Hay Fever Site

Medications containing corticosteroids – often referred to simply as ‘steroids’ – can effectively regulate immune system function, suppress­ing the inflammatory response and giving fast relief. As a result, they work very well, but should only be used when all else fails and some­thing stronger is required to deal with severe symptoms. Corticosteroids are available only on prescription from your doctor, who will carefully explain the warnings and special precautions attached to them.

Although there have been no adequate trials into the effects of corticosteroids in pregnancy, recent analysis of data suggests a small but significant link between corticosteroids taken in the first trimes­ter (three months) of pregnancy and cleft palate in the newborn. It is advisable, therefore, to avoid corticosteroids during pregnancy. There is no available data into the effects of corticosteroids when breastfeed­ing, so it is best to ask your doctor’s advice.

Corticosteroidal tablets

Corticosteroids in tablet form are powerful drugs for the treatment of severe hay fever. They may not remove every last symptom, but they can make life a lot more bearable and are particularly useful for allowing you to function more normally in important life events, such as exams, weddings, interviews and so on.

The steroid used in hay fever medications is not of the type used by athletes to enhance their performance, with notorious side effects – that is, anabolic steroids. However, if not administered within the proper guidelines they do carry the slight risk of the following adverse effects:

• increased appetite and weight gain

• water and salt retention leading to swelling

• fat deposits in the face, chest, stomach and upper back

• high blood pressure

• increased susceptibility to infection

• diabetes

• cataracts

• acne

• depression

• muscle weakness.

To minimize the possible occurrence of side effects, it will probably be recommended that you take only a low dose of this oral drug for a very short period. Your doctor will doubtlessly monitor your progress very carefully and ask you to stop taking the drug once the crisis or important event is over.

While taking corticosteroids, it is safe to use other hay fever treatments.

Corticosteroidal injections

If you have severe symptoms that fail to respond to other treatments, it is possible to have a corticosteroidal injection. Unlike corticoster­oidal tablets which are effective for only the short period of time you take them, the injection administers what doctors call ‘depot steroids’ that remain active for a longer time, whether you still require them to be in your body or not. The injection comes with all the risk factors of tablet-form corticosteroids; in addition it can cause ‘fat atrophy’, in which a dent in your buttock appears where the injection was delivered. In rare cases an abscess can occur at the injection site.

A corticosteroidal injection administered when hay fever symptoms first appear can give symptom remission that lasts for the duration of the entire pollen season. However, due to the many possible side ef­fects associated with corticosteroids (as listed above) doctors will offer the injection only as a last resort. ,

Corticosteroidal nasal sprays

Corticosteroidal sprays – sometimes referred to as ‘sticky sprays’ – have anti-inflammatory properties and effectively reduce swelling and con­gestion in the sinuses and nasal cavities, without causing drowsiness. Moreover, when used in the nose, this steroidal drug is actually very safe and works better than any other spray.

Corticosteroidal nasal sprays are even believed to be safe for long-term use. This is due to the following:

• The dosage of steroidal medicine in a nasal spray is very low.

• The medicine in the spray breaks down very quickly in the body, not allowing sufficient time for side effects to arise.

• In the past doctors were concerned that prolonged use of a steroidal nasal spray would make the nose lining very thin. However, time has shown that the lining is actually healthier after long-term ster­oidal use than it would have been after prolonged inflammation.

As with most nasal sprays that are aimed at treating hay fever, using this medication can cause an inflamed nose to sting for a while. If this happens, try to persevere with the spray for a few days, and the mem­branes should gradually become less swollen. In a small percentage of people, unfortunately, the stinging may continue. Seek your doctor’s advice if this happens to you.

Some people find sufficient relief from using a corticosteroidal nasal spray and don’t need to take tablets, which get into the whole body. If you can’t help worrying about the effects of using steroids, even in a spray, you may find that an antihistamine spray is equally effective. As with most other hay fever treatments, more benefit is gained from using it early – for about two weeks prior to the start of the hay fever season. This stops the inflammation from building up. For maximum benefit, the spray must then be used on a daily basis for the duration of the hay fever season.

There are two available over-the-counter preparations – beclometh-asone (brand name Beconase) and fluticasone (brand name Flonase). Other corticosteroidal nasal sprays are available on prescription only.

Although there have been no adequately controlled trials into the effects of corticosteroidal nasal sprays in pregnancy, there have also been no reports of resultant birth defects. However, caution is always advisable when thinking of taking medications during pregnancy and breastfeeding. Ask your doctor’s advice if you are unsure of what to do.

Corticosteroidal eye drops

Unfortunately, corticosteroids have many possible disadvantages when used in the eye, such as impairing the ability of the eye to fight infec­tions and repair itself after injury. Glaucoma (increase in pressure in the eye), cataracts and eventual loss of vision can also occur. For these reasons, such drops should be used in only very severe cases, in people whose eyes have become very itchy, inflamed, watery and bloodshot, and when no other eye treatment has proved effective. They can, how­ever, make a great difference. Like the steroidal nasal spray, the best results come from using eye drops shortly before the hay fever season gets under way.

These eye drops should only be used in pregnancy and breastfeed­ing if the potential benefit outweighs the possible risk. Ask your doc­tor about this.