Hay Fever Treatment in Children: From Antihistamines to Immunotherapy
Dr Mugilan Anandarajan
Consultant Paediatrician with special interest in allergy, eczema & respiratory conditions, FRCPCH
Hay fever is one of the most common allergic conditions in children, yet it is frequently undertreated. Many families rely on over-the-counter antihistamines alone — but for children with moderate-to-severe symptoms, a stepwise treatment approach and specialist assessment can make a dramatic difference to quality of life, sleep, and school performance.
Why hay fever matters in children
Hay fever affects up to 1 in 4 children in the UK. Beyond the obvious nasal and eye symptoms, it can significantly impair sleep, concentration, and academic performance. This is particularly important during the GCSE and A-level exam season (May–July), which coincides with peak grass pollen season. Studies show that children with untreated hay fever perform measurably worse in exams. Getting treatment right — ideally before the season starts — is important.
Step 1: Antihistamines
Non-sedating antihistamines (cetirizine, loratadine, fexofenadine) are the first-line treatment for mild hay fever. They are effective for sneezing, runny nose, and eye symptoms but less effective for nasal congestion. They are available over the counter and are safe for children from age 2 upwards (age varies by product). Sedating antihistamines (e.g. chlorphenamine) should be avoided in children as they impair concentration and learning.
Step 2: Intranasal corticosteroid sprays
For moderate-to-severe hay fever, intranasal corticosteroid sprays (e.g. fluticasone, mometasone, beclometasone) are the most effective treatment. They reduce nasal inflammation, congestion, sneezing, and runny nose. They work best when started 2 weeks before the pollen season begins and used consistently throughout the season. They are safe for long-term use in children and have minimal systemic absorption when used correctly.
Step 3: Eye drops and add-on therapies
- Antihistamine eye drops (e.g. azelastine, olopatadine) — for allergic conjunctivitis not controlled by oral antihistamines
- Sodium cromoglicate eye drops — a safe, preservative-free option for younger children
- Nasal saline irrigation — reduces pollen load in the nasal passages; safe from any age
- Leukotriene receptor antagonists (montelukast) — useful add-on therapy, particularly for children with co-existing asthma
When medication is not enough: allergen immunotherapy
For children with moderate-to-severe hay fever not adequately controlled by medication, allergen immunotherapy (AIT) offers the prospect of long-term disease modification. Unlike medication, which only suppresses symptoms while it is being taken, immunotherapy reprograms the immune system and can provide lasting relief even after the course is completed. It is the only treatment that changes the underlying allergic disease.
Sublingual immunotherapy (SLIT) — grass pollen tablets
Sublingual grass pollen tablets (Grazax, Itulazax) are taken daily under the tongue, starting at least 4 months before the pollen season. They are licensed in the UK from age 5. Clinical trials show they significantly reduce rhinitis symptoms, reduce medication use, and improve quality of life. Treatment is typically continued for 3 years. They are taken at home — no clinic visits required after the initial assessment.
Subcutaneous immunotherapy (SCIT)
Subcutaneous immunotherapy involves injections of gradually increasing doses of allergen given in clinic. It is more suitable for children with multi-pollen sensitisation or those who cannot tolerate sublingual tablets. It is generally considered from age 5–6 upwards. Dr Anandarajan will advise on the most appropriate form of immunotherapy for your child.
Practical pollen avoidance tips
- Check the pollen forecast daily and plan outdoor activities accordingly
- Keep windows closed during high pollen periods, especially in the morning
- Shower and change clothes after being outdoors during pollen season
- Wear wraparound sunglasses outdoors to protect the eyes
- Apply a thin layer of petroleum jelly (Vaseline) around the nostrils to trap pollen
- Dry clothes indoors during pollen season rather than on a washing line
- Start treatment 2 weeks before the expected pollen season
If your child's hay fever is affecting their sleep, school performance, or quality of life, a specialist assessment is worthwhile. Dr Anandarajan will identify the specific pollen triggers, optimise the treatment plan, and advise on whether allergen immunotherapy is appropriate. No GP referral is required.