5.1.5. Antihistamines
Antihistamines are a first-line treatment for athletes suffering from AR
and are currently allowed by the WADA regulations 61.
They are very effective for treating histamine-induced symptoms such as
rhinorrhea, sneezing and itch, but are somewhat less effective on nasal
obstruction 68 and therefore often combined with INS.
Surprisingly, two RCTs have also shown a beneficial effect of topical
azelastine in NAR patients 69, 70, probably due to
secondary effects on neuropeptide release. In most countries, a
combination formulation of intranasal azelastine with the INS
fluticasone proprionate (MP-029) is available and has been shown to be
effective in reducing symptoms in a population of both AR and NAR
patients 71 with a specific reduction of NHR in AR
patients 72.
The above-mentioned study by Walker however, has shown that
antihistamines were rarely used by elite hockey players when compared to
recreational players or non-sporting controls 14. It
was believed to be due to the athletes’ fear of side effects of these
kind of drugs or misperception of WADA regulations. Nonetheless, it is
well-known that second-generation antihistamines are much less sedative
than older antihistamines and cardial arythmias are only seen with
overdosing 73, 74. Topical antihistamines have no side
effects but the disadvantage of shorter duration of activity20.