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.