In short: UK hay fever treatments differ in how quickly they work, which symptoms they target and who can use them. Antihistamine tablets act within hours and suit sneezing and itching; steroid nasal sprays take longer to build up but are the most effective option for a blocked nose and persistent symptoms; eye drops target the eyes. Decongestants are for a few days only, and immunotherapy is a long-term specialist treatment for severe allergy.

This comparison, written by a Ready Health prescribing pharmacist, sets out the practical differences between the main options so you can have a better-informed conversation with your pharmacist or prescriber.

How do hay fever treatments compare at a glance?

Treatment	Helps most with	How fast	Things to know
Non-drowsy antihistamine tablets (e.g. cetirizine, loratadine, fexofenadine)	Sneezing, itching, runny nose, mild eye symptoms	Usually within a few hours	Less effect on a blocked nose; cetirizine can make some people drowsy
Sedating antihistamines (e.g. chlorphenamine)	Similar symptoms	Within hours	Drowsiness can affect driving, work and school; not preferred for regular daytime use
Steroid nasal sprays (e.g. beclometasone, fluticasone, mometasone)	Blocked, runny nose and sneezing; can also ease eye symptoms	Some benefit within hours to days; full effect up to two weeks	Needs daily use and good technique; may cause nasal dryness or nosebleeds
Antihistamine or combination nasal sprays	Fast relief of nasal symptoms	Within minutes to hours	Prescription only; can leave a bitter taste
Eye drops (sodium cromoglicate or antihistamine)	Itchy, red, watery eyes	Fast for antihistamine drops; cromoglicate works best used regularly	Remove soft contact lenses unless the product says otherwise
Decongestant nasal sprays	Severe blockage	Within minutes	No more than about a week, or blockage can rebound; not for everyone
Allergen immunotherapy	Severe, confirmed pollen allergy not controlled by other treatments	Builds over months and years	Specialist-led; usually continued for around three years

Which treatment suits which symptoms?

Mostly sneezing and itching, on and off: a non-drowsy antihistamine taken when needed, or daily on high-pollen days, is often enough.
Blocked nose or symptoms most days: a daily steroid nasal spray is the preferred choice, with an antihistamine added if needed.
Eyes are the main problem: eye drops alongside your other treatment.
Still uncontrolled: a prescriber can review technique and consider prescription combinations or referral.

Are some options better for pregnancy, children or drivers?

Pregnancy: UK specialist pregnancy guidance generally favours loratadine or cetirizine where a tablet is needed, and steroid nasal sprays are considered when non-drug measures are not enough. Decongestants should be avoided. Always check with a pharmacist, midwife or prescriber first.
Children: several antihistamines come as liquids for younger children, and some steroid sprays can be prescribed for children. Many over-the-counter steroid sprays are only licensed for adults, so check the age on the pack.
Drivers and people in safety-critical jobs: choose a non-drowsy antihistamine and see how it affects you before driving.

What about other treatments mentioned online?

Montelukast, an asthma medicine, is not a routine treatment for hay fever on its own in the UK, and the MHRA has highlighted a risk of neuropsychiatric side effects such as sleep disturbance, mood changes and, rarely, suicidal thoughts. Long-acting steroid injections are also not licensed for hay fever in the UK and are not recommended in UK guidance, because they act on the whole body for weeks and carry risks including fat and skin thinning at the injection site, raised blood sugar, mood and sleep changes and, with repeated use, effects on bones and natural steroid production.

Frequently asked questions

Can I use a steroid spray and an antihistamine tablet together?

Yes, this is a common and sensible combination for persistent symptoms. Avoid taking two antihistamine tablets at once unless a prescriber advises it.

Which hay fever treatment works fastest?

Decongestant and antihistamine nasal sprays act quickly, and antihistamine tablets work within hours. Steroid sprays are slower to start but give the most consistent control with regular use.

Do I need a prescription for hay fever treatment?

Many antihistamines, some steroid sprays and some eye drops are available from pharmacies. Combination sprays, stronger options and treatments for younger children may need a prescription.

Key takeaways

Match the treatment to your main symptoms and how often they occur.
Steroid nasal sprays take longer to work but are the most effective for persistent symptoms.
Pregnancy, age and driving can all affect which product is best.
Montelukast is not a routine UK hay fever treatment and carries an MHRA safety warning.

For more detail on the two most common choices, read our guide to hay fever symptoms, treatments and prevention.

Sources and further reading

Last reviewed: October 2026 by Shamir Patel, Independent Prescribing Pharmacist, Ready Health. This article is general information and does not replace advice from your own clinician.

Not sure which option suits you? Ready Health in Standish, Wigan, offers hay fever consultations where a clinician can review your symptoms and current treatment.