DS13 severe hay-fever. Fexofenadine not working

[SplendidPendips]

DS13 is suffering from horrendous hay-fever, as he does every year. Horrendous blocked/runny nose that prevents him from sleeping is his worse symptom. But he also gets itcy eyes and it triggers asthma attacks. GP prescribed fexofenadine two years ago, he could only have the 60mg tablets the first year but since last year has been allowed 120mg. We make sure to start taking them before hay-fever season kicks off, take them daily, use nasal spray, shower every night and have an air purifier in his room. It's just not working. He's been up all night with horrible symptoms. What can we do? I am so so worried about gcses in a few years time. He can barely sleep or function.

Add olpatadine eyedrops, start a steroid inhaler(or increase the dose) before hay fever season, try nasal saline rinses(‘netipot’). Ask to be referred to an allergy specialist.

If asthma is also a problem, montelukast may help. Ask the GP.

Montelukast would be helpful, possibly with a steroid nasal spray as well.

Have you checked if he can take Piriton (chlorphenamine) at night too? I know I was prescribed both, but was an adult. (The Piriton made me drowsy, so just took at night.)

As pp said, eye drops would probably help massively too. We used Optrex Itchy Eyes or Opticrom, which can be used up to 4 times a day, but once was sufficient for my son.

Tackle each symptom separately if necessary and ask pharmacy for advice. I recommend Nasal Rinse, in a squirty bottle, rather than the netipot. Can be bought in pharmacies or online. Also sunglasses when possible, as they can limit pollen exposure to eyes.

I sympathise entirely OP. I've had every medication going over a lifetime. I even had 5yrs of allergen specific immunotherapy injections and it made not one jot of difference. I've given up.

I was taking 180mg a day by that age.

He might well need a preventer inhaler as well.

Is his throat and nose okay? When I was that age my hat fever was so bad my throat could often be red raw from sneezing/mucus etc. Steroid nasal sprays helped quite a lot with that.

Have you also done all the (annoying but helpful) non-medical interventions? I.e. washing face whenever you get inside, washing hair daily, not drying sheets outside.

It's a cost and wouldn't have been an option while I was young but friends have air filter devices with a HEPA filter in and say running those in their bedroom has helped.

I used to be so ill that sometimes I'd have a day off sick and mum would take me to the seaside as it was the only place I wasn't miserable and constantly sneezing.

For exams, it was a total pain but I used to take cold elderflower cordial in (the sugar was more soothing to my throat than water and it's clear), tissues etc. And actually adrenaline did a lot for meaning I got through the exams themselves okay.

Oh yes and as an adult in the worst phases I take fexofenadine in the morning and a loratidine at night. No idea if it's allowed but it hasn't killed me yet.

I find that becocleanse nasal hygiene spray works well for me on top of all the drugs. I have v bad hay fever and it does make a difference.

It is so awful for him.

Thank you. I think he will need a referral to a specialist. In the meantime I plan to either double up on the fexofenadine by giving him one in the evening too, or give him Piriton.

I've not heard of montelukast so will research that. He has a preventor inhaler already, although we've been slack at using that recently as the asthma effect has only just kicked in, so need to get better.

He already takes a nasal spray but I will try to persuade him to use a nasal rinse too. He's a baby about stuff like that though!

Piriton is a fast acting antihistamine. And can be taken with fexo, which is a longer acting antihistamine.

And yes to 180 Mg, at 13 he should be able to have the higher dose. And a steroid nasal spray and eye drops. Throw everything at it.

If I was you, I'd de pollen a room. Close the windows, get an air purifier (with a pollen filter) and run it. Strip the bed. Damp dust the room, vacuum the carpet, try and get under the bed, on top of wardrobes etc. Replace bedding with non-line dried bedlinen. Get ds to shower. Dry himeslef on a towel that hasn't been line dried.

At that age, mine was at its worst. A short course of steroids was a feature of most summers (always started in exam week, which is now). In my mid 40s now and it's so much better, for no apparent reason. Total sympathy, it's absolutely rotten.

I have bad rhinitis all year round but summer is shocking. I have Dymista steroid and antihistamine spray which isn't bad. I usualy have a steroid spray all year round but need the dymista in Summer. I ran out of my prescription stuff and the pironase spray has been really good.

Has he had any allergy tests to pinpoint the allergens? If not that will help identify some strategies for prevention.

I've always found 120mg of Fexofenadine isn't really enough for the summer, need 180. Depending on his allergens it might be he needs it all year round, I take 120 in the winter and 180 in the summer.

My main allergen in summer is grass pollen. I had immunotherapy for grass pollen and it did make a difference.

Monteleukast is really good if asthma is involved, more effective than inhalers alone, but I had to stop taking it because of side effects (it can cause depression).

If he's not on a steroid inhaler he needs to be.

Eye drops are good too, make sure they have drugs in them tho and aren't just "soothing eyebright".

I found it quite challenging to get my GP to treat mine effectively because my symptoms didn't quite fit any box - allergies were clearly an issue but my asthma symptoms weren't consistent. Once I saw the allergy specialists I got better help (not least because they were fascinated by my being alive at all given the level of some of my allergies!)

Thanks everyone. I will ring the GP on Monday and, as well as asking for a referral, I will ask for an increase to the 180mg of fexofenadine. I know fexofenadine is often hailed as a miracle, but it honestly doesn't seem any better for him than any other hay-fever remedies, which is so disappointing.

He is prescribed Nasobec Aqueous nasal spray at the moment, which is beclometasone dipropionate. Sounds like I need to ask for a steroid nasal spray then.

I have already de-pollened his bedroom - have an airpurifier in then, don't dry his clothes or bedding outside, he showers and washes his hair every evening. I even bought him a new bed two weeks ago so that we had more underbed storage so that I can clear surfaces to wipe them more easily. Nothing seems to work :-(

I think beclometasone is a steroid one but let me check.

Edit: yes it is a steroid nasal spray.

For some reason you can't take Hay-fever medication for more than one or two years. They need to be changed.

I'd also start giving him local honey. Over time that actually helps reduce Hay-fever symptoms. Medication just suppresses the symptoms.

Hope he feels better soon.

Please don't double the fexofenadine without medical advice, as 2 x 120mg is a lot more than the prescribed 120mg or your request for 180mg.

But as Piriton is a different class of antihistamine, it is much safer to add, especially if spaced apart with Fexo in the morning and Piriton (not Piriteze) at night. Piriton comes as a syrup or a tablet.

Glad you are getting a GP appt, but if there is a wait, a decent pharmacy will help advise what combinations are safe in the meantime.

Agree with PP re Dymista - think it is relatively expensive to prescribe but worth trying made such a difference for my endless allergies

My ds is 16 and takes 2 fexofendine a day on advice of dr however he’s under a specialist

I think the threshold for too much anti-histamine must be quite high. At point I was prescribed, off label, up to 720mg of fexofenadine per day!

OP I think you’re doing all the main things but I was wondering how much water your son is drinking? I drink about 3- 4L a day during tree pollen season. I notice a huge flare in symptoms if I don’t stay over-hydrated. Histamine is released if you are dehydrated.

Honey is a pointless suggestion as you’d need to have started taking it back in February. It doesn’t work once symptoms have started.

Local Honey won’t work if he’s allergic to tree or grass pollen, bees don’t make honey from either of them.

My DS suffered too. The best thing for him was rinsing out his nose with salt water. You can buy a kit in Boots.

He hated it at first. Referred to it as water torture but will now seek it out for the relief.

Salt baths also good.

Do you have a salt cave near you (one near here is a shop with salt everywhere, you lie on sun beds for an hour. It's great. I love it).

with GPs advice DS can also take cetirizine at night. Fexofenadine in the am.

Be very careful with montelukast. Research the side effects. They can be horrific. New warnings have just been added to the packs.

DH has been prescribed Dymista through his respiratory consultant a couple of
months ago and, for the first time since meeting him nearly 30 years ago, he can go outside, cut the grass, sit in the garden, even go passed a florist shop without sneezing.

It’s been life changing. And for me, since he can mow the lawn now lol. Seriously, he’s gone from (with no exaggeration) sneezing over 50 times a day to a couple of sneezes in the morning before he uses it.

He has also been on fexofenidine & montelukast for over a decade and he’s had a little relief with them (as well as a variety of steroidal nasal sprays). But the Dymista has been truly life changing this spring, especially as his hay fever season is so long (with tree pollen extending his season from late February until November).

Poor boy.

Try a change of antihistamine plus a steroid nasal inhaler.

Honey will not help him.

Our GP recommended Fexofenadine with Loratidine for DD when she has bad hayfever, she said it was ok to take them together. DD had one in the morning and one at night.