Allergy medication dosing can be confusing, particularly when terms like '90 mcg' appear on labels or online information. In the UK, 90 micrograms per actuation is not a standard licensed dose for any commonly prescribed allergy medicine — it is a US convention for salbutamol (known as albuterol in the United States). UK-licensed intranasal corticosteroids and inhalers use different dose strengths, regulated by the MHRA. This article explains how common UK allergy medicines work, who can use them safely, what side effects to watch for, and how to access treatment through the NHS or privately — helping you make informed decisions about your care.

What Is 90 mcg Allergy Medication and How Does It Work?

The term '90 mcg (micrograms) allergy medication' does not correspond to a standard metered dose for any commonly licensed allergy medicine in the UK. It is important to clarify this at the outset: most UK-licensed intranasal corticosteroid sprays deliver 50 micrograms per actuation (e.g., fluticasone propionate nasal spray) or 27.5 micrograms per actuation (e.g., fluticasone furoate, brand name Avamys), whilst UK salbutamol pressurised metered-dose inhalers (pMDIs) are licensed at 100 micrograms per actuation. A dose of 90 micrograms per actuation is a US convention (used for salbutamol, known in the US as albuterol) and is not routinely encountered in UK clinical practice.

If you have seen '90 mcg' on a medicine label or in information provided to you, always check the patient information leaflet (PIL) supplied with your specific product and confirm the dose with your GP or community pharmacist. The Medicines and Healthcare products Regulatory Agency (MHRA) is the UK regulator responsible for licensing medicines; product-specific dosing, indications, and safety information are published on the Electronic Medicines Compendium (EMC) in the form of Summary of Product Characteristics (SmPC) documents.

Allergy medicines used in the UK broadly fall into two categories relevant to this topic:

• Intranasal corticosteroids: Used for allergic rhinitis (hay fever and perennial rhinitis). They work by reducing inflammation in the nasal passages, inhibiting the release of inflammatory mediators — including prostaglandins and leukotrienes — triggered when the immune system reacts to allergens such as pollen, dust mites, or pet dander. Unlike antihistamines, which block histamine receptors after release, corticosteroids act upstream to dampen the entire inflammatory cascade, making them particularly effective for persistent or moderate-to-severe nasal symptoms (NICE CKS: Rhinitis).

• Inhaled corticosteroids and bronchodilators: Used in the management of asthma, which may have an allergic component. Inhaled corticosteroids reduce airway inflammation; bronchodilators such as salbutamol relieve acute bronchospasm. These are distinct drug classes with different roles and should not be confused with one another.

Always use the exact product and dose prescribed or recommended for you, and do not substitute one product for another without professional advice.

Common Allergy Medicines Used in the UK and Their Licensed Doses

Rather than focusing on a single dose figure, it is more helpful to understand the UK-licensed products commonly used for allergic conditions and their actual approved strengths. The following examples reflect current UK licensing as documented in MHRA-approved SmPCs on the EMC:

• Fluticasone propionate nasal spray (e.g., Flixonase): Available over the counter (OTC) and on prescription for allergic rhinitis. Each actuation delivers 50 micrograms of fluticasone propionate. The standard adult dose is 2 sprays per nostril once daily (200 micrograms total). Licensed for adults and children aged 4 years and over (age threshold varies by product — always check the SmPC).

• Fluticasone furoate nasal spray (Avamys): A prescription-only medicine (not available OTC). Each actuation delivers 27.5 micrograms of fluticasone furoate. Avamys contains a different active substance to fluticasone propionate and is not interchangeable with it. Licensed for adults and children aged 6 years and over.

• Salbutamol pMDIs (e.g., Ventolin Evohaler): UK-licensed salbutamol inhalers deliver 100 micrograms per actuation — not 90 micrograms, which is a US convention. Salbutamol is a short-acting bronchodilator used to relieve asthma symptoms; it is not itself an anti-inflammatory allergy treatment.

• Beclometasone dipropionate inhalers (e.g., Clenil Modulite, Qvar): Used as preventer therapy in asthma. UK-licensed strengths are typically 50, 100, and 200 micrograms per actuation for standard-particle formulations, and extrafine formulations (e.g., Qvar) have different dose equivalences. A 90 micrograms/actuation strength is not a standard UK licensed dose for beclometasone. Dose equivalence between different inhaled corticosteroid products and devices is not straightforward; refer to the BNF (inhaled corticosteroid dose equivalence table) and NICE NG80 for guidance.

Key points to note:

• Different devices, particle sizes, and formulations are not interchangeable even if the labelled dose appears similar.

• NICE NG80 (Asthma) and NICE CKS (Rhinitis) recommend using the lowest effective dose to minimise systemic side effects.

• Always confirm the exact product, strength, and dosing schedule with your prescriber or community pharmacist before switching between brands or formulations.

• For allergic rhinitis, refer to NICE CKS (Rhinitis) and BSACI guidance; for asthma, refer to NICE NG80.

Who Can Use These Allergy Medicines Safely?

Eligibility for allergy medication depends on the specific medicine, the patient's age, medical history, and the nature of their allergic condition. Age licensing varies by product and must be confirmed in the individual SmPC rather than assumed:

• Fluticasone propionate nasal spray (OTC): licensed from 4 years in some products, but OTC use is typically restricted to adults and children aged 18 years and over without pharmacist or GP involvement — check the specific product label.

• Fluticasone furoate nasal spray (Avamys): licensed from 6 years, prescription only.

• Inhaled corticosteroids for asthma: available across age groups; paediatric formulations and lower-dose options exist for younger children (refer to individual SmPCs and NICE NG80).

Certain groups require additional caution or medical supervision:

• Pregnant or breastfeeding women: Intranasal corticosteroids at low doses are generally considered low risk during pregnancy, but all medicines should be reviewed by a GP or obstetrician before use. For asthma, NICE NG80 advises that preventer inhalers (including inhaled corticosteroids) should not be stopped during pregnancy, as uncontrolled asthma poses greater risk to mother and baby than the medicine itself. Budesonide has the most safety data as an inhaled corticosteroid in pregnancy. Refer to NHS and BNF guidance on corticosteroids in pregnancy and breastfeeding.

• People with active or latent tuberculosis, fungal infections, or untreated bacterial infections: Corticosteroids can suppress local immune responses and may worsen these conditions.

• Patients already taking systemic corticosteroids or potent CYP3A4 inhibitors (e.g., ritonavir, itraconazole): Combining inhaled or intranasal corticosteroids with these medicines increases the risk of systemic corticosteroid effects, including adrenal suppression. Refer to individual SmPCs for interaction details.

• People with recent nasal surgery, nasal ulceration, or recurrent epistaxis: Intranasal corticosteroids should be used with caution; seek medical advice before starting.

• People with a history of ocular herpes simplex: Intranasal corticosteroids should be avoided or used only under medical supervision.

• Children and adolescents: Growth should be monitored in children using inhaled corticosteroids long-term, as per NICE NG80. Use the lowest effective dose.

Anyone with poorly controlled symptoms, frequent exacerbations, or significant comorbidities should seek a formal clinical assessment rather than self-managing with OTC products alone.

Possible Side Effects and Safety Considerations

Like all medicines, allergy medications carry a risk of side effects, though these are generally mild and localised when used correctly at recommended doses.

Common side effects of intranasal corticosteroids include:

• Nasal irritation, dryness, or stinging

• Epistaxis (nosebleeds), particularly with incorrect technique or if the spray is directed at the nasal septum

• Headache

• Unpleasant taste or smell

A rare but important risk with intranasal corticosteroids is nasal septal perforation, particularly with prolonged use or incorrect technique. Using the correct technique (directing the spray away from the septum) significantly reduces this risk.

Common side effects of inhaled corticosteroids (e.g., for asthma) include:

• Oral candidiasis (thrush) — reduced by rinsing the mouth and gargling with water after each use, and by using a spacer device

• Hoarseness or dysphonia

• Cough

Systemic side effects are uncommon at low-to-moderate recommended doses but become more relevant with higher doses, prolonged use, potent formulations, or interactions with CYP3A4 inhibitors. These may include adrenal suppression, reduced bone mineral density, and — particularly in children — slowed growth. Regular clinical review is recommended for patients on long-term inhaled corticosteroids, in line with NICE NG80 and NICE CKS guidance.

Ocular effects: Prolonged or high-dose use of intranasal or inhaled corticosteroids has been associated with raised intraocular pressure and cataract formation; patients with a history of glaucoma should seek medical advice.

Important safety signals that warrant prompt medical attention include:

• Worsening of symptoms despite regular use

• Increased need for a reliever inhaler (salbutamol), night-time waking due to asthma, or reduced exercise tolerance — these may indicate deteriorating asthma control and require urgent GP review

• Signs of oral or nasal fungal infection

• Significant, recurrent, or unexplained nosebleeds

• Any new or unexplained symptoms following initiation of treatment

Seek emergency help (call 999 or go to A&E) if you experience a severe asthma attack, including severe breathlessness, inability to speak in full sentences, or if your reliever inhaler is not providing relief.

If you think you have experienced a side effect from any medicine, you can report it directly to the MHRA via the Yellow Card Scheme at yellowcard.mhra.gov.uk. This helps the MHRA monitor the safety of medicines used in the UK.

How to Use Your Allergy Medication Correctly

Correct technique is essential to ensure that allergy medication reaches the intended site of action and delivers maximum therapeutic benefit with minimal side effects.

1. For intranasal sprays:
2. Gently blow your nose before use.
3. Shake the bottle if instructed and prime the pump before first use (and after periods of non-use).
4. Tilt your head slightly forward — do not tilt it back.
5. Insert the nozzle into one nostril, angling it slightly away from the nasal septum (towards the outer wall of the nostril).
6. Spray whilst breathing in gently through the nose.
7. Breathe out through the mouth and repeat for the other nostril.
8. Avoid blowing your nose immediately after use.

Intranasal corticosteroids may take several days to reach full effect; do not discontinue treatment prematurely if you do not notice immediate relief. NICE CKS (Rhinitis) recommends reviewing treatment response after 2–4 weeks. If symptoms remain poorly controlled, a step-up in therapy or further investigation may be warranted.

For pressurised metered-dose inhalers (pMDIs):

• Use a spacer device where recommended to improve drug delivery to the lungs and reduce oral deposition (which lowers the risk of thrush and systemic absorption).

• Inhale slowly and deeply when using a pMDI.

• Wait 30–60 seconds between actuations if more than one puff is required.

• Rinse your mouth and gargle with water after each use of an inhaled corticosteroid.

• Clean your spacer regularly according to the manufacturer's instructions (typically monthly with warm water and allow to air dry) to maintain effective drug delivery.

For dry powder inhalers (DPIs):

• Inhale quickly and forcefully (unlike pMDIs, which require a slow breath).

• Do not use a spacer with a DPI.

• Follow the specific loading and priming instructions for your device.

Follow the prescribed dosing schedule consistently — do not skip doses or double up if a dose is missed. Your GP, asthma nurse, or community pharmacist can provide personalised inhaler technique checks and ongoing support. The NHS also provides device-specific inhaler technique guidance online.

Getting Allergy Treatment on the NHS or Privately

In the UK, allergy treatment is accessible through both NHS and private healthcare pathways. Understanding your options can help you access the right care in a timely manner.

NHS pathways:

• Many allergy medications, including intranasal corticosteroids and inhaled therapies, are available on NHS prescription via your GP. Standard prescription charges apply unless you are exempt (e.g., under 16, over 60, or holding a valid medical exemption certificate).

• Prescribing decisions in primary care are informed by NICE CKS (Rhinitis) and BSACI guidance for allergic rhinitis, and NICE NG80 for asthma, ensuring treatments are evidence-based and cost-effective.

• Some intranasal corticosteroids (e.g., fluticasone propionate nasal spray 50 micrograms/spray) are available over the counter at pharmacies without a prescription for adults with mild-to-moderate symptoms. Note that Avamys (fluticasone furoate) is prescription-only and is not available OTC.

• For complex or poorly controlled allergies, your GP may refer you to an NHS allergy clinic or respiratory specialist. Waiting times vary by region and local Integrated Care Board (ICB) pathways.

• Allergen immunotherapy (desensitisation) is available on the NHS in specialist secondary care centres for selected patients — for example, those with severe allergic rhinitis unresponsive to standard pharmacotherapy, or insect venom allergy. Availability depends on local commissioning; your GP or specialist can advise on eligibility and referral.

Private pathways:

• Private allergy testing (including skin prick tests and specific IgE blood tests) and specialist consultations are available through private clinics, often with shorter waiting times.

• Allergen immunotherapy may also be accessed privately for conditions such as severe hay fever or insect venom allergy, subject to clinical assessment.

When to seek help: If your allergy symptoms are significantly affecting your quality of life, sleep, ability to work or study, or are not adequately controlled despite correct use of OTC treatments, contact your GP. Referral to a specialist should be considered for persistent uncontrolled symptoms despite adherence and correct technique, or where asthma features are present. Early, appropriate treatment — guided by NICE and BSACI recommendations — can substantially improve outcomes and reduce the need for higher-dose or more complex interventions over time. For NHS self-care advice, see the NHS hay fever page.

Frequently Asked Questions