In short: Most people with hay fever get good control from a non-drowsy antihistamine, a steroid nasal spray, or both, used regularly and started before the pollen season. Eye drops help with itchy eyes. If symptoms persist despite correct use, a clinician can review your treatment and, for severe cases, a specialist may consider immunotherapy.

This guide, written by a Ready Health prescribing pharmacist, explains the treatment options that UK guidance supports and why the order in which they are tried matters.

What is hay fever?

Hay fever (seasonal allergic rhinitis) is an allergic reaction to pollen. When pollen lands in the nose, eyes or throat, the immune system overreacts and releases chemicals such as histamine. That causes sneezing, a runny or blocked nose, itchy and watery eyes, an itchy throat and, for many people, poor sleep and tiredness.

In the UK, symptoms are usually worst between late March and September. Tree pollen tends to come first in spring, followed by grass pollen in early summer, which affects the largest number of people, and then weed pollen later in the summer.

What are the main hay fever treatment options?

UK guidance, including the NHS and NICE Clinical Knowledge Summaries, follows a step-by-step approach. Most people only need the first one or two steps.

Option	Best for	Where to get it
Non-drowsy antihistamine tablets	Sneezing, itching, runny nose, mild eye symptoms	Pharmacy or supermarket
Steroid nasal spray	Blocked or runny nose, moderate to persistent symptoms	Pharmacy; stronger options on prescription
Antihistamine or anti-allergy eye drops	Itchy, red, watery eyes	Pharmacy or prescription
Combination nasal spray (steroid plus antihistamine)	Symptoms that persist despite a correctly used steroid spray	Prescription
Allergen immunotherapy	Severe hay fever that does not respond to other treatment	Specialist allergy service

Why do steroid nasal sprays work so well?

Steroid nasal sprays reduce inflammation inside the nose, where most hay fever symptoms start. Guidance describes them as the most effective single treatment for moderate to severe allergic rhinitis. Only a very small amount of medicine is absorbed into the rest of the body, which is why they are suitable for regular use through the season.

They are not instant. They build up over several days, so the best results come from starting one to two weeks before your symptoms usually begin and using the spray every day, not just on bad days.

Why do some people feel their treatment has stopped working?

It is common to hear that tablets and sprays "don't work any more". Often the cause is something that can be fixed:

Spray technique: aiming the spray at the outside wall of the nostril (away from the middle), keeping the head tilted slightly forward and not sniffing hard makes a big difference.
Using it only when symptoms flare: nasal steroids need daily use to work properly.
Starting too late: once inflammation is established it takes longer to settle.
Missing eye symptoms: tablets alone may not fully control itchy eyes; drops can help.
Another cause: year-round symptoms may point to dust mite or pet allergy, or a non-allergic cause, which needs a different plan.

You may see long-acting steroid injections mentioned online. They are not licensed for hay fever in the UK and are not recommended in UK guidance, because a single dose affects the whole body for weeks and can cause side effects such as fat and skin thinning where it is given, raised blood sugar, mood and sleep changes, suppression of the body's own steroid production and, with repeated use, effects on bones. Reviewing the options above with a clinician is the recommended route.

What can I do myself to reduce symptoms?

Check the pollen forecast and keep windows closed on high-count days.
Wear wraparound sunglasses outdoors.
Shower and change clothes after spending time outside.
Avoid drying washing outside when pollen is high.
Apply a barrier balm around the nostrils to help trap pollen.

When should I get advice?

Speak to a pharmacist first for mild symptoms. See a GP or prescriber if symptoms are getting worse, are not improving with pharmacy treatments used correctly, are affecting sleep, work or exams, or if you have asthma that worsens in the pollen season. Seek urgent help if you have wheeze or breathing difficulty.

Frequently asked questions

What is the most effective treatment for hay fever?

For moderate or persistent symptoms, a steroid nasal spray used daily is generally the most effective single treatment. Many people combine it with a non-drowsy antihistamine.

Can I use antihistamine tablets and a nasal spray together?

Yes, an oral antihistamine and a steroid nasal spray are commonly used together. Check with a pharmacist if you take other medicines.

What if nothing seems to work?

A clinician can check your diagnosis, technique and treatment combination. For severe, persistent hay fever, referral for specialist immunotherapy may be considered.

Key takeaways

Antihistamines, steroid nasal sprays and eye drops are the first-line hay fever treatments in the UK.
Start treatment before the season and use it every day for the best results.
Poor spray technique is a common reason treatment seems to fail.
Immunotherapy is a specialist option for severe hay fever.

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.

If hay fever is affecting your sleep, work or studies, you can book a hay fever consultation at Ready Health in Standish, Wigan. A prescriber will review your symptoms, medical history and current treatment and explain suitable options. For most people that means getting first-line treatments working better. Any prescription is only issued if a prescriber decides it is clinically appropriate.