Hay Fever
An allergy to pollen, dust mites, mould or pets: sneezing, runny or blocked nose, itchy eyes. About 1 in 5 Australians has it. A daily nasal spray beats a cupboard full of tablets.
The hay fever ladder
Start low, but don’t skip step 3: a daily steroid spray is the single most effective treatment.
- Step 1 · Self-careDodge the pollen and rinse it outCheck pollen forecasts, wraparound sunglasses, shower after time outside, saline rinses.
- Works
- Saline rinses ease nose symptoms by about a quarter in small trials; avoidance helps on bad days
- Cost
- Free to about $10–25 for a saline rinse kit
- How long
- Through your season
- Watch for
- Use sterile or cooled boiled water for rinses.
Drying sheets on the line in spring is a pollen collection service.
- Step 2 · PharmacyNon-drowsy antihistamine tablets (cetirizine, loratadine, fexofenadine)For sneezing, itch, runny nose and watery eyes.
- Works
- Modest benefit over a dummy treatment in trials: good for itch and sneezing, little help for a blocked nose
- Cost
- About $10–25 for 2–3 months of generic tablets
- How long
- Work within an hour; take daily in season or as needed
- Watch for
- Some people still feel a bit drowsy, especially on cetirizine.
Generic and brand-name tablets are the same medicine in a different box.
- Step 3 · PharmacySteroid nasal spray (budesonide, fluticasone, mometasone)Calms the inflamed nose lining.
- Works
- Beat antihistamine tablets for nose symptoms across 16 trials; the most effective single treatment
- Cost
- About $15–25 a bottle (1–2 months)
- How long
- A few days to start working, up to 2 weeks for full effect. Daily through the season.
- Watch for
- Nosebleeds and dryness. Aim towards the outer side of the nostril, not the middle.
It’s not a rescue spray. Daily, even on good days.
- Step 4 · PharmacyCombination spray (azelastine with fluticasone)A steroid and an antihistamine in one spray.
- Works
- Beats either spray alone: about 50% more benefit over a dummy treatment than the steroid spray alone in trials
- Cost
- About $30–35 a bottle
- How long
- Works within an hour; use daily
- Watch for
- Bitter taste, nosebleeds, mild drowsiness.
For when one spray isn’t pulling its weight.
- Step 5 · SpecialistAllergen immunotherapy (desensitisation)Tablets or drops under the tongue, or injections, to retrain the immune system. For proven allergy not controlled by sprays.
- Works
- Symptoms and medicine use about 20–30% lower than a dummy treatment; benefits last years after a 3-year course
- Cost
- About $100–150 a month for tablets or drops (not on the PBS), plus specialist fees
- How long
- 3–5 years
- Watch for
- Itchy mouth or throat early on. Rarely, severe allergic reactions: first doses are supervised.
The only treatment that changes the allergy itself. A marathon, not a sprint.
Save your money
Popular, heavily marketed or often asked about, but the evidence is weak or says no.
- The ‘hay fever injection’A steroid shot risks weaker bones, high blood sugar and mood changes, and safer options work. One jab, months of side effects.
- HomeopathyA major Australian review (NHMRC) found no health condition where it works better than a dummy treatment. Expensive water.
- Local honeyThe one small trial found it no better than a dummy treatment. Lovely on toast, useless against pollen.
- Old sedating antihistamines (e.g. promethazine)No better than modern non-drowsy ones, and the drowsiness affects driving, work and school.
- Unproven allergy tests (IgG, kinesiology, hair analysis)Not valid for diagnosing allergy and often lead to pointless diets. Skin prick or IgE blood tests do the job.
What you can do
- Try not to rub itchy eyes: frequent rubbing is linked to keratoconus, a thinning of the cornea. Treat the itch instead.
- Start your steroid spray a couple of weeks before your usual season.
- Decongestant sprays: 3 days max, or your nose gets more blocked than before.
- Antihistamine eye drops help itchy, watery eyes.
- Dust mites: wash bedding weekly in hot water and use mite-proof covers.
See your GP if
- Symptoms aren’t controlled after a few weeks of daily steroid spray
- Cough, wheeze or tight chest, especially in spring: you may have asthma
- Blocked nose on one side only, nosebleeds, or loss of smell
- You’d like allergy testing or to ask about immunotherapy
Call 000 for trouble breathing, wheeze or a tight chest that isn’t quickly relieved by a reliever puffer. Thunderstorm asthma can start fast during or after a spring storm, even if you’ve never had asthma. If you have asthma, take your preventer every day through pollen season and always carry your reliever.
Common questions
What is the most effective hay fever treatment?
A steroid nasal spray used every day, especially for a blocked nose. Full effect takes a few days to 2 weeks. A combined steroid and antihistamine spray works better than either alone.
Do antihistamines help a blocked nose?
Not much. Non-drowsy antihistamines help sneezing, itch and watery eyes, but do little for a blocked nose.
Is a hay fever injection safe?
Steroid injections aren’t recommended. Risks include weakened bones, raised blood sugar and mood changes, and safer treatments work. Allergen immunotherapy is different: it’s a long-term desensitisation treatment.
What is thunderstorm asthma?
Sudden asthma that can start during or after a spring storm on high-pollen days, even in people who’ve never had asthma. Call 000 for trouble breathing that isn’t quickly relieved by a reliever puffer.
Is it hay fever or a cold?
Hay fever causes itchy eyes and nose, sneezing fits and a clear runny nose that last for weeks and come back each season, without a fever. A cold usually lasts 7 to 10 days and may bring a sore throat, aches or a low fever.
When is hay fever season in Australia?
In south-eastern Australia, grass pollen peaks from about October to December. Tree pollen can start in late winter. Further north the season is longer, and dust mites, pets and mould cause symptoms all year.
Can hay fever be cured?
Allergen immunotherapy (desensitisation), given as tablets, drops or injections for 3 to 5 years, can reduce symptoms for years after it stops. For most people, a daily steroid nasal spray controls symptoms well.
Helpful resources
- ASCIA: Allergen immunotherapy FAQPlain-English answers on desensitisation: who it suits, how long it takes and what to expect. Free.
- Asthma + Lung UK: How to use a nasal sprayShort nurse-led video. Plenty of ‘useless’ sprays are really technique problems. Free.
Evidence and more information
- ASCIA: Allergic rhinitis (hay fever)
- ASCIA: Allergic rhinitis treatment plan
- National Asthma Council: Thunderstorm asthma
- Healthdirect: Hay fever
- Am J Rhinol Allergy (2012): Saline rinses for hay fever, meta-analysis
- BMJ (1998): Steroid sprays vs antihistamine tablets, meta-analysis
- Azelastine–fluticasone prescribing information: trial results
- MDedge: Grass pollen immunotherapy tablet trial
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