Will over-the-counter (OTC) antihistamines help treat nasal polyps?

OTC Antihistamines for Nasal Polyps

OTC antihistamines are not effective for treating nasal polyps and should not be used as primary therapy for this condition. 1

Understanding Nasal Polyps and Treatment Options

Nasal polyps are inflammatory outgrowths of the nasal and paranasal sinus mucosa that require specific targeted therapy. The European Position Paper on Rhinosinusitis and Nasal Polyps (EPOS 2020) provides clear guidance on their management:

Why Antihistamines Are Not Recommended:

• There is insufficient evidence supporting antihistamine use for nasal polyps 1
• Only one study evaluated antihistamines in chronic rhinosinusitis with nasal polyps (CRSwNP), showing no effect on polyp size 1
• The EPOS 2020 steering group concluded there is insufficient evidence to recommend antihistamines for CRSwNP 1

Effective Treatment Options for Nasal Polyps:

1. First-line treatment: Intranasal corticosteroids

   • Most effective medication for controlling nasal polyp symptoms 2
   • Reduces polyp size and prevents recurrence 3
   • Can be used as long-term therapy for mild cases 3

2. For moderate to severe cases:

   • Short courses of systemic (oral) corticosteroids 4
   • Acts as a "medical polypectomy" with effects on all symptoms including sense of smell 3
   • Should be used short-term due to potential adverse effects 2, 3

3. Adjunctive therapies:

   • Nasal saline irrigation to improve symptoms 4
   • Leukotriene receptor antagonists (e.g., montelukast) may provide some benefit, especially in patients with comorbid asthma 5
   • Doxycycline has shown moderate but longer-lasting effects on polyp size in controlled studies 6

4. For refractory cases:

   • Endoscopic sinus surgery when medical treatment fails 4
   • Post-surgical medical therapy is essential to prevent recurrence 4

Clinical Considerations

• In patients with allergic rhinitis and nasal polyps, treating the allergic component may help overall symptom management, but antihistamines primarily target allergic symptoms, not the polyps themselves 1
• Combination therapy with intranasal corticosteroids and other agents is often more effective than monotherapy 2
• Studies show that even with optimal medical therapy including steroids, complete eradication of polyps is achieved in only 12% of patients without surgery 7

Treatment Algorithm

1. Start with daily intranasal corticosteroids as baseline therapy
2. For significant symptoms or large polyps, add a short course (5-7 days) of oral corticosteroids
3. Consider adding leukotriene antagonists for patients with comorbid asthma
4. Refer for endoscopic sinus surgery if medical management fails after 3-6 months
5. Continue intranasal corticosteroids post-surgery to prevent recurrence

While antihistamines may help with concurrent allergic rhinitis symptoms, they should not be considered primary treatment for nasal polyps themselves.