When hay fever season blows in, don't bother popping tablets. Stick to nasal sprays, revised US guidelines confirm.
Roughly 18 per cent of children and adults in Australia and New Zealand have seasonal allergic rhinitis, triggered by windborne pollen most commonly from grasses, weed and sometimes trees. Many seek relief with over-the-counter antihistamine tablets from the pharmacy.
But a Joint Task Force of US allergy, asthma and immunology specialists have confirmed intranasal corticosteroids alone should be used to treat allergic rhinitis in people 12 years and older.
The guidelines echoed recommendations from the Australasian Society of Clinical Immunology and Allergy (ASCIA) that have long recommended corticosteroid nasal sprays to prevent and treat seasonal hay fever, rather than antihistamine tablets or a combination of the tablets and sprays.
A systematic review found taking the oral antihistamines to treat allergic rhinitis offered no additional benefit, according to the paper published in the Annals of Internal Medicine.
The tablets, particularly the first generation oral antihistamines, were instead likely to cause drowsiness and other adverse events, particularly when used with alcohol or other medications.
Intranasal corticosteroids reduce inflammation in the blood vessels of the nose, which causes a runny nose, congestion, itching and sneezing. They work best when used daily, starting at the beginning of pollen season to stop the swelling in the mucosal lining of the nose, and applied correctly to avoid irritation.
Oral antihistamines work by blocking the histamine immune response to foreign pathogens or allergens but do not relieve congestion.
Professor of immunology and allergy at Western Sydney University Connie Katelaris said the revised guidelines were very sensible and in line with recommendations Australian doctors had been following for years.
Professor Katelaris said people who experience hay fever should follow their doctor's advice when it came to using nasal sprays to prevent and treat the symptoms, instead of opting for the "quick fix" tablets from the chemist that were in fact no fix at all.
"People with chronic hay fever need a proper plan that involves starting on [corticosteroids] early so they don't get to the stage where their nose is blocked and they're miserable," Professor Katelaris said.
The taskforce also recommended doctors consider a combination of corticosteroid and antihistamine nasal sprays for people 12 years and older with moderate to severe allergic rhinitis, concluding the two nasal sprays were more beneficial than the combination of intranasal corticosteroids and an oral antihistamine.
Clinicians should also opt for intranasal corticosteroids over leukotriene receptor antagonists for initial treatment in people 15 years and older, the guidelines advised.
