Allergy and immunology

Medicines for Hay fever & allergic rhinitis

An allergic reaction in the nose causing sneezing, itching, a runny or blocked nose and itchy eyes — managed by avoiding triggers and using antihistamines and nasal sprays.

Education and reference only. This explains which medicines are used and why, in plain language — it deliberately contains no doses and is not a substitute for advice from your doctor or pharmacist. Always discuss your own treatment with a qualified clinician, and check the BNF and the product labelling for prescribing detail.

Written by Meds Global Health Clinical Team · Clinically reviewed by Dr Muhammad Suffyan, MB BS, Founder & Clinical Director · Last reviewed · How we review

Quick answer

What is Hay fever & allergic rhinitis?

Allergic rhinitis is inflammation of the lining of the nose triggered when the immune system overreacts to harmless airborne particles such as pollen, house dust mites, mould or animal dander. The classic symptoms are sneezing, an itchy or runny nose, nasal blockage and itchy, watery eyes, and many people also notice tiredness or poor concentration.

  • How it is treated: Where possible, reducing exposure to the trigger comes first, though for pollen this is hard to achieve fully.
  • Self-care: Avoiding triggers where possible helps: for pollen, checking forecasts, staying indoors when counts are high, keeping windows shut, showering and changing clothes after being outside, and wearing wraparound sunglasses; for indoor allergens, reducing house dust mites and avoiding contact with pets that trigger symptoms.
  • When to seek help: See your pharmacist or GP if symptoms are not controlled by over-the-counter treatments, are interfering with sleep, work or school, or if you also have asthma that seems harder to control.

What it is

Allergic rhinitis is inflammation of the lining of the nose triggered when the immune system overreacts to harmless airborne particles such as pollen, house dust mites, mould or animal dander. The classic symptoms are sneezing, an itchy or runny nose, nasal blockage and itchy, watery eyes, and many people also notice tiredness or poor concentration. When it is driven by pollen it is called hay fever and follows the seasons; when caused by year-round triggers such as dust mites or pets it is perennial and persists throughout the year. Allergic rhinitis and asthma frequently coexist — the "one airway" idea reflects how inflammation in the nose and the lungs are linked — so good control of the nose can also help asthma.

How it is treated

Where possible, reducing exposure to the trigger comes first, though for pollen this is hard to achieve fully. Medicines are then chosen according to which symptoms dominate and how persistent they are. For sneezing, itch and a runny nose, antihistamines — taken by mouth or used as a nasal spray — are a first-line choice, and non-sedating types are generally preferred so they do not cause drowsiness. For a blocked nose and for overall control of moderate or persistent symptoms, a nasal corticosteroid spray is the most effective option, but it needs to be used regularly and with the correct technique to work, often taking a little time to reach full effect. Mast-cell stabilisers used in the eyes or nose can help prevent symptoms, particularly before known exposure. In selected people, especially those who also have asthma, a leukotriene receptor antagonist may be added. Combining a nasal steroid with an antihistamine is common where one alone is not enough.

For this condition, these medicines

Medicine classes used for Hay fever & allergic rhinitis

Each links to a full, dose-free guide — what it is, how it works, who can and cannot use it, side effects, interactions and FAQs.

Antihistamines Allergy First-line for sneezing, itch and a runny nose; taken by mouth or as a nasal spray, with non-sedating types preferred. Nasal corticosteroids Allergy The most effective option for nasal blockage and overall control; need regular use and correct technique. Mast-cell stabilisers Allergy Used in the eyes or nose to help prevent symptoms, particularly before known exposure. Leukotriene receptor antagonists Respiratory An add-on in selected people, especially where asthma is also present.

Symptom checker

Symptoms that can point to Hay fever & allergic rhinitis

Hay fever & allergic rhinitis can be one cause of these symptoms. Each guide explains the other possible causes and the red-flag warning signs that mean you should get urgent help:

Itchy eyesAn itchy, watering or gritty sensation in one or both eyes that is most often due to aller…NosebleedsA nosebleed is bleeding from inside the nose, usually from small, delicate blood vessels n…SnoringA rattling, snorting or whistling noise made when breathing during sleep as air passes a p…Hoarse voiceA rough, raspy, weak or croaky change in the voice from irritation, swelling or strain of …Dry mouthA persistent feeling that the mouth is dry and short of saliva — often a side effect of me…Feeling of a lump in the throatA persistent sensation of something stuck in the throat when nothing is actually there — u…Watery eyesEyes that overflow with tears or stream more than usual, most often from irritation, aller…Sticky or discharging eyeA sticky, crusty or running discharge from the eye — which can be watery, mucky or pus-lik…Swollen eyelidPuffiness or swelling of one or both eyelids — usually caused by a stye, blepharitis, an a…Barking cough in a childA harsh, barking cough in a child, often worse at night and sometimes with a rasping noise…Blocked or stuffy noseA stuffy, congested or blocked nose where the lining is swollen and the airways feel obstr…Loss of smellA reduced or absent sense of smell — often dulling the sense of taste as well — which is m…Loss of tasteA reduced or altered sense of taste, where food tastes bland, odd or of nothing at all — u…Frequent sneezingRepeated, sudden bursts of sneezing as the nose tries to clear an irritant — most often fr…

By active ingredient

Specific medicines used for Hay fever & allergic rhinitis

Dose-free guides to individual active ingredients used in hay fever & allergic rhinitis — what each is, how it works, how to take it, and its advantages and disadvantages:

MontelukastA once-daily tablet that helps control asthma and hay fever by blocking inflammatory chemi…CetirizineA once-daily, less-sedating antihistamine for hay fever and hives — available over the cou…LoratadineA non-drowsy, once-daily antihistamine for hay fever and itchy rashes, available over the …DiphenhydramineAn older, sedating antihistamine that causes drowsiness — used in the UK mainly as a sleep…PseudoephedrineAn oral decongestant that unblocks a stuffy nose; raises blood pressure and heart rate, so…FexofenadineA non-drowsy antihistamine used for hay fever and allergic rhinitis, relieving sneezing, a…PromethazineA sedating older antihistamine used for allergies, short-term sleep problems, and nausea o…MometasoneA steroid nasal spray that controls hay fever and other nasal allergy symptoms when used r…ChlorphenamineA sedating older antihistamine for allergies, hay fever and itchy rashes, also found in ma…LevocetirizineA once-daily, less-sedating antihistamine for hay fever and hives; non-drowsy for most peo…DesloratadineA once-daily, less-sedating antihistamine for hay fever and hives; non-drowsy for most peo…AcrivastineA fast-acting, less-sedating antihistamine for hay fever and itchy allergic rashes; it wor…BilastineA once-daily, non-drowsy antihistamine for hay fever and hives; it must be taken on an emp…MizolastineA once-daily, low-drowsiness antihistamine for hay fever and itchy rashes.…RupatadineA once-daily, mostly non-drowsy antihistamine for hay fever and chronic hives.…KetotifenAn antihistamine with mast-cell-stabilising action, available as tablets for allergy and a…Azelastine (nasal/eye)A fast-acting antihistamine, used as a nasal spray for hay fever or as an eye drop for itc…Mometasone (nasal spray)A steroid nasal spray for hay fever, persistent allergic rhinitis and nasal polyps that wo…Fluticasone furoateA once-daily inhaled or nasal steroid used to control asthma or to ease allergic rhinitis …EphedrineA medicine used to raise blood pressure during anaesthesia and, as drops or spray, to reli…Grass pollen extractAn allergen treatment that gradually trains the immune system to react less to grass polle…House dust mite extractAn allergen treatment that gradually trains the immune system to react less to house dust …ClemastineAn older, sedating antihistamine used to relieve allergy symptoms and itching.…TriprolidineA sedating antihistamine used to relieve allergy symptoms, often found in cough and cold c…BrompheniramineAn older, sedating antihistamine used for allergy symptoms and commonly found in cough and…PhenylephrineA decongestant in cold remedies and nasal sprays, also given by injection to raise blood p…DexbrompheniramineAn older, sedating antihistamine used to relieve allergy symptoms such as a runny nose, sn…PheniramineAn older, drowsy-type antihistamine used to relieve allergy symptoms such as itching, snee…CarbinoxamineAn older sedating antihistamine used to ease allergy symptoms such as a runny nose, sneezi…DexchlorpheniramineA sedating antihistamine used to relieve allergy symptoms such as hay fever, itching and r…FlunisolideA steroid nasal spray used to ease the symptoms of allergic rhinitis, such as a blocked, r…TripelennamineAn older sedating antihistamine used to ease allergy symptoms and itching, which commonly …TriamcinoloneA steroid medicine that reduces inflammation, often given as an injection into a joint or …

Beyond medication

Lifestyle and self-care

Avoiding triggers where possible helps: for pollen, checking forecasts, staying indoors when counts are high, keeping windows shut, showering and changing clothes after being outside, and wearing wraparound sunglasses; for indoor allergens, reducing house dust mites and avoiding contact with pets that trigger symptoms.

When to get help

When to see a doctor

See your pharmacist or GP if symptoms are not controlled by over-the-counter treatments, are interfering with sleep, work or school, or if you also have asthma that seems harder to control. Seek urgent help for any sudden severe breathing difficulty, swelling of the lips or throat, which suggests a more serious allergic reaction.

999Emergency — call 999 or go to A&E
111Urgent advice — call NHS 111 or use 111 online
GPNon-urgent — see your GP or pharmacist

Not sure how urgent it is? It is always OK to call NHS 111 for advice, day or night.

Answers

Hay fever & allergic rhinitis: frequently asked questions

What medicines are used for hay fever and allergic rhinitis?

Antihistamines (oral or nasal) are first-line for sneezing, itch and a runny nose, with non-sedating types preferred. Nasal corticosteroid sprays are the most effective for a blocked nose and for overall control. Mast-cell stabilisers can help prevent eye and nose symptoms, and a leukotriene receptor antagonist may be added in selected people, particularly those with asthma.

Why isn’t my nasal spray working?

Nasal corticosteroid sprays need regular daily use and correct technique to be effective, and they can take several days to reach their full effect. Using one only occasionally, or aiming it incorrectly, are common reasons it seems not to help. Your pharmacist can check your technique and advise on using it consistently.

Which antihistamine should I choose?

Non-sedating antihistamines are generally preferred because they are less likely to cause drowsiness, which matters for driving, work and studying. They are available both as tablets and as nasal sprays. A pharmacist can help you pick one suited to your symptoms and circumstances.

How is hay fever linked to asthma?

The nose and lungs share a connected airway, so allergic inflammation often affects both — this is sometimes called "one airway, one disease". Many people have both conditions, and treating allergic rhinitis well can improve asthma control. Tell your clinician if both seem to flare together.

Keep reading

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Sources

Where this is drawn from

  • NICE CKS: Allergic rhinitis.
  • NICE CKS: Hay fever.

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