NASAL PREPARATIONS

Nasal preparations contain anti-inflammatory, sympathomimetic decongestant or antihistamine ingredients.

Anti-inflammatories

These are the corticosteroids beclomethasone, fluticasone and triamcinolone acetonide. They down-regulate the inflammatory response of type I allergic reactions by reducing the number of basophils and mast cells, and by blocking release of mediator substances. They inhibit both early and late responses to allergen exposure, and are therefore effective in relieving nasal congestion. They are effective in relieving all nasal symptoms of hay fever, but take some days to achieve optimum effect. Treatment should ideally be started at least 2 weeks before symptoms are expected. Patients should be advised that, if symptoms are already present when treatment is started, it could be several days before an effect is noted and several weeks before full relief is obtained.

Anti-inflammatories are presented as aqueous non-aerosol sprays. Absorption from the nasal mucosa is low, and systemic effects are highly unlikely at recommended doses. Treatment may need to be maintained throughout the hay fever season and repeated each year. They can be used for up to 3 months without consulting a doctor. They are licensed for use in adults aged 18 years and over. They should be avoided if there is infection in the nose or eye. There are otherwise no significant contraindications or interactions.

Sympathomimetic decongestants

Drops and sprays containing sympathomimetic decongestants are used to relieve nasal congestion associated with hay fever and may be useful to begin treatment when the nose is badly blocked. Compounds available are oxymetazoline, phenylephrine and xylometazoline. All exert a rapid and potent vasoconstricting effect when applied directly to the nasal mucosa. They should only be used for short periods as rebound congestion can occur.

EYE PREPARATIONS

Agents available are sodium cromoglicate, lodoxamide and an antihistamine/sympathomimetic decongestant combination. Most eye symptoms relating to hayfever will be controlled by oral antihistamines, but if symptoms are persistent or particularly troublesome, eye drops are usually effective. Sodium cromoglicate and lodoxamide are mast cell stabilisers; they are used four times daily and are suitable for children. One eye drop preparation contains an antihistamine: antazoline sulphate 0.5%, and xylometazoline hydrochloride 0.05%. The latter has vasoconstrictor action and is included as a conjunctival decongestant. This preparation can be used for the short-term treatment of hayfever symptoms, but prolonged use may raise intraocular pressure and precipitate glaucoma. The drops are used twice or three times daily and are suitable for children from 5 years of age.

All eye drops for allergic conjunctivitis contain the preservative benzalkonium chloride, which is absorbed into soft contact lenses and released onto the cornea during wear, causing inflammation and irritation. Soft lenses should not be worn while using these products. Gas-permeable lenses may be inserted 30 minutes after using the eye drops.