Dr Phil Kieran: How can I manage my daughter's hay fever? 

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My 12-year-old daughter suffers from hay fever during the spring and summer months. We usually manage her symptoms with OTC antihistamines and limit her time outdoors when the pollen count is high. She naturally finds this restrictive, particularly when she wants to be with her friends. Is there a medication or therapy you could suggest?

Hay fever or allergic rhinitis is a common complaint, with more than 10 to 15% of the population suffering from it to a greater or lesser extent. It is caused by a hypersensitivity to pollen—similar symptoms can be caused by other allergies, such as dust allergies or pet allergies. Hay fever usually occurs at the same time each year for the sufferer. Tree pollen causes problems in the spring and early summer, while grass pollen is the usual culprit from summer to early autumn.

The first line of treatment is to avoid high pollen exposure, so watching the pollen count on Met.ie can help when planning outdoor activities. Drying clothes indoors and keeping windows closed also reduce exposure. However, this can be very restricting, particularly for a 12-year-old who would much rather be outside playing with her friends on sunny days.

The next step in treatment, as you are already doing, is to try OTC antihistamines, which can be very effective for some. Other steps to reduce symptoms include applying a small amount of Vaseline to the edges of the nostrils (this can trap pollen and prevent it from entering the nose) and using saline nasal rinses, which have been shown to significantly reduce symptoms. Saline can be used once a day when symptoms are mild, increasing to twice daily during high pollen times.

If these interventions fail, it is a good idea to see your GP as prescribed antihistamines may be more effective. Your doctor may also recommend a medicated nasal spray to help alleviate symptoms.

If routine treatments are not working, blood tests may be considered to ensure no other issues are contributing to the overall symptoms, such as a recurrent respiratory infection or an additional allergy. In the vast majority of cases, it is possible to achieve good control of symptoms without severe restrictions on normal activities.

Sometimes, doctors exhaust routine treatments without achieving good symptom control. In these cases, the patient may be referred to an immunology or respiratory/ENT service for advice on further management. In the most severe cases, immunotherapy can reduce and control hay fever inflammation, but thankfully, this is rare.

In your daughter’s case, I would suggest starting with saline nasal rinses and trying a dab of Vaseline around the nose. This—in conjunction with the antihistamine—could give good symptom control and allow her to live life without restriction. Failing this, seeing your GP for alternative antihistamines and considering nasal sprays would be the next step.

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