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Antihistamines in severe/chronic rhinitis

Oral antihistamines generally represent the first line of treatment (after allergen avoidance) in mild seasonal allergic rhinitis (SAR), and in perennial allergic rhinitis (PAR) where symptoms are intermittent. They are safe, effective and easily administered. First‐generation antihistamines experienced problems mainly with sedation and anticholinergic activity. Second‐generation antihistamines are safer and have largely eliminated these effects, although a very small number of patients taking terfenadine or astemizole have developed a characteristic ventricular dysrhythmia, ‘torsade de pointes’.