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Health condition · Clinically reviewed

Hay fever, nasal sprays, antihistamines and disease-modifying immunotherapy.

Sneezing, blocked nose and itchy eyes for months on end is not something to just put up with. A stepped UK plan gets most people back to normal seasons.

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Why trust this guide

  • 01

    Clinically reviewed

    Written by our editorial team and reviewed by a registered UK clinician before publication.

  • 02

    Sourced from guidance

    Checked against BSACI, ARIA and NICE CG103 sources you can see at the end.

  • 03

    Current for 2026

    Reflects modern UK allergy practice, including sublingual immunotherapy tablets and anti-IgE biologics.

Key facts

Hay fever at a glance.

The essentials, in plain English - what it is, the main triggers in the UK, and how it is treated today.

  • What it is

    IgE-mediated Type I hypersensitivity of the nose and eyes to airborne allergens - a very common allergic rhinoconjunctivitis.

  • How common

    Up to a fifth to a third of UK adults live with hay fever, with grass pollen the dominant driver from May to July.

  • Main triggers

    Grass pollen (May to July), tree pollen (birch and oak, March to May), weed pollen, fungal spores, house dust mites and animal dander.

  • Atopic march

    Often overlaps with eczema, asthma and food allergy, so a joined-up allergy plan matters more than a single medicine.

  • Foundation therapy

    Daily intranasal corticosteroid spray throughout the season, with a non-sedating oral antihistamine as needed.

  • Disease-modifying

    Sublingual immunotherapy tablets (grass, birch and house dust mite) offer three years of specialist-led treatment with lasting benefit.

Why this guide matters

A stepped ladder, not a rummage through the pharmacy.

Hay fever is common, treatable and - with the right stepped plan - usually controllable. The three ideas below shape the rest of this page.

  • Nasal steroid sprays are foundational

    Fluticasone, mometasone or budesonide sprayed daily throughout the season does far more than tablets alone.

  • Antihistamines are add-ons, not solos

    A non-sedating oral antihistamine helps sneezing, itch and eye symptoms - but rarely fixes hay fever on its own.

  • Immunotherapy changes the trajectory

    Sublingual tablets for grass, birch and house dust mite offer three years of specialist treatment with lasting benefit.

How the diagnosis is made

From first sneezes to a clear allergy plan.

The steps a UK GP or allergy specialist will normally follow, in order - so you know what to expect and why.

  1. 01

    Assessing

    Focused allergy history

    Seasonality, triggers, personal and family atopy - the story does most of the diagnostic work in typical rhinoconjunctivitis.

  2. 02

    Assessing

    Nasal and eye examination

    A look for the pale, boggy nasal mucosa of allergic rhinitis, along with any polyps and signs of conjunctivitis.

  3. 03

    Assessing

    Consider co-existing asthma

    Spirometry and FeNO where wheeze, cough or chest tightness suggest asthma alongside the nasal symptoms.

  4. 04

    Confirming

    Skin prick testing

    A specialist allergy clinic test that pinpoints the exact aeroallergens driving the symptoms.

  5. 05

    Confirming

    Specific IgE blood tests

    Component-resolved diagnostics such as Bet v 1 for birch and Phleum p 1 for grass sharpen the picture before immunotherapy.

  6. 06

    Preparing

    Rule out non-allergic rhinitis

    Vasomotor, gustatory and medication-related rhinitis (including rhinitis medicamentosa) can look similar and are treated differently.

  7. 07

    Preparing

    Specialist allergy referral

    For severe, poorly controlled or occupation-limiting disease, and to consider sublingual immunotherapy or biologics.

Typical timeline: a first GP visit to a settled seasonal plan in a matter of weeks.

Symptoms

What hay fever actually feels like.

The classic mix of sneezing, blocked nose, itch and conjunctivitis - and the wider effects on sleep, mood and performance.

  • Sneezing and rhinorrhoea

    Repetitive sneezing fits with a clear, watery runny nose - the classic hallmark of seasonal allergic rhinitis.

  • Nasal blockage

    A blocked, congested nose that muffles the voice and disturbs sleep, often worse first thing in the morning.

  • Itchy nose, palate and throat

    An irritating itch across the nose, roof of the mouth and back of the throat that antihistamines target well.

  • Itchy, watery, red eyes

    Allergic conjunctivitis - itching, tearing and redness that often bothers people as much as the nose.

  • Ear pressure and reduced smell

    Blocked eustachian tubes, muffled hearing and a reduced sense of smell reflect wider upper-airway inflammation.

  • Fatigue and poor sleep

    Nights broken by congestion translate into daytime tiredness, brain fog and reduced focus.

  • School and work impact

    Reduced academic performance in exam season and reduced occupational performance at work are well recognised harms.

  • Red flag - asthma flare

    A hay fever season that triggers wheeze, chest tightness or a rescue-inhaler surge needs urgent asthma review.

Treatment

How hay fever is treated in the UK.

Nasal sprays first, antihistamines and eye drops next, sublingual immunotherapy tablets for the moderate-to-severe end, and biologics for a small refractory group.

  • Allergen avoidance

    Track the pollen forecast, keep windows shut on high-count days, shower and wash hair after being outdoors, and wear wraparound sunglasses. A thin smear of Vaseline inside the nostrils traps pollen.

  • Nasal saline rinse

    A simple, cheap first step that washes pollen and mucus from the nose and improves how well corticosteroid sprays work.

  • Intranasal corticosteroids

    The first-line medicine - fluticasone, mometasone or budesonide - used daily throughout the season, with specialist advice on technique.

  • Combined nasal spray (Dymista)

    Fluticasone with azelastine in one spray - a step up when a single steroid spray is not enough on its own.

  • Oral antihistamines

    Non-sedating options such as cetirizine, fexofenadine, loratadine, desloratadine and bilastine are preferred. Sedating ones are used selectively.

  • Intranasal antihistamine

    Azelastine or olopatadine sprays give fast, targeted relief and can be added to a steroid spray.

  • Allergy eye drops

    Olopatadine, azelastine, emedastine or cromoglicate drops tackle itchy, watery eyes when antihistamines are not enough.

  • Montelukast

    A leukotriene receptor antagonist used mainly where asthma coexists, with MHRA-flagged neuropsychiatric side effects to discuss.

  • Short-course oral prednisolone

    A reserved, specialist-guided option for severe flares or exam periods. Depot steroid injections such as Kenalog are discouraged.

  • Sublingual immunotherapy (SLIT)

    NHS-approved tablets - Grazax and Oralair for grass, Acarizax for house dust mite and Itulatek for birch - given by specialist allergy teams over three years.

  • Subcutaneous immunotherapy

    Specialist injected immunotherapy for selected patients where sublingual options are not suitable.

  • Omalizumab (anti-IgE)

    A biologic used selectively for severe, refractory disease in specialist commissioned centres and often for coexisting asthma.

What this guide is based on

The sources behind every claim on this page.

UK national guidance and specialist society standards, current at the time of last review.

Key references

Guidelines and standards we relied on.

A quiet reminder

This guide is for information, not medical advice.

Your GP or allergy specialist knows your full history and can tell you which parts apply to you. If in doubt, get seen.

  • BSACI. Guideline for the diagnosis and management of allergic and non-allergic rhinitis.

  • NICE Clinical Knowledge Summary. Allergic rhinitis (based on CG103 principles).

  • ARIA. Allergic Rhinitis and its Impact on Asthma guidelines.

  • MHRA. Montelukast: reminder of the risk of neuropsychiatric reactions.

  • Allergy UK and BSACI patient information leaflets.

Red flags

When hay fever needs urgent attention.

Most hay fever is manageable in primary care. These are the situations that are not - and where an urgent or specialist opinion is needed.

  • Poorly controlled asthma

    Increasing wheeze, cough at night or reliever-inhaler overuse during pollen season needs same-week review.

  • Anaphylaxis features

    Any suggestion of throat tightness, breathing difficulty, faintness or widespread rash is a 999 call, not a hay fever plan.

  • Unilateral nasal symptoms

    One-sided blockage, one-sided bleeding or a one-sided facial pain deserves ENT review to rule out other causes.

  • Blood-stained discharge

    Persistent bloody nasal discharge is not typical of hay fever and warrants specialist assessment.

  • Facial pain or fever

    Sinus pain, tenderness or fever points to bacterial sinusitis rather than uncomplicated allergic rhinitis.

  • Rhinitis medicamentosa

    Rebound congestion after prolonged decongestant spray use - stop the spray and switch to a steroid spray with specialist advice.

  • Nasal polyps

    Suspected polyps or loss of smell that does not recover need ENT review and consideration of biologic therapy.

  • Occupational disease

    Symptoms clearly worse at work suggest occupational rhinitis and asthma, and need occupational health input.

  • Severe exam-period disease

    Hay fever that risks GCSE or A-level performance is a reason to escalate treatment early, not to gamble on antihistamines.

Living with it

A treatable condition, with a clear ladder.

Four things that make the biggest difference day to day - starting early, spraying properly, reducing pollen at home and knowing when to step up.

A quiet reminder

Consistency beats intensity, every season.

Daily use of a well-aimed steroid spray, started early, does more than a fistful of tablets rescued at peak season.

  1. 01 Plan

    Start before the season

    Begin the daily steroid nasal spray a fortnight before your usual trigger season starts - it works best used consistently, not just when symptoms flare.

  2. 02 Technique

    Spray the right way

    Aim the nozzle slightly outwards towards the ear, breathe gently and avoid sniffing hard - good technique doubles the benefit of any nasal spray.

  3. 03 Home

    Reduce the pollen coming in

    Keep bedroom windows shut on high-count days, dry laundry indoors during peaks, and shower before bed to wash pollen off your hair and skin.

  4. 04 Escalate

    Ask about immunotherapy

    If two or three seasons in a row are ruined despite optimal treatment, ask your GP about a specialist allergy referral for sublingual immunotherapy tablets.

Frequently asked

Everything we get asked about hay fever.

Quick answers on nasal sprays, antihistamines, immunotherapy and severe disease options.

  • What causes hay fever?

    Hay fever is an IgE-mediated allergic reaction to airborne allergens - most often grass pollen in the UK (May to July), plus tree pollen (birch and oak, March to May), weed pollens, fungal spores, house dust mites and animal dander. The immune system releases histamine and other mediators in the nose and eyes, producing the classic sneezing, runny nose, blockage, itch and conjunctivitis.

  • What is the first-line treatment for hay fever?

    A daily intranasal corticosteroid spray, such as fluticasone, mometasone or budesonide, used throughout the season. A non-sedating oral antihistamine (cetirizine, fexofenadine, loratadine, desloratadine or bilastine) is added when needed. Nasal saline rinses and allergen-avoidance measures support both.

  • How is hay fever diagnosed?

    Usually from a focused history of seasonal symptoms and personal or family atopy, with an examination of the nose and eyes. Skin prick tests and specific IgE blood tests are done by allergy specialists where the picture is unclear, disease is severe, or immunotherapy is being considered.

  • When should I see a specialist?

    Consider a specialist allergy referral if symptoms are severe, poorly controlled on optimal first-line treatment, disrupting sleep, exams or work, or if immunotherapy is being considered. ENT input helps with suspected polyps, unilateral symptoms or long-standing loss of smell.

  • What is allergen immunotherapy?

    Immunotherapy is a specialist-led, disease-modifying treatment that gradually retrains the immune system. Sublingual immunotherapy tablets - Grazax and Oralair for grass, Acarizax for house dust mite and Itulatek for birch - are NHS-approved and taken daily for three years. Subcutaneous immunotherapy (injections) is used in selected cases.

  • Are there any newer options for severe hay fever?

    For severe, refractory disease, specialist teams can consider anti-IgE therapy with omalizumab (Xolair) in commissioned centres, often where asthma coexists. Depot steroid injections such as Kenalog are discouraged because of long-lasting systemic effects.

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