Hay Fever: What Actually Works? A Conversation with Professor Adam Fox
By Dr Daniel Gordon • 02, Jun 2025
Sneezing, itchy eyes, blocked sinuses, poor sleep — for some, hay fever is just a mild seasonal nuisance. But for others, it’s weeks of misery. A condition that not only drains energy but can seriously disrupt daily life. If that sounds familiar, you’re not alone.
This month on The Health Perspective, I sat down with Professor Adam Fox — one of the UK’s leading experts in paediatric allergy — to talk about hay fever: why it’s become so common, why some treatments fail, and what actually works. It was one of the most practical and eye-opening conversations I’ve had about an issue that affects nearly one in four adults in the UK.
What follows is a reflection on that dialogue, a guide to understanding hay fever not as something to just tolerate, but something we can manage with the right tools and knowledge.
A Condition That Deserves Attention
One of the first things I asked Adam was whether hay fever is something we’re guilty of underestimating — and his answer was clear.
“For lots of people, it is just a bit irritating,” he told me. “But for a significant minority, it’s a real problem.”
The data backs this up. Hay fever has been shown to lower exam grades in teenagers, reduce concentration while driving, and even — surprisingly — impact patterns of behaviour across entire cities. (One New York study found fewer street crimes on days with high pollen counts, because even muggers didn’t want to be outside.)
And it’s not just a summer problem. While most people associate hay fever with May and June, symptoms can start as early as January with tree pollen — particularly birch — and continue into the late summer with grasses and weeds. Some people, Adam explained, suffer almost year-round due to overlapping sensitivities.
Why Are So Many People Allergic Now?
I asked Adam the question I often hear from patients: Why are we all suddenly allergic to pollen?
It turns out the rise in hay fever isn’t so sudden, but it is dramatic. In 200 years, we’ve gone from just a handful of documented cases to nearly 25% of adults in the UK being affected.
The old theory — the “hygiene hypothesis” — suggested that children who grew up in cleaner environments were more prone to allergies. But as Adam pointed out, that theory has too many holes. Today, the focus is on something far more complex and compelling: the gut microbiome.
Factors like hospital births, early antibiotic use, reduced exposure to diverse bacteria, and diets high in ultra-processed foods may all be reshaping how our immune systems respond to the outside world.
What we’re seeing, Adam explained, is a mismatch between modern lifestyles and our biology, with allergies as one of the consequences.
Why Steroid Injections Aren’t the Answer
Every spring, I get patients asking about steroid injections for hay fever. They’ve heard it works. And it does — at least in the short term.
But the risks are real.
“It’s a huge dose of steroid that slowly releases into your system over months,” Adam explained. “The longer-term side effects — reduced bone density, increased fracture risk, cataracts — often aren’t discussed properly. And once those risks show up, it’s too late.”
While short courses of oral steroids can be useful for short-term relief — say, during exams — Adam was clear that steroid injections for hay fever have been banned on the NHS for good reason. They’re not just a quick fix. They can be a long-term mistake.
What Actually Works: The Hay Fever Treatment Ladder
So, what should people be doing instead?
Adam laid it out clearly — a ladder of evidence-based treatments that go from simple steps to more advanced solutions:
1. Non-sedating Antihistamines
Start with long-acting options like Cetirizine, Loratadine or Fexofenadine. Avoid sedating ones like Piriton, which may make you feel worse.
2. Nasal Steroid Sprays
These are the cornerstone of treatment, but timing is key. Start a couple of weeks before your usual symptoms begin, and use them consistently throughout the season.
3. Eye Drops & Barrier Methods
Eye symptoms? Add antihistamine drops. Use Vaseline around your nostrils to trap pollen, and wash your hair before bed to avoid transferring pollen to your pillow.
4. Double Up If Needed
If symptoms break through, it’s often safe to increase antihistamine doses or use combination nasal sprays — speak to your GP or pharmacist first.
For Severe Cases: Desensitisation (Immunotherapy)
For those who’ve tried everything — and are still suffering — there’s another option: sublingual immunotherapy (SLIT).
This daily tablet, placed under the tongue, contains small amounts of the allergen (like grass pollen) and gradually retrains the immune system to respond differently.
“It’s not a cure,” Adam told me. “But it’s disease-modifying. You finish a 3-year course, and the benefits last for years.”
Unfortunately, access remains limited in the UK, despite being a licensed treatment. In countries like Germany, 700 people are treated for every one in the UK. It’s something both Adam and I hope to see change.
Long-Term Antihistamines: Are They Safe?
Some patients worry about taking antihistamines daily, especially over many months. I raised this with Adam, and the reassurance was clear.
“There’s no link to dementia with modern, non-sedating antihistamines,” he said. “We have decades of safety data from people taking them for chronic conditions like urticaria — and they still work just as well over time.”
If they’re helping you, it’s safe to keep using them during allergy season.
Final Thoughts
Hay fever may not sound serious, but for many, it is. It can affect school, work, relationships, and overall wellbeing. But the good news is that help exists.
Whether it’s getting your antihistamines right, using nasal steroids early, or exploring immunotherapy, you don’t have to just suffer through it.
My hope is that this conversation helps you feel informed and empowered — not just to manage symptoms, but to take your health seriously, even when it’s “just hay fever.”
If this discussion resonated with you, I encourage you to watch the full interview with Professor Adam Fox — or share it with someone who may need it.
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