Be alert to the new hazards

Hay fever sufferers over the age of 30 will remember only too well the misery of summer exams: either you sneezed and snuffled your way through the papers, or you took an antihistamine tablet - and struggled to keep awake. All that changed in the 1980s when the first non-sedating antihistamines came onto the market. Suddenly, hay fever victims found they could get near-total relief in the pollen season, without the soporific side effects. The new drugs, like the old, blocked the activity of histamine, the chemical that causes the immune reaction; but unlike the old, they did not pass through the blood-brain barrier, nor depress the nervous system. They were also less likely to have other adverse side-effects such as nausea, dry mouth and blurred vision.

But concern is mounting over the risks these non-sedating treatments may present. Terfenadine, one of the most popular (eight million packets sold last year), has been linked to 19 deaths in Britain, 14 of them heart- related, since it came on the market in 1982. Last week, the Committee on the Safety of Medicines recommended it be made prescription-only and products containing terfenadine (including Triludan, Aller-Eze and some Boots own brands), are now sold only on pharmacists' advice. And a study published last week in The Lancet raised a question mark over the safety of five other non-sedating antihistamines, particularly loratadine (in Clarityn and a Boots brand), and astemizole (now only sold on pharmacists' advice, under the brand names Polloneze and Hismanal).

So should anyone with an allergy to pollen look for alternatives? Not necessarily, especially where they have been used without problems for years. Terfenadine should certainly be avoided by those with heart or liver problems, and by anyone taking certain antibiotics or anti-fungal drugs, and it should never be taken with grapefruit juice, which increases its uptake in the blood; but in the majority of cases it is quite safe.

For those wishing to avoid the antihistamines, corticosteroid nose-drops, on prescription only, can damp down inflammation; while newer drugs, called "mast cell stabilisers", (mast cells being the ones which release histamine), taken as nasal spray can also give relief. Decongestants are highly effective for a blocked nose but should not be taken for lengthy periods.

One promising new drug, fexofenadine, is thought to be just as effective as terfenadine without having the side-effects. It is available on prescription only. Desensitisation injections are nowadays less popular with GPs, chiefly because resuscitation equipment has to be available in surgeries in case of any adverse reaction.

Non-medical alternatives often recommended for hay fever include steam inhalations, decongestants such as eucalyptus, cod-liver oil which reduces inflammation, and honey, although there is no evidence that it works.

The simplest answer is to avoid pollen as far as possible. Shut windows and rinse hair at night; dry clothes indoors and change them when you get home. Outdoors, keep car windows shut (or buy a car with air-conditioning), wear eye-shields or even, if you can bear it, a mask - and get someone else to mow the lawnn

Cherrill Hicks