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Q1: I wear contact lenses sometimes instead of glasses. I find that wearing soft lenses stops the pollen from getting into the centre of my eyes, and I rub them less to avoid damaging the lenses. Am I imagining the benefits? Name and address withheld

A1: No. You are not imagining this. Unfortunately many people who suffer from allergic rhinitis develop such eye problems that it is impossible for them to put any lens into their eye, and if they do it increases the inflammation. I would strongly recommend that you also try and take a non-sedating hay fever regularly. Although the first generation of hay fever treatments have the advantage that many of the preparations are available over the counter they may be very sedating. The aim must be to free yourself of the symptoms but not at the cost of taking tablet that is going to make concentration and driving difficult.

Every doctor, and patient has their favourite remedy and mine is NeoClarityn generically known as Desloratadine.

Although antihistamine preparations have tended to be the first line of attack on hay fever in this country and local nasal sprays have only been regularly used as a back-up or first aid measure the American Public Health Service recommends that we should follow the path supported by sound clinical evidence that suggests that there is a clear benefit in using intra-nasal cortico steroids in the treatment of all hay fever. In fact these should be first line treatment for hay fever and other forms of allergic rhinitis.

Q2: I currently take Zirtek but find that on windy days my eyes in particular are problematic. The dosage is one table per day, is it possible to increase this or is there something I can additionally take? Name and address withheld

A2: Zirtek is a good tablet. One tablet a day is a standard dose. You might be helped by taking Xyzal levocetirizine that acts rather faster and is said to be more effective. Conversely your doctor may feel that it is worthwhile trying local nasal sprays or nasal drops such as Flixonase. Doctors avoid steroid drops into the eyes so far as is possible as these can lead to cataracts but there are other anti-inflammatory eye drops such as Opticrom or Hay Crom. These can't be used if you are also wearing soft contact lenses and when the drops are first put in they are rather uncomfortable and for a few moments there is blurring of vision.

Q3: I get hay fever but the "may make you drowsy" antihistamines like Claritin knock me out and I end up sleeping for hours. I can't seem to find non-drowsy pills any more. What would be the best think to take? Derek Haywood, Leeds

A3: Clarityn was replaced by NeoClarityn which is even less sedative than its forerunner. It would be worthwhile trying this or one or the other popular non-sedative anti histamines such as Zirtek or Xyzal, but unfortunately these require a prescription. If you find that even the non-sedative antihistamines make you drowsy I should discuss swopping to a intra nasal preparation. I always prescribed Flixanase but other similar preparations are equally good.

Q4: My doctor prescribes cetirizine for me as a one-a-day tablet. It works quite well except that when the pollen is at it height I find that the hay fever symptoms return around late afternoon. This can make for an unpleasant evening and night. I've never dared take another tablet and must admit I haven't been to see my doctor as hay fever seems to me to be wasting his time. Sue Post, Chelmsford

A4: Cetirizine is also known as Zirtek. Most people find that it will last throughout the day but if it doesn't they supplement it with a nasal inhalation at lunchtime. Zirtek doesn't have the disadvantage of making people sleepy but it sometimes causes a headache, dry mouth and dizziness so that I wouldn't recommend doubling the dose by taking a second tablet. American research would certainly support the use of an intra-nasal cortico steroid inhalation in a case of this sort.