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What is hayfever and what causes it?

Hayfever is an allergic reaction to pollen. When tiny particles of pollen come into contact with the immune cells that line the mouth, nose, eyes and throat, triggering an allergic reaction. This means that the body overreacts to something that it perceives to be a threat – in this instance pollen, which is mistaken for an infection.

The immune system wrongly releases chemicals designed to limit the spread of infection and, in doing so, sets off symptoms like itching, swelling, watery eyes and a runny nose.

What are the symptoms of hayfever?

Symptoms, ranging from mild to extreme, include itchy eyes, sore throats, runny noses and sneezing and can have a significant impact on the patient’s quality of life. In children, this can affect concentration at school and exam performance, while adult sufferers often feel less focused, are less productive and also experience sleep difficulties. Reactions to grass pollen can, in some instances, also trigger asthmatic episodes.

Is there anything else my symptoms could be caused by?

The first possibility is that allergic rhinitis could be caused by allergies other than grass pollen. This is particularly likely if symptoms are experienced all-year round or at other times of the year besides late spring to late summer. It is therefore vital that the symptoms are carefully assessed, a detailed personal history is taken and allergy testing is carried out.

While the majority of hayfever sufferers are sensitive to grass pollen, some instead react to pollen from trees. It is therefore vital that the allergen culprit is correctly identified. If the allergy is not to grass pollen, treatment with grass pollen immunotherapy such as GRAZAX would not be effective and the cost of the treatment would be wasted.

If the symptoms are more persistent and not just confined to the warmer months, symptoms could be caused by something else like dust or animal fur. A small minority of people experience symptoms that cannot be explained by allergies – this is known as non-allergic rhinitis.

An important part of the evaluation process will be to confirm that symptoms are indeed caused by an allergen and that sublingual immunotherapy would therefore be a suitable treatment.

Professor Stephen Till says: “when we assess a patient at Smart Allergy Solutions, we will seek to confirm the most appropriate treatment, including whether sublingual immunotherapy is a suitable option.”

When is the grass pollen hayfever season?

It begins in May and runs through to August, with the season generally peaking between mid-June and mid­-July.

What are the benefits of sublingual immunotherapy?

Most patients receiving sublingual immunotherapy report an improvement in symptoms and less use of traditional treatments, such as antihistamines and steroid nasal sprays. In addition, using sublingual immunotherapy from an early age may actually prevent new allergies developing and also reduce the likelihood of getting asthma – which is eight times more likely in children who suffer from hayfever.

How do I know if sublingual immunotherapy will be suitable for me?

One of our team of specialist allergists will take a medical history and perform a skin prick test in order to confirm that you are allergic to grass pollen. Sublingual immunotherapy is generally recommended where symptoms are not adequately controlled by standard medications and affects quality of life and functioning (such as social activities, work or sleep). If you suffer from asthma, the doctor will also confirm that it is well controlled enough for you to receive the treatment.


How do I use sublingual immunotherapy?

Sublingual immunotherapy comes in dissolvable tablet or liquid forms manufactured by different companies. The tablet form is used at Smart Allergy Solutions because this is the only kind that is fully approved by the Medicines and Healthcare products Regulatory Agency in the UK.

The tablet is placed under the tongue where it dissolves within 10-20 seconds. The first dose will be given under close supervision and the immunotherapy is then taken daily.

Will my hayfever be instantly cured?

The benefits of taking sublingual immunotherapy will only be apparent once the allergen season begins. Symptoms should be milder during the first season. If sublingual immunotherapy is initiated, you will be advised to still continue other hayfever medications (see below: ‘What are the alternatives?’), although research suggests immunotherapy patients need and use these medications less.

How long will the treatment last?

Usually, your treatment will ideally start at least three months before the normal onset of symptoms and continue all year round for three years. Improvements in symptoms would be expected from the first year of treatment, but research suggests that this benefit will continue for some years beyond the end of the course.

Does treatment exist for other forms of hayfever and allergy?

A number of manufacturers supply sublingual immunotherapy vaccines for grass pollen and other allergies.  The Medicines and Healthcare products Regulatory Agency has provided authorisation for grass pollen, tree pollen and house dust sublingual immunotherapy vaccines. Treatments are on offer for other allergens (such as cat and dog) but they are not licensed in the UK. They may be available on a named patient basis if there is a clinical need. If you think this may benefit you, please contact either Professor Fox or Professor Till in their private practice. Their details can be found under the “contact us” box.

Is sublingual immunotherapy safe?

Sublingual immunotherapy frequently causes mild itching and swelling in the mouth a few minutes after it is taken, but this usually stops occurring within a few weeks of the course. Antihistamines can be taken beforehand during this period. Occasionally some patients develop abdominal pain and diarrhoea. Knowledge of the safety of this treatment is based on multiple studies from around the world.

Most patients tolerate sublingual immunotherapy well and severe reactions are uncommon. Studies from Europe report that side effects are seldom troublesome enough for the patient to stop the treatment.

Is sublingual immunotherapy available for free on the NHS?

There is very limited access to sublingual immunotherapy on the NHS at present. If you wish to be considered for option please discuss this with your NHS GP or specialist.

Why not use an online pharmacy selling sublingual immunotherapy?

Smart Allergy Solutions has been set up by two of Britain’s top allergy specialists, Prof Adam Fox (paediatric) and Professor Stephen Till (adult). They have decades of combined experience, together with vast specialist technical knowledge, enabling patients to rest assured that their treatment is in expert hands.

“Allergies can be a lot more than irritating and is probably having a bigger effect on your life than you realise.

We don’t really understand why there has been such a massive increase in the amount of allergies but at least we have a better understanding about its underlying causes and how to effectively treat it,” says Prof Fox.

He adds: “The main reason that has driven myself and Professor Till to set up Smart Allergy Solutions is to make sure that everybody who is eligible has the opportunity to benefit from effective treatments that they simply are not getting access to through the NHS.”

By choosing Smart Allergy Solutions, we can assure you of an expert assessment as to whether immunotherapy treatment is suitable for you andaccess to expert advice throughout your course of treatment.

How much would sublingual immunotherapy cost?

The cost of the grass pollen sublingual immunotherapy  tablet (GRAZAX) is approximately [£3] per day, about the same as one cappuccino a day. Sublingual immunotherapy  tablets for tree pollen and house dust mite allergy are approximately £4 per day.

What are the alternatives?

Standard allergy medicines suppress the symptoms, such as anti-histamines and steroid based medicines, such as nasal sprays are helpful treatment that will provide relief for many patients. For those with more troublesome hayfever, using these medications remains advisable but often will only provide partial relief from symptoms. These treatments also only work when they are taking and do not reduce the long-term severity of the underlying allergy. Slow release steroid injections are strongly advised against by allergy specialists due to the risk of long term side effects.

Immunotherapy is the only treatment which affects the underlying cause of an allergy. Where immunotherapy is recommended, this is additional to standard hayfever medications although clinical trials show that immunotherapy patients need less of these medications over time.

What if it doesn’t work?

There is no guarantee that sublingual immunotherapy will prove effective. Not everybody will benefit from taking this, sometimes because they find it difficult to remember to take it regularly. In this instance, it may be worth trying subcutaneous immunotherapy (injections). We send every patient an assessment at the end of the first season. If there has been no change in the patient’s condition, there is no point in continuing with treatment.

Can I eat and drink while taking sublingual immunotherapy?

You should not swallow for the first minute after taking the treatment. It is then recommended that you avoid consuming food and drink for five minutes afterwards.

Can I drive and/or use machinery while taking sublingual immunotherapy?

Sublingual immunotherapy has no, or negligible, influence on the ability to drive or use machines. However, you are the best judge of your own ability. If you are unsure, please consult a doctor.

Is sublingual immunotherapy suitable for vegetarians?

Some sublingual immunotherapy products contain a very small amount of fish gelatin. The decision to take these products  is therefore a matter of personal choice.

Can I take sublingual immunotherapy if I’m pregnant or breast­feeding?

Very little research has been done into the effects of sublingual immunotherapy during pregnancy, so initiating the treatment at this time should be avoided. However, immunotherapy courses that commenced before conception can be continued. If you fall pregnant during the course of the treatment, please consult Smart Allergy Solutions as soon as possible to discuss whether it is appropriate to continue.

Although there is no data available on sublingual immunotherapy use during breastfeeding, no effects on breastfed babies are anticipated.

Can children take sublingual immunotherapy?

Children aged five and over are eligible to take grass pollen sublingual immunotherapy and the process is the same as in adults. The ages vary for other allergies, so if this applies please contact our office for more information.

The treatment must, however, be stopped for seven days when the child loses a milk tooth. It should also be temporarily suspended if the young patient is asthmatic and suffering from an acute upper respiratory tract infection. Numerous studies have shown sublingual immunotherapy for grass pollen is safe in children aged two and upwards, but the full product licence is restricted to those over the age of five.

What happens if I miss a dose?

For the best results, sublingual immunotherapy must be taken on a daily basis. Missing a dose should not bring on side effects, but may mean that allergic symptoms return. Take the dose as soon as you remember, but do not take a double dose on any single day.

What happens if I take too much?

If you take a greater amount than the prescribed dosage, you may experience allergic symptoms in the mouth and/or throat. Contact a doctor immediately if the reaction is severe.

What if I need to speak to someone at Smart Allergy Solutions?

In the majority of cases, we find that our system of email contact works well ( However, if you require further advice or reassurance we can arrange a further consultation at an additional cost.

Is there anything that will stop me from taking sublingual immunotherapy?

If you suffer from any of the following, you must inform a doctor before starting treatment:

  • Cancer
  • Severe asthma
  • Illnesses that affect the immune system
  • Severe inflammation of the mouth

Special care should be taken if:

  • You have recently had a tooth out or had oral surgery.
  • You have a severe allergy to fish.
  • You have previously experienced an allergic reaction to an injection of grass pollen allergen.

These issues can be addressed at your initial assessment consultation.

What are the side effects?

Like all medicines, sublingual immunotherapy can potentially cause side effects. In the early stages of treatment it is common to experience mouth itching and an irritating sensation in the throat within a few minutes of taking the dose. This is a mild allergic reaction and in most cases settles down within 20 minutes of starting treatment. Simple over-the-counter antihistamines, such as cetirizine or loratidine, can help alleviate symptoms and can be taken before the immunotherapy dose to reduce the risk of side effects if preferred.

Other common side effects (which may affect up to one in 10 people) include: headache, prickling sensation or numbness of the skin, mouth or tongue, eye or ear itching, eye, nose or mouth inflammation, asthma symptoms, shortness of breath, cough or sneezing, dry throat, nasal discomfort, stuffy or runny nose, swelling of lips or tongue, stomach pain or discomfort, mouth blistering, heartburn, itching, tiredness, fever and chest discomfort. These generally occur in the first week of taking the medication and tend to be mild to moderate and short-lived.

Stop taking sublingual immunotherapy immediately and consult a doctor if you experience any of the following:

  • Rapid swelling of face, mouth or throat
  • Difficulties in swallowing
  • Difficulties in breathing
  • Hives
  • Voice changes
  • Worsening of existing asthma
  • Severe discomfort
Can I get sublingual immunotherapy cheaper elsewhere?

Smart Allergy Solutions ensures we offer our members access to treatment at a highly competitive rate. A member of the public under UK laws cannot purchase medicine without a prescription from a doctor.

The allergist specialists who conceived Smart Allergy Solutions aim to widen access to grass pollen immunotherapy by working directly with the distributor to minimise additional charges whilst ensuring that sublingual immunotherapy is only prescribed to those suitable for this treatment via the face to face assessment.

Professor Stephen Till says: “It is important that patients who have this treatment are suitable for it and we are rigorous about our testing and checks.”

However, should you wish to see either Professor Fox or Professor Till in their private practice, their details can be found under the “contact us” box.

How much will the treatment cost?

For a £150 fee, the patient will have a consultation with one of our highly trained allergists in a convenient location (Smart Allergy Solutions will initially operate in a small number of locations across London, with a gradual roll out across the major UK cities). The consultation will include skin prick testing. Recommendations will be made about treatment and if suitable, an initial test dose of sublingual immunotherapy.

Assuming all is satisfactory, an email will then be sent requesting payment for the subsequent three months worth of tablets (which will be delivered by post) which costs £330 for GRAZAX and £405 for other allergy treatments.

Then monthly payments will be taken until the course ends after 36 months.  The monthly cost is £110 for grass pollen immunotherapy and £135 for house dust mite and tree pollen treatment.

Once the patient commits to the course, Smart Allergy Solutions guarantees to freeze the price for three years.

Will I be eligible for a refund if I cancel part way through the course?

In order to feel the full benefit of sublingual immunotherapy, a continuous three-year course is recommended. Patients can cancel at any time, however the laws governing prescription medicine mean that you cannot return any unused tablets for a refund.

Can I pay monthly?

Smart Allergy Solutions will make contact after the initial consultation with login details for the online system. It is possible to then set up monthly payments, however, an initial six-month payment is required to cover the first batch of GRAZAX.

Why use Smart Allergy Solutions? I feel unsure about receiving treatment from an online service.

It is totally unsatisfactory to administer immunotherapy when the patient has only done an online tick-box questionnaire, which takes just minutes to complete. But this is far from the case with Smart Allergy Solutions. Guidelines on the use of immunotherapy require that treatment be initiated by doctors who are trained and experienced in using the treatment.

The immunotherapy will not be initiated without an evaluation of the hayfever allergy. Secondly, if appropriate, advice may be given about other standard allergy treatments in addition to sublingual immunotherapy. Finally, the initial dose of sublingual immunotherapy will only administered under close medical supervision by experienced doctors, so as to see whether patient has any kind of negative reaction.

Our website is secure and confidential. We automatically inform your GP of the initial results and about the course of treatment.

You will be asked to log in with a username and password. This also links into the payment module for which we utilise a third party’s trusted payment system.

What is the next step?

Go through the registration process and online questionnaire on this website to determine if you could be suitable and if so then be booked in for your consultation, test, and if deemed suitable, your initial dosing.

Register now and answer a few simple questions to discover if you could be eligible for our treatment

Register now