60 sprays £7.24; 120 sprays £11.66. Date of last revision: April 2023.
Product information – Piriton Syrup and Piriton Allergy Tablets

Piriton Children’s Allergy Syrup and Piriton Allergy Tablets (chlorphenamine maleate) Indications: Symptomatic relief of allergic conditions including hay fever. Symptomatic relief of itch associated with chickenpox. Dosage and method of use: Adults and children 12 years and over: 4 mg 4-6 hourly. Max 24 mg/24h. Elderly: Lower dose should be considered. Children 6-12 years: 2 mg 4-6 hourly. Max 12 mg/24h. Piriton Allergy Tablets not recommended for children under 6 years. Do not use either product continuously for more than two weeks without consulting a doctor. Syrup only: Children 2-6 years: 2.5 ml (1 mg) 4-6 hourly. Max 6 mg/24h. Children 1-2 years: 2.5 ml (1 mg), twice daily. Max 2 mg/24h. Not recommended for children below 1 year. Contraindications: Hypersensitivity. Treatment with MAOIs within last 14 days. Warnings and Precautions: Avoid concurrent use with other antihistamines and alcohol. May seriously affect ability to drive and use machinery. Caution in enlarged prostate, severe hypertension, cardiovascular disease or respiratory conditions, hepatic or renal impairment, epilepsy, raised intraocular pressure, bronchitis, bronchiectasis and asthma. Avoid use in elderly patients with confusion. Avoid concurrent use with drugs which cause sedation. Those with fructose or galactose intolerance, Lapp lactase deficiency, glucose-galactose malabsorption or sucrose-isomaltase insufficiency should not take these medicines. Syrup: Contains sucrose, hydroxybenzoates (E218, E214, E216) which may cause allergic reactions, and ethanol (6.3% v/v). Side effects: Sedation, somnolence, fatigue, disturbance in attention, abnormal coordination, dizziness, headache, blurred vision, nausea, dry mouth, allergic disorders including anaphylaxis. Children and the elderly are more prone to the neurological anticholinergic effects and rarely may become confused or excitable. See SPC for full details. Legal category: P. PL numbers: Syrup: PL 44673/0094. Tablets: PL 44673/0093. Product licence holder: Haleon UK Trading Limited, The Heights, Weybridge, Surrey, KT13 0NY, UK. Package quantity and RSP (excl. VAT): Syrup: 150 ml £5.42. Tablets: 30s £4.58, 60s £7.92. Date of last revision: January 2024.
Product Information – Piriteze

Piriteze Hayfever & Allergy 10mg Film Coated Tablets, Piriteze Children's Hayfever & Allergy 1mg/ml Syrup (GSL)and Piriteze Children's Hayfever & Allergy 1mg/ml Syrup (P) (cetirizine hydrochloride). Indication: Symptomatic treatment of seasonal and perennial allergic rhinitis, and chronic idiopathic urticaria. Dosage and method of use: Adults and adolescents over 12 years: 10 mg daily. Children 6-12 years: 5 mg twice daily. Elderly: As adults if renal function normal. Allergy Tablets and Syrup: Children under 6 years: Not recommended. P-line Syrup only: Children 2 to 6 years: 2.5mg twice daily. Children under 2 years: Not recommended. Adjust dose in moderate to severe renal impairment. See SPC for details. Contraindications: Hypersensitivity to ingredients, hydroxyzine, piperazine derivatives or severe renal impairment (creatinine clearance <10 ml/min). Warnings and Precautions: Concomitant alcohol. Predisposition factors of urinary retention (e.g. spinal cord lesion, prostatic hyperplasia). Epilepsy/risk of convulsions. Pruritus and/or urticaria may occur when cetirizine stopped, may require treatment to be restarted. Tablets: Not suitable for those with galactose intolerance, Lapp lactase deficiency or glucose-galactose malabsorption. Syrup: Not to be taken by those with fructose intolerance. Contains methyl and propyl parahydroxybenzoate which may cause allergic reactions. Side effects: See SPC for full details. Dizziness, headache, fatigue, somnolence, dry mouth, sore throat, abdominal pain, nausea, diarrhoea, rhinitis, allergic disorders including anaphylaxis and hypersensitivity, suicidal ideation, depression, nightmares, inflammation of the liver, skin eruptions, joint pain. Legal category: GSL: Syrup (6years+) and Tablets: 70ml/ 7, 14, 30 P: Syrup (2years+): 70ml. PL numbers: Tablets: PL 44673/0097. Syrup (GSL): PL 44673/0095. Syrup (P): PL 44673/0096. Product licence holder: Haleon UK Trading Limited, The Heights, Weybridge, Surrey, KT13 0NY, United Kingdom Package quantity and RSP (excl. VAT): Tablets: 7s £3.73, 14s £6.66, 30s £9.16. Syrup (GSL): 70 ml £5.41. Syrup (P): 70ml £5.41 Date of last revision: Aug 2023.
Product Information - Pirinase Hayfever

Pirinase Hayfever Once Daily 0.05% Nasal Spray (fluticasone propionate). Indications: Treatment of allergic rhinitis. Dosage and method of use: Adults: Two sprays into each nostril once a day, preferably in the morning. Maintenance: one spray per nostril once a day, if symptoms recur the dosage may be increased accordingly. Use lowest possible maintenance dose. Max 2 sprays a day in each nostril. Children under 18 years: Not to be used. Contraindications: Hypersensitivity to ingredients. Concomitant use with HIV medicines. Warnings & Precautions: Seek medical advice if inadequate relief after 7 days or require more than 1-month continuous use. Seek medical advice before use with: corticosteroid use, nasal/sinus infection, recent nasal injury/surgery, nasal ulceration. Caution due to interactions with potent cytochrome P450 3A4 inhibitors which may increase systemic exposure to fluticasone. Treatment with higher than recommended doses of nasal corticosteroids may result in clinically significant adrenal suppression. Systemic effects of nasal corticosteroids may occur, particularly at high doses prescribed for prolonged periods. May cause visual disturbance. Contains benzalkonium chloride which may cause bronchospasm. Side effects: Dryness and irritation of the nose and throat, nasal ulcers, nasal septal perforation, unpleasant taste and smell, headache and epistaxis. Hypersensitivity reactions including skin rash and oedema of the face or tongue. Eye disorders such as glaucoma, raised intraocular pressure, cataract and blurred vision. Anaphylaxis/ anaphylactic reactions and bronchospasm. Legal category: GSL. Product licence number: PL 44673/0100. MAH: Haleon UK Trading Limited, The Heights, Weybridge, Surrey, KT13 0NY, UK. RRP (excl. VAT): 60 sprays £7.92. Text prepared: April 2023.