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Hay fever: no miracle cure

Hay fever treatments provide limited benefits and can cause major adverse effects. Subcutaneous desensitisation is inconvenient and not very effective. Sublingual desensitisation is no improvement.

The October issue of la revue Prescrire looks at allergic rhinitis (hay fever), a benign ailment that can cause discomfort and disrupt day-to-day life. When drug treatment seems advisable, especially when exposure to allergens is unavoidable, the first-line treatment is sodium cromoglicate, in the form of a nasal solution or single-dose eye drops.

In the event of severe symptoms that do not respond to this treatment, a nasal or even oral corticosteroid can be used, but only for a short period due to sometimes-severe adverse effects. Antihistamines are a slightly less effective alternative to corticosteroids, whose adverse effects include drowsiness in particular.

When severe symptoms persist in spite of treatment and an allergen is identified, subcutaneous desensitisation is sometimes suggested. Its effectiveness as a preventative is limited. It is inconvenient due to the high number of injections required, and exposes the patient to the risk of rare allergic reactions.

The efficacy of sublingual desensitisation in adults is dubious; it has no proven efficacy in children and causes frequent local adverse effects. This drug should not be prescribed more widely in the mistaken belief that its sublingual method of administration is safe. It is best avoided altogether.

©Prescrire 1 November 2007

Source: "Rhinite allergique saisonnière" Rev Prescrire 2007; 27 (288): 752-757.

See also: "Vu d'ailleurs : Extrait de pollen de phléole des prés (Grazax°)" (in French).

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