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Widening access to services in independents, provided proper funding is in place, can reduce the reliance on GP appointments for allergy management. Steve Titmarsh reports…

Hay fever affects a large number of people and can cause significant impairment. A change in the licensing of an intranasal corticosteroid offers greater access to this effective treatment to younger people with the allergy.

Over the last 20 years, the number of cases of hay fever has trebled according to the government’s Centre for Climate and Health Security. Around 10-15 per cent of children and 26 per cent of adults in the UK are affected.^1,2

People with eczema or asthma are at greater risk, and hay fever is a risk factor for asthma so it is important that it is treated. Hay fever often develops among children and teenagers but it can happen to people at any age.²

Symptoms of hay fever can be mild; however, it can disrupt sleep affecting concentration during the daytime and can result in people taking time off school or work.²

Seasonal allergic rhinitis triggered by tree or grass pollen is generally known as hay fever. It occurs when pollen from trees (typically from March to mid-May), grass (mid-May to July) and weeds (typically end of June to September) are released.^2,3

People with perennial rhinitis have symptoms all year round and they tend to be triggered by house dust mites and animal dander.³

Environmental factors can play a significant part in when people experience hay fever symptoms and how severe they are. In the north of the UK the pollen season is shorter and starts later than in the south, and pollen counts are lower in urban and coastal areas than they are in rural and inland locations.²

Cold winters can delay pollen production because trees and plants stay dormant for longer and heavy rainfall usually results in lower pollen concentrations.^2,4 

Treatment

People with hay fever should avoid the allergen or allergens causing symptoms as much as possible. Nasal irrigation with saline should also be considered.

Pharmacological treatment involves intranasal corticosteroids and antihistamines as first-line options. Patient preference, age and severity and persistence of symptoms inform treatment choice.

Intranasal corticosteroids are more effective than antihistamines for allergic rhinitis, but they take time to act (maximal effect may not be seen for two weeks or more) whereas intranasal antihistamines have an effect on symptoms within minutes. Some people prefer oral medication.⁵

For children with mild, intermittent hay fever an antihistamine may be the best first choice. For adolescents and adults an intranasal corticosteroid or an antihistamine can be recommended. 

People with moderate-to-severe symptoms that affect quality of life, sleep or daily living activities or persistent symptoms can be offered an intranasal corticosteroid combined with intranasal antihistamine.⁵ 

Greater access to treatment for 12-year-olds

In December 2025, the Medicines and Healthcare products Regulatory Agency (MHRA) approved the reclassification of fluticasone propionate (Pirinase Allergy 0.05% w/w nasal spray) as a pharmacy medicine, making it available without a prescription for adolescents aged 12 years and over. 

It was the first intranasal corticosteroid to be sold by pharmacists to adolescents from age 12 years in Europe.⁶

The medicine is licensed for the prophylaxis and treatment of allergic rhinitis including hay fever and that caused by other airborne allergens such as house dust mite and animal dander.

It can be used by adults and adolescents aged 12 years and over. Prophylaxis of allergic rhinitis requires treatment before contact with allergen.

The medicine also provides symptomatic relief of sneezing, itchy and runny nose, itchy and watery eyes, nasal congestion and associated sinus discomfort. For full therapeutic benefit regular usage is recommended. Maximum benefit may require 3-4 days of continuous treatment in some people.⁷ 

Before use the bottle needs to be primed by pumping until a fine spray is produced.⁷

Dr Ravina Barrett, Self Medication and Reclassification Team Lead at the MHRA, said:⁸ ‘By widening access, this reduces the reliance on GP appointments for allergy management, freeing up GPs to focus on primary care priorities, aligning with the NHS Long Term Plan by delivering more care in the community and improving overall patient access.’

Dr Gary Stiefel, the chair of the Allergy UK Health Advisory Board and a consultant in paediatric allergy, said:⁹ “Fluticasone proportionate 0.05% nasal spray is extremely safe and can be very effective if used alone or in conjunction with non-sedating antihistamines for the treatment of hay fever.

“Its use in children from 12 years of age will significantly help large numbers of children who suffer from hay fever and we are supportive of this additional medicine. It is important to ensure that young people are shown how to use the device correctly.”

The patient information leaflet explains how to use Pirinase Allergy 0.05% nasal spray as follows:⁷ 

1. Shake the bottle gently and remove the dust cap.

2. Blow your nose gently.

3. Close one nostril and put the nozzle in the other nostril. Tilt your head forward slightly and keep the bottle upright. 

4. Start to breathe in slowly through your nose. While you are breathing in, squirt a spray of fine mist into your nostril by pressing down firmly on the collar with your fingers.

5. Breathe out through your mouth. Repeat step 4 to take a second spray in the same nostril, if required.

6. Remove the nozzle from this nostril and breathe out through your mouth.

7. Repeat steps 3 to 6 for the other nostril.

8. After using the spray, wipe the nozzle carefully with a clean tissue or handkerchief and replace the dust cap.

The product should not be used for more than three months continuously. If needed for longer than this, then patients are advised to see their doctor.⁸

As with all medicines, the MHRA will monitor the safety and effectiveness of Pirinase Allergy 0.05% w/w nasal spray. Anyone experiencing suspected side effects is encouraged to report them through the MHRA Yellow Card scheme at yellowcard.mhra.gov.uk or via the Yellow Card app.⁸ 

New developments

New approaches to allergy focus on modifying the body’s immune response. For example, in July 2025 the National Institute for Health and Care Excellence approved betula verrucosa for sublingual treatment for moderate-to-severe allergic rhinitis caused by pollen from the birch homologous group of trees in adults who have failed to respond to other therapies.

Rather than simply dampening down symptoms, as symptomatic treatment do, this new approach effectively trains the immune system to tolerate tree pollen by daily exposure to small doses of birch pollen allergen extract over a period of three years.

The hope is that these types of treatment will confer a long-lasting reduction in moderate-to-severe allergic rhinitis and conjunctivitis symptoms.¹⁰

Pollen from birch and related trees such as alder, hazel, oak, hornbeam, chestnut and beech, is the most dominant tree pollen type in Northern and Central Europe.

Pollen from these trees is regarded as an homologous group and recognises there is a degree of cross-reactivity between pollens from the group, which is a major cause of allergic rhinitis and may also cause asthma symptoms.¹¹

References

1. Scadding GK, Kariyawasam HH, Scadding G, et al. BSACI guideline for the diagnosis and management of allergic and non-allergic rhinitis (Revised Edition 2017; First edition 2007). Clin Exp Allergy 2017;47(7):856–889.

2. GOV.UK. Guidance: Hay fever and airborne allergens (www.gov.uk/guidance/hay-fever-and-airborne-allergens#:~:text=sneezing,it%20%E2%80%8B(5)%E2%80%8B; accessed March 2026).

3. Clinical Knowledge Summaries (CKS). Allergic rhinitis: What is it? (https://cks.nice.org.uk/topics/allergic-rhinitis/background-information/definition; accessed March 2026).

4. Met Office. When is hay fever season in the UK? (https://weather.metoffice.gov.uk/warnings-and-advice/seasonal-advice/health-wellbeing/pollen/when-is-hayfever-season; accessed March 2026).

5. Clinical Knowledge Summaries. Allergic rhinitis: Scenario: Management (https://cks.nice.org.uk/topics/allergic-rhinitis/management/management; accessed March 2026).

6. GOV.UK. European first as MHRA approves over-the-counter allergy treatment for adolescents aged 12 and over (www.gov.uk/government/news/european-first-as-mhra-approves-over-the-counter-allergy-treatment-for-adolescents-aged-12-and-over; accessed March 2026).

7. emc (Electronic Medicines Compendium). Pirinase Allergy 0.05% nasal spray (www.medicines.org.uk/emc/product/4502/smpc; accessed March 2026).

8. GOV.UK. European first as MHRA approves over-the-counter allergy treatment for adolescents aged 12 and over (www.gov.uk/government/news/european-first-as-mhra-approves-over-the-counter-allergy-treatment-for-adolescents-aged-12-and-over; accessed March 2026).

9. Allergy UK. MHRA approves over-the-counter allergy treatment (www.allergyuk.org/news/pirinase-update; accessed March 2026).

10. National Institute for Health and Care Excellence (NICE). Betula verrucosa for treating moderate to severe allergic rhinitis or conjunctivitis caused by tree pollen. Technology appraisal guidance TA1087 (www.nice.org.uk/guidance/ta1087/chapter/1-Recommendation; accessed March 2026).

11. Biedermann T, Winther L, Till SJ, et al. Birch pollen allergy in Europe. European Journal of Allergy and Clinical Immunology 2019;74(7):1237–1248.