Ask the Doctor: ‘I’ve developed hay fever in adulthood, is it dangerous to rely on antihistamine tablets?’

“Some of my family members and I have developed hay fever in the last couple of years, having previously never suffered with it. Firstly, why have we collectively developed it in adulthood (we are not all blood related)? Secondly, when the pollen count rises, I get through it thanks to daily antihistamine tablets. I am not someone who usually reaches for tablets but when it comes to this, I haven’t found any other option. Is it dangerous to be taking these daily, each hay fever season?”

Answer from Dr. Abhilash Sahadevan, Consultant in Respiratory & General Internal Medicine, Beacon Hospital

The rise in new cases of allergic diseases globally is a cause for concern. The hygiene hypothesis, which suggests that our cleaner environments and the eradication of parasitic infections in the developed world may be contributing to this increase, has gained traction. However, there are also growing concerns about the role of air pollution and environmental toxins in this trend. These are not just theories, but potential factors that could be behind the surge in hay fever cases, although the evidence is not yet definitive.

In my respiratory practice, there has been a noticeable increase in patients reporting all forms of allergic rhinitis since the Covid pandemic, including hay fever or grass pollen allergic rhinitis. Large-scale studies show this to be true across most developed health systems. It is likely that COVID-19 infections have caused immune system disruption and increased the incidence of allergic rhinitis and hay fever.

Oral antihistamines are safe. They have a good track record with no obvious loss of effect over time. The newer second-generation antihistamines are usually non-sedating, which was a big issue with the first-generation antihistamines like Piriton.

Contrary to popular practice, if you are getting daily symptoms of hay fever, a nasal steroid spray taken daily is more effective than daily oral antihistamines. Maximal benefits will be seen across most symptoms after a few days of starting a nasal spray for hay fever. For more severe symptoms, there are now 2 combination nasal steroid and nasal antihistamine sprays on the market, Dymista and Ryaltris. All nasal steroid sprays require a prescription. A small proportion of people will have drowsiness with the newer oral antihistamines, further emphasising the benefits of continuously using nasal steroids as opposed to daily tablets. At all times, daily saline rinses of your nose will help reduce symptoms.

Have a question for the professionals you’d like answered? Get in touch with sarah.gill@image.ie with the subject headline ‘Ask The Doctor’.