Hay fever and nasal allergies

What usually happens

For persistent symptoms the nasal spray outperforms the tablet. Antihistamine tablets are what most people reach for, but a steroid nasal spray is usually more effective for blockage and for daily symptoms — which surprises people who have only ever tried tablets.

Technique decides whether it works. Aim the spray outward, toward the same-side ear rather than at the middle of your nose, and do not sniff hard afterwards — sniffing sends it straight down the throat instead of leaving it where it acts.

It takes days, not minutes. Nasal steroids build up over a week or two of daily use. Used only on bad days they will seem useless, which is the usual reason people give up on them.

Starting before the season helps more than chasing it. If your symptoms are predictable, beginning treatment a couple of weeks ahead works considerably better than starting once you are already miserable.

At your appointment

We will ask about timing and pattern — year-round or seasonal, indoors or out — because that points at the trigger better than most testing does.

We will ask what you have tried and, specifically, how you used it. Technique and duration are usually where the problem is.

We will check whether it is affecting your sleep or concentration, which is what turns a nuisance into something worth treating properly.

Testing is not routine. It helps when the trigger is unclear and would change what you do, or when immunotherapy is being considered.

Worth asking

• —Can you show me how to use the spray properly?
• —How long should I use it before deciding whether it works?
• —Should I be taking anything else alongside it?
• —Is it worth finding out exactly what I am allergic to?