"Do your eyes itch?" The pharmacist asks without looking up from her screen. Bryony — 28, a payroll officer — is still halfway through a sentence about "this cold that just won't shift". Late March, a Tuesday, twenty to seven in the evening. The chemist's smells of soap and new cardboard; a strip light buzzes above the suncream aisle. Bryony has come in for the decongestant tablets she took last winter. She lists the rest — three weeks of streaming nose, sneezing fits on the bus, a packet of tissues a day. At the question about her eyes, she stops. She rubs her eyelids without thinking. Then she says yes. "In that case, I'm not sure this is a cold."
Bryony told me about it a few days later. She was still laughing at herself — rubbing her eyes at the very moment someone asked whether they itched. Her story is an ordinary one, and that is the problem: a runny nose in spring gets treated as a cold until proven otherwise. Yet hay fever is common: the Met Office's list of pollen facts puts it simply: "Hay fever affects 1 in 5 people". This guide will help you tell a cold from hay fever and choose (and pay less for) a pharmacy treatment. It also explains how to follow the pollen forecast — and when immunotherapy is worth raising with your GP.
Cold or hay fever: the clues that give it away
A cold and hay fever look alike at first glance (runny nose, blocked nose, sneezing). They do not last the same length of time, though. The NHS explains that cold symptoms come on gradually (over 2 to 3 days), and that you should begin to feel better in about 1 to 2 weeks. Its hay fever page draws the contrast plainly: "Hay fever can last for weeks or months, unlike a cold". Three weeks of symptoms — at the same time as last year — is a reason to change your theory. It is not a cold that won't clear; it is a calendar that repeats itself.
The list of hay fever symptoms is longer than most people expect. The familiar ones are sneezing and coughing, a runny or blocked nose, and itchy, red or watery eyes. Others include an itchy throat, mouth, nose and ears, loss of smell, pain around the sides of your head and your forehead, headache and feeling tired. The itch — in the eyes, throat, mouth, nose and ears — is the clue to pay attention to. Symptoms are usually worse between late March and September — especially when it is warm, humid and windy. That is when the pollen count peaks.
| What you notice | What it suggests |
|---|---|
| Symptoms that build over 2 to 3 days and ease within 1 to 2 weeks | More likely a cold |
| Symptoms that go on for weeks or months | More likely hay fever |
| Itchy, red or watery eyes | A classic hay fever symptom |
| An itchy throat, mouth, nose and ears | Another classic hay fever symptom |
| The same symptoms, at the same time, every year | Seasonal allergic rhinitis, usually pollen |
| Wheezing, breathlessness or a cough that keeps coming back | Possible asthma: see a GP |
Hay fever — also called allergic rhinitis — is an allergic reaction: the immune system overreacts to allergens in the air. None of this replaces a diagnosis. But these clues are often enough to ask the right question at the counter.
Why pollen makes you sneeze: how the allergy works
You sneeze because your immune system mistakes pollen — the fine powder that plants produce — for a threat. When a person with hay fever meets the allergen, their immune system releases histamines and other chemicals. Those chemicals cause the symptoms — sneezing, a runny or stuffy nose, itchy eyes — usually once the pollen has come into contact with your mouth, nose, eyes and throat.
This is why the first-line treatments are called antihistamines. Your body produces histamine when it comes into contact with something you are allergic to (pollen, animal hair or fur), and an antihistamine blocks the effects of that histamine. Not all pollens are equal, either. Allergy UK considers silver birch the most allergenic of the UK's spring trees.
The climate adds its share. A changing climate is expected to affect UK pollen in at least three ways. Changes in temperature and rainfall may lengthen the pollen season (and potentially make concentrations higher). The potency of pollen may change. And allergenic plants may spread to new areas. Common ragweed (ambrosia) is on the watch list — a single plant can produce a billion grains of pollen per season. Its pollen causes strong allergic reactions.
Tree, grass, weed: the UK pollen calendar
The Met Office's guide to the hay fever season describes three seasons in a row, not one. Tree pollen comes first — typically from late March to mid-May. Most people are allergic to grass pollen, whose season runs from mid-May until July. Weed pollen can be released at any time, but its season typically covers the end of June to September.
- Trees (late March to mid-May): birch is the one to watch in April.
- Grass (mid-May to July): across England and Wales, the first peak usually starts in the first two weeks of June. A second, lower peak follows in the first two weeks of July.
- Weeds (end of June to September), with common ragweed on the watch list.
Where you live changes the picture. In the north of the UK, the season starts later and is shorter (there is generally less pollen). Urban areas have lower counts than the countryside, and inland areas have higher counts than the coast. The weather decides the rest. Early, heavy and prolonged rain tends to keep counts low all day, while afternoon rain has less of an impact. For grass, a maximum temperature between 18 and 28°C could give a high count — on a dry day, with low humidity and a gentle breeze. Trees respond best between 13 and 15°C. Above 28°C, all pollen levels decrease.
Reading the pollen forecast and the pollen count
The pollen forecast combines Met Office weather data with expertise from organisations such as the National Pollen and Aerobiological Unit. The result: forecasts for 5 days ahead, across the whole of the UK. It goes quiet out of season and returns in March — so it is already running as you read this. Check it daily, and stay indoors wherever possible when the count is high (generally on warmer, dry days). Rain washes pollen from the air — so cooler, wet days should bring lower counts.
Two terms are often mixed up. The pollen count is the amount of pollen per cubic metre observed over 24 hours; the forecast uses that count — plus the weather — to predict the risk over the coming days. The Met Office's hay fever page sets the threshold at 50: hay fever symptoms usually appear when the pollen count exceeds it. For grass, a reading between 50 and 150 grains per cubic metre is considered high. For birch, the high band runs from 81 to 200. Sensitivity varies from person to person, so some people react at lower levels than others.
Over-the-counter antihistamines: what to buy and what to pay
A pharmacist is the obvious first stop. They can give you advice and suggest treatments such as antihistamine drops, tablets or nasal sprays, and steroid nasal sprays. Some antihistamines can make you very sleepy, so ask about non-drowsy ones if you need to. Allergy UK sorts antihistamines into two main groups: drowsy ones such as chlorphenamine (Piriton), and non-drowsy ones such as acrivastine, cetirizine, fexofenadine and loratadine. Non-drowsy types are generally the best option — though a drowsy one may suit you better if your symptoms stop you from sleeping.
Non-drowsy does not mean identical. The NHS guide to cetirizine notes that it seems to be more likely to make you feel sleepy than loratadine, desloratadine or fexofenadine — yet those other non-drowsy antihistamines seem to work just as well. You should start to feel better within an hour of taking cetirizine. And it is best not to drink alcohol while you are taking it, as the combination can make you feel sleepy.
Where you buy makes a real difference to the cost of a season. When Which? compared hay fever tablet prices in June 2024, the gap between branded and generic packs of the same active ingredient was striking:
| Active ingredient | Branded (30 tablets) | Generic |
|---|---|---|
| Cetirizine 10mg | Piriteze Allergy, £11 at Sainsbury's | Bell's Allergy Relief, 89p for 30 at B&M |
| Loratadine 10mg | Clarityn Allergy, £10.99 at Boots | Galpharm One-a-day, 79p for 14 at Aldi |
| Fexofenadine 120mg | Allevia, £11.99 at Boots | Galpharm Treathay, £7 for 30 at Sainsbury's |
Those were non-offer prices at the time, so check the shelf before you buy. By law, generic and own-brand medicines have to meet exactly the same standards of quality, safety and efficacy as branded ones. Same active ingredient, same main action.
Nasal sprays and eye drops: the local treatments
When your nose stays blocked despite a tablet, local treatments can take over: antihistamine eye drops or nasal sprays, or a steroid nasal spray. Allergy UK notes that most nasal sprays work faster than tablets, and many are sold over the counter in supermarkets and pharmacies. Technique matters, too: using a nasal spray incorrectly can reduce its effectiveness, so ask the pharmacist to show you how to angle it.
If pharmacy treatments are not enough, the GP might prescribe a steroid treatment. That is the step before any talk of immunotherapy. Take your pollen notes along to the appointment: they show the GP when your symptoms start and how long they last.
Everyday habits that cut your pollen exposure
There is currently no cure for hay fever, and you cannot prevent it. You can, however, ease your symptoms when the pollen count is high. The checklist is short and practical:
- put petroleum jelly (such as Vaseline) around your nostrils to trap pollen, or an allergen barrier balm;
- wear wraparound sunglasses, a mask or a wide-brimmed hat;
- shower and change your clothes after you have been outside, to wash pollen off;
- keep windows and doors shut as much as possible;
- vacuum regularly and dust with a damp cloth, ideally with a HEPA filter in the vacuum cleaner;
- use a pollen filter in your car's air vents, if it has one.
And the things to avoid? Cutting grass or walking on it, spending too much time outside and keeping fresh flowers in the house. Smoking, or being around smoke, makes symptoms worse. Clothes dried outside can catch pollen, and pets can carry it indoors — keep them out of the house if possible. If you are planning on painting a room yourself, pick a wet or low-pollen day, so you can keep the room aired without letting pollen in.
Eyes, hair and evenings: adapting your routine
Itchy, red or watery eyes are one of the main symptoms of hay fever, and wraparound sunglasses help stop pollen getting into them outdoors. Allergy UK points out that many people treat their nasal symptoms and ignore their itchy, red, watery eyes. If your eyes are the main problem, say so at the counter — antihistamine eye drops exist for exactly that reason.
In the evening, the shower-and-change habit fits easily into what you already do. On high pollen days, shower and wash your hair after arriving home: the point is to wash off the pollen you have picked up outside. If you follow a complete beauty routine in the right order, simply put it at the top of the list. Hair washed, make-up removed, face cleansed — then the rest of your usual steps. Bryony got into the habit within the first week — "I do it while I take my make-up off, it doesn't add a minute".
One more detail from the Met Office: alcohol worsens the effects of pollen, because beer, wine and other spirits contain histamine (the chemical that sets off allergy symptoms). It is not a reason to cancel the pub garden, but it is worth knowing on a high-pollen evening.
Immunotherapy: who it is for and how it works
Immunotherapy — often called desensitisation — is the one treatment in this guide that aims to change how your immune system reacts, rather than to calm the symptoms. If steroids and other hay fever treatments do not work, the NHS says the GP may refer you for it. You are given small amounts of pollen as an injection or tablet, to slowly build up your immunity to it.
Timing matters. This kind of treatment usually starts a few months before the hay fever season begins, and it is a specialist service that may not be available everywhere. Allergy UK describes it as a well-established treatment reserved for certain severe allergies, including severe allergic rhinitis that has not been controlled by any of the anti-allergy medicines tried. It usually involves increasing doses of allergen extract over a period of time, by injection or by drops or tablets under the tongue (sublingual).
In practice, April is usually too late to start for this season, but it is the right month to take notes. If this season is miserable despite antihistamines and a steroid spray, record it now: dates, symptoms, treatments tried. That record is what your GP will need to judge whether a referral makes sense before next spring.
When to see a GP, and why asthma matters
See a GP if your symptoms are getting worse, or if they do not improve after taking medicines from the pharmacy. Testing is not automatic: according to Allergy UK, it is needed when the trigger is not obvious — or when exact identification is required for a treatment such as immunotherapy. Skin prick tests and blood tests (specific IgE to the allergen being tested) are the correct tests.
Asthma is a serious reason not to shrug off a runny nose. Allergic rhinitis and asthma share such a strong connection that they are often referred to as the "united airway disease". People with allergic rhinitis are at a higher risk of developing asthma, and those with asthma commonly experience allergic rhinitis symptoms. The inflammation in the nose can extend to the lower airways, potentially triggering or worsening asthma.
Frequently asked questions
Can a cold last three weeks?
Cold symptoms come on gradually over 2 to 3 days, and you should begin to feel better in about 1 to 2 weeks (symptoms can last longer in young children). Symptoms that drag on for weeks, especially in spring and with itchy eyes, point more towards hay fever. A pharmacist is a good first person to ask.
Do hay fever tablets make you drowsy?
Some do. Older antihistamines such as chlorphenamine (Piriton) can make you very sleepy. Non-drowsy ones such as cetirizine, loratadine and fexofenadine are less likely to. Even so, cetirizine seems more likely to cause sleepiness than loratadine, desloratadine or fexofenadine.
Are cheap own-brand antihistamines as good as branded ones?
If the active ingredient is the same, yes: by law, generic and own-brand medicines must meet the same standards of quality, safety and efficacy as branded ones. In June 2024, a Which? price check found own-brand cetirizine for 89p for 30 tablets, against £11 for a branded pack.
When is the pollen count considered high?
Hay fever symptoms usually appear when the pollen count exceeds 50 grains per cubic metre. A grass pollen reading between 50 and 150 is considered high, and a birch reading between 81 and 200 is high. Individual sensitivity varies, so your own threshold may be lower.
Can I drink alcohol while taking cetirizine?
It is best not to drink alcohol while taking cetirizine, as it can make you feel sleepy. Beer, wine and other spirits also contain histamine, the chemical behind allergy symptoms.
Does rain help with hay fever?
Rain lowers the amount of pollen in the air — and early, heavy, prolonged rain tends to keep counts low all day. But rain also helps grass grow, so if it is followed by dry weather, pollen levels can end up higher.
Can I take hay fever tablets if I'm pregnant or breastfeeding?
Ask about cetirizine first. The NHS page on cetirizine in pregnancy and breastfeeding says it "can be taken in pregnancy", and that if you need an antihistamine while breastfeeding, "cetirizine is one of the best choices". The same page asks you to tell your doctor if you are pregnant or breastfeeding. Other tablets and sprays are not covered by that advice: check each one with your pharmacist, midwife or GP before you start.
Is immunotherapy available on the NHS?
It can be. A GP may refer you for immunotherapy if steroids and other hay fever treatments do not work. Treatment usually starts a few months before the season, and it is a specialist service that may not be available everywhere.
Can a pharmacist help with hay fever?
Yes. A pharmacist is the first person to speak to: they can give advice and suggest treatments such as antihistamine drops, tablets or nasal sprays, and steroid nasal sprays. See a GP if your symptoms get worse or do not improve with pharmacy medicines.
Sources
- NHS — Hay fever (reviewed March 2024)
- NHS — Common cold (reviewed March 2024)
- NHS — Common questions about cetirizine (reviewed February 2025)
- Met Office — When is hay fever season in the UK?
- Met Office — Hay fever: pollen count and forecast
- Met Office — Pollen forecast
- Met Office — 10 things you should know about pollen
- Which? — Cheap hay fever tablets: how to save £10 a month (prices checked June 2024)
- NHS — Pregnancy, breastfeeding and fertility while taking cetirizine (reviewed February 2025)
- Allergy UK — Hay fever (allergic rhinitis)