NICE Guideline on hayfever:
Reinforce advice about allergen avoidance, if applicable, and check compliance with first-line treatment.
For people taking an oral antihistamine, add an intranasal corticosteroid and review after 2 to 4 weeks.
For people using an intranasal corticosteroid, ensure they have a good technique. If they have, step up to the maximum licensed dose of the intranasal corticosteroid and review after 2 to 4 weeks.
For people with residual symptoms on a maximum licensed dose of intranasal corticosteroid, continue with treatment and:
If there is persistent nasal itch, sneezing, rhinorrhoea, or allergic conjunctivitis, add an oral antihistamine.
If rhinorrhoea persists despite combined use of intranasal corticosteroid and antihistamine, add an intranasal antimuscarinic drug (ipratropium bromide).
If nasal blockage is a problem, prescribe an intranasal decongestant for up to 7 days.
For people requiring rapid resolution of severe symptoms that are impairing their quality of life, start or continue treatments to control symptoms long term, and consider prescribing a 5–10 day course of prednisolone: 20–40 mg a day in adults and 10 mg a day in children.
For people with persistent symptoms despite being on maximal medical therapy, refer for specialist assessment and management.
Nasal spray technique [Scadding et al, 2008]:
Gently blow the nose to try and clear it.
Shake the bottle well.
Close off one nostril and put the nozzle in the other, directing it away from the midline. Tilt head forward slightly and keep the bottle upright.
Squeeze a fine mist into the nose while breathing in slowly. Do not sniff hard.
Breathe out through the mouth.
Take a second spray in the same nostril then repeat this procedure for the other nostril.