Natural Remedies for Hay Fever: What Actually Works

I am asked about natural hay fever remedies more than almost any other seasonal question, usually by someone who has tried a tablet and felt drowsy, is pregnant, or simply wants to use less medication. The honest answer is that some of these remedies work well, some do nothing, and the useful ones are the least glamorous. Here is how the evidence stacks up.

Remedies with good evidence

Saline nasal rinsing

Rinsing the nose with a salt water solution, from a squeezy bottle, neti pot or pre made spray, physically washes pollen and mucus out of the nasal lining. A Cochrane review found it reduces symptoms and reduces antihistamine use, with essentially no side effects. Use it once or twice a day during the season, and always after being outside. Make the solution with cooled boiled water, or buy sachets; never use tap water straight from the tap.

A barrier balm around the nostrils

A smear of petroleum jelly or a purpose made balm just inside and around the nostrils traps pollen before it reaches the lining. Small trials show a modest but real reduction in symptoms. Reapply every few hours and after blowing your nose. Cheap, safe in pregnancy and for children.

Pollen avoidance, done properly

Most people know to check the forecast. The measures that make the difference are the specific ones: shower and wash your hair before bed so you are not sleeping in pollen; change clothes when you come in; dry washing indoors on high days; keep windows closed in the early morning and early evening when counts peak; wear wraparound sunglasses; keep car windows up and use the pollen filter; wipe pets down after walks. Each is small, together they are substantial.

Cold compresses and eye washes

Itchy eyes respond to a cold flannel or a cooled saline eye wash, which rinses pollen off the surface of the eye. Contact lens wearers often do better in glasses during the season. Sodium cromoglicate eye drops are drug based but very gentle and safe in pregnancy and children.

Knowing your pollen

Tree pollen runs March to May, grass May to July, and weeds into September. If you know which one affects you, you can start preventive measures a fortnight before your season and relax outside the rest of the summer. A GP or an allergy test can pin this down.

Remedies with some evidence

• Acupuncture. Several reasonable trials show a modest benefit over sham treatment for nasal symptoms. Expensive for the size of the effect, but safe.
• Quercetin and vitamin C. Both have a plausible mechanism (quercetin stabilises mast cells) and small, mixed trials. Not harmful at normal doses; do not expect much.
• Probiotics. Some strains reduce symptom scores slightly in trials. The effect is small and strain specific, and supplements vary enormously.
• Butterbur. One of the better studied herbs, with trials showing an effect similar to a mild antihistamine. The catch: unprocessed butterbur contains liver toxic compounds, so only PA free certified products are safe, and it is not advised in pregnancy or for children.
• Air purifiers with HEPA filters reduce indoor pollen in the bedroom, with modest symptom benefits in trials. Worthwhile if you sleep badly in the season.

Remedies without evidence

• Local honey. The idea is that eating local pollen builds tolerance. The pollen in honey is mostly from flowers, which are insect pollinated and rarely cause hay fever; the culprits are wind blown tree and grass pollens. Trials show no benefit over placebo. Honey is pleasant; it is not treatment.
• Homeopathy. No effect beyond placebo in systematic reviews.
• Apple cider vinegar, garlic, nettle tea, essential oils, "detoxes". No trial evidence. Essential oils in the nose or eyes can irritate and make things worse.
• Cutting out dairy. Dairy does not increase mucus; the sensation of thicker mucus after milk is texture, not production.

Using natural remedies alongside medication

These approaches are not either or. Saline rinsing before a steroid nasal spray makes the spray work better, because it reaches clean lining. Avoidance measures mean you need less antihistamine. A sensible plan for moderate hay fever is: start the avoidance measures and a steroid nasal spray two weeks before your season, rinse daily, add a non drowsy antihistamine on bad days, and keep the eye wash in the fridge.

Hay fever in pregnancy

Pregnancy is where natural remedies earn their place, because many women want to avoid tablets. Saline rinsing, barrier balms, avoidance and cold compresses are all safe. If more is needed, sodium cromoglicate eye and nose drops, and the steroid nasal sprays beclometasone and budesonide, have good safety records in pregnancy, and loratadine or cetirizine are the antihistamines usually chosen. Decongestant sprays and tablets are best avoided. Discuss anything beyond the drug free measures with a GP or midwife.

When natural remedies are not enough

Add medication, or see a GP, if you are:

• waking at night with a blocked nose, or sleeping badly through the season
• losing days to it, or unable to work, study or exercise outside
• getting wheeze, chest tightness or a cough with it, which can mean the pollen is reaching the lungs
• already taking an antihistamine and a nasal spray correctly and still struggling
• pregnant and unsure what is safe

A GP can check the spray technique, which is wrong in most people and halves the effect, prescribe a stronger or combined spray, add an eye drop, and for the most severe cases discuss the steroid injection or a referral for immunotherapy, which over three years retrains the immune system and is the one treatment that changes the condition rather than the symptoms.

Questions people ask

What is the best natural remedy for hay fever?

Saline nasal rinsing has the strongest evidence: it washes pollen out of the nose, reduces symptoms and reduces the amount of antihistamine people need. A barrier balm around the nostrils and proper pollen avoidance (shower and hair wash before bed, change clothes when you come in, windows shut at peak times) are the next most effective. Together they can halve symptoms in mild hay fever.

Does local honey help hay fever?

No. The theory is that it builds tolerance to local pollen, but honey contains flower pollen, which insects carry and which rarely causes hay fever; the pollens that do are wind blown tree and grass pollens that are not in honey. Trials comparing local honey with placebo show no difference.

What can I take for hay fever when pregnant?

Start with the drug free measures: saline rinsing, a barrier balm, pollen avoidance and cold compresses, all of which are safe. If you need more, sodium cromoglicate drops and the steroid nasal sprays beclometasone and budesonide have good safety records in pregnancy, and loratadine or cetirizine are the antihistamines usually recommended. Avoid decongestants. Check with a GP, pharmacist or midwife before starting anything.

Does vitamin C or quercetin cure hay fever?

Neither cures it. Both have a plausible mechanism and small, mixed trials showing at most a modest reduction in symptoms. They are safe at normal doses, so there is little harm in trying, but they are not a substitute for a nasal spray if you are struggling.

Can hay fever be cured naturally?

Not by a remedy. The only treatment that changes the underlying allergy is immunotherapy, which exposes the immune system to controlled doses of pollen over three years and leads to lasting improvement in most people. Everything else, natural or pharmaceutical, controls symptoms for as long as you use it.

Is the hay fever injection a natural remedy?

No. It is a long acting steroid given into the muscle, which suppresses the allergic response for several weeks. It is effective for severe hay fever that has not responded to sprays and tablets, but it carries the risks of any steroid and is not recommended as a first choice, which is why it is given only after a GP assessment. At OneMedicine the assessment and injection cost £75.

How early should I start hay fever remedies?

About two weeks before your pollen season begins: late March for tree pollen, early May for grass. Starting avoidance measures and a steroid nasal spray before symptoms begin works far better than starting once the nose is already inflamed.

Written by Dr Ibrar Ahmed, MBChB MRCP MRCGP PhD PG Dip (Cardiology), GMC 4401399
Specialist interest: Cardiovascular Medicine · OneMedicine, CQC registered clinic