The West

People often get it wrong when trying to find the right hay fever medication to relieve their symptoms.

Richard Loh, president of the Australasian Society of Clinical Immunology and Allergy, said either they opted for cheaper sedating antihistamines without realising the drowsy side effects or they bought nasal steroid sprays expecting immediate relief, when in reality it could take around two weeks for improvement.

"So they squirt it up their nose for a couple of days, get no benefit and don't think it works. So it is lack of education," Dr Loh said.

Even health professionals were sometimes not aware of the latest treatments available, particularly in relation to immunotherapy, he said.

Effective hay fever treatments include corticosteroid nasal sprays which reduce inflammation in the nose and non-sedating antihistamines which help control sneezing and itching.

Eye drops can aid itchy, swollen or runny eyes, however, while drops are available over the counter at pharmacies, prescription-only medication tends to be more effective.

Decongestant nasal sprays can offer quick relief from a severely blocked or runny nose, but can only be used for a few days, otherwise people risk damaging the lining of the nose.

A helpful preventative treatment for those known to be allergic to hay fever triggers including house dust mites and grass pollens is immunotherapy, either via injections, drops or, just introduced last year, tablets that are placed under the tongue.

Immunotherapy exposes patients to increasing amounts of an allergen to reduce their allergic symptoms.

Injections require weekly treatments for 14 weeks followed by monthly injections. The tablets or the drops need to be taken under the tongue every day for about three years.

Dr Loh said immunotherapy could be expensive and time consuming - about $1000 a year - so it was important patients were assessed by an allergist to see if it would help.

Only patients who are allergic to northern hemisphere grasses would benefit from those desensitisation treatments, and even then they were not perfect. They were effective for 70-80 per cent of patients.

Dr Loh said often the best results were in children because they had fewer allergies than adults who could accrue multiple allergies as they aged.

When it came to treating the symptoms, Dr Loh said it was important people avoided sedating antihistamines, even though they were cheaper. They also should not be scared to use nasal steroids.

"Everyone is terrified of squirting steroids up their nose but these are very low dose steroids with a very good safety profile. There are people who don't mind using inhaled steroids for their asthma but when you start talking about their nose they start getting really worried," he said.

"Concern about (a side effect of) bleeding noses is related to poor technique."

Lung Institute of WA medical director Professor Philip Thompson said there was much confusion about the various nasal medicines.

The one people were most familiar with, antihistamines, was mainly designed to stop acute sneezing and itch.

"Unless the nasal blockage is a direct by-product of a lot of sneezing, then it won't help with a blockage. If you predominantly have a very blocked nose and you can't sleep, antihistamines won't help," Professor Thompson said.

"The best treatment for this are drugs that are first cousins to adrenaline - pseudoephedrines. Like adrenaline, they constrict blood flow and by shutting down the blood flow through the nose, limit the tissue fluid leakage and allow the swelling to go away and suddenly you can breathe."

This was available in a spray or tablet form, however sprays tended to be better because they were localised, rather than exposing the whole of the body to the drug, he explained.

However, this meant people had to ensure they used the sprays correctly to get the benefit. Such treatments were short-term and using nasal steroids would provide long-term protection.

"For anyone with chronic problems it is not unreasonable that they seek expert assessment at least once, so they know exactly where they stand and they can then use that to formulate their future treatment plan," he said.

Future treatments of hay fever could include a botox gel.

Researchers at Monash Medical Centre announced last month that they were recruiting people for a trial of a botox gel that could potentially offer relief by blocking nerve endings in the nasal passage to reduce symptoms.

Spray technique:

·Blow nose before spraying

·Tilt head slightly forward and gently insert nozzle into nostril. Use your right hand for left nostril and left hand for right nostril.

·Aim the nozzle away from the middle of the nose and direct it into the nasal passage - not upwards towards the tip of the nose, but in line with the roof of the mouth

·Avoid sniffing hard during or after spraying

The West Australian

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