Are antihistamines performance enhancing drugs?
The short answer: maybe. The long answer: it’s not clear. Here’s more information about why antihistamine ingestion qualifies as doping in sports and what this means for the everyday athlete, whether competing or just running with hayfever and seasonal allergies.
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Athletes Banned for Using Antihistamines
Before 2014, few professional athletes realized that they could be accused of doping for taking allergy medication. Then, hockey player Nicklas Backstrom failed the Sochi Olympics final drug test for having a prescription antihistamine in his system. The native Swede has suffered from seasonal allergies for years since moving to Washington D.C. to play for the Washington Capitals. His story pulled on the heartstrings of other allergy sufferers. It also called doctors’ knowledge of banned substances into question(1).
Unfortunately, Nicklas isn’t the only athlete whose doctors unintentionally prescribed him a banned asthma medication. According to an article in Reuters, four out of 5 doctors prescribed one of the prohibited forms of corticosteroids. Many doctors knew athletes could not orally ingest the medications, but they did not realize that ointments, creams, injections, and inhalers were not allowed.
Nicklas’ story wasn’t enough to educate the entire sports world on the danger of using antihistamines to treat exercise and allergies(2). In 2016, the professional cyclist Simon Yates tested positive for a banned antihistamine. He had been taking prescription allergy medicine that contained the chemical, Terbutaline. It’s a muscle relaxant for the lungs used during an allergic reaction. As a result, he was banned from the sport for four months and could not qualify for the Tour de France. While Nicklas was blamed for his infraction, Simon’s team took responsibility for not having applied for a doctors’ exemption. Therefore, Simon’s infraction was deemed “non-intentional.”(3)
While it’s true that both of these athletes were highly competitive, neither one showed or expressed increased performance while taking the drugs. Both men used them for years to deal with seasonal allergies, just like many other non-athletes. So are antihistamines actually doping?
Antihistamine Medication and the Meaning of Doping
According to the World Anti-Doping Agency (WADA), “Doping consists of the use of various substances to help improve performance by targeting strength, alertness, speed and levels of oxygen in the blood, despite the adverse health effects with which it is associated.”(4) The International Olympic Committee was the first to test athletes for doping in the 1960s. Then and now, doping most often refers to the ingestion or injecting of hormonal supplements. Today, athletes found guilty for the first time are typically banned from their sport for a while. When found guilty multiple times, they can be banned for life.
What Causes a Substance to be Prohibited?
While the injection of performance-enhancing hormones seems like an obvious “no-no” in the sports world, countries worldwide have extensive banned-substance lists for athletes of all ages and skill levels. Most countries work together to create a globally accepted list based on the Olympic Committees’. So, how does a substance become prohibited?
According to Sport Integrity Australia, a substance is prohibited because it’s been proven to create an unfair advantage. But a substance can also be banned on suspicion of having such an effect. Here’s a summary of why a substance may be prohibited (quoted directly from the website):
- It has the potential to enhance, or it does enhance a performance in sport
- It has the potential or represents an actual risk to an athlete’s health
- It violates the spirit of Sport…
- Some substances in the “open” category undergo preclinical or clinical development. Other categories are “substances with similar chemical structure or similar biological effects” as banned substances, even if these substances are not explicitly named…
It seems that oral antihistamines are more widely banned than inhaled ones (i.e., nasal sprays are okay, allergies pills are not). An athlete can inhale a certain amount of allergy medication and still pass a drug test. But, most oral medications have such a high level of banned substances in them that they’d be immediately considered a “doping pill” and render the athlete non-compliant(5).
The Truth About Antihistamines and Performance
Since antihistamines are banned, that must mean that they have a positive impact on performance. Right?
Well, that’s still to be determined. L.C. Montgomery and P.A. Deuster are scientists. They have conducted at least two surveys of antihistamine ingestion and performance. First, they analyzed the effect on muscle strength and endurance(6). Then, they analyzed aerobic and glycolytic work performance (sustained, high-intensity, muscle isometric contraction).(7)
“No differences in performance measures were detected across the treatment conditions…”
“This study demonstrates that a one-time administration of [antihistamines]… does not significantly affect muscle endurance…”
“The results indicate that a single dose of antihistamine will neither compromise nor improve aerobic and glycolytic work performance…”
Basically: there’s no proof that antihistamines affect the performance of athletes.
Other studies by independent researchers support Montgomery and Deuster’s findings. But in his analysis of the research thus far, P.A. Deuster noted an intriguing gap in the data:
“The only studies have found that exercise performance is NOT impacted (positively or negatively) in individuals WITHOUT symptoms. But, there is little research on the effect on people who are symptomatic.”(8)
So, while the science shows that people who do not have seasonal allergies also do not experience increased performance on antihistamine medications, people who do have allergies might perform better. As Deuster states, “There is little research on the effect on people who are symptomatic.”
Are Antihistamines Making Competitors Worse?
Anyone who’s ever suffered from allergies knows that running with hayfever stinks (not literally, of course, since smelling anything is impossible with such a stuffy nose). Allergy medications are grouped into two categories: the older generation and the newer generation. The older one is known for causing extreme drowsiness(9). From falling asleep while driving to overdosing, over-the-counter and prescribed allergy medicine can be dangerous. The first generation of allergy medications is more dangerous than the second.(10)
Allergies and Running: What the Antihistamine Ban in Competitive Sports Means for You
The risk of drowsiness and fatigue outweighs any potential gains from antihistamine doping pills. But, running with allergies is challenging and frustrating. So here’s what you need to know about safely taking hay fever meds.
You’re The Accountable Person
As we saw in the case of hockey player Nicklas Backstrom, under the World Anti-Doping Code’s “strict liability” principle, the athlete is responsible for any banned substance they test positive for – regardless of how it got there (Sport Integrity Australia). Some of the medications you’re using might contain trace amounts of banned substances. “Accidental doping” is when an athlete ingests a banned substance without realizing it. The accident could be your own or your doctor’s. It’s for this reason that due diligence is in order. Here’s a list of resources; use the links to conduct your research:
Therapeutic Use Exemptions (TUE)
The saddest part of cyclist Simon Yates’ ban was that he had the right to apply for a TUE. His team took responsibility for his ban because they forgot to apply on his behalf. And yet, he was unable to compete in the most critical cycling race of the year.
If you are an athlete with severe, verifiable, and dangerous allergies, you’re qualified to ingest a certain amount of antihistamines. You and your doctor must follow your country’s sports protocols.(11)
The Dose Makes The Poison
The United States Anti-Doping Agency (USADA) has clear outlines for what is accepted in American sports. Athletes can safely inhale specific amounts of nasal allergy spray within a day. The exact amount depends on the chemicals in the medicine. And that amount may also be affected by other medications, like diuretics.(12)
testez différents traitements pour vos allergies
Hay fever can be debilitating. There is no end to the itchy nose, watery eyes, and sneezing even in regular daily activities. Unfortunately, springtime is also prime training time for marathon runners. Here are a few recommendations from Pouria regarding non-medicinal ways to manage exercise and allergies.
Strengthen Your Immune System: Indoor/Outdoor Workouts
Regular outdoor exercise outdoors can be as effective as allergen immunotherapy.(14) If you’re struggling with any outdoor activity, try alternating your workouts indoors and outdoors. This gradually strengthens your immune system and creates a smooth transition to resilience.
Tip from the experts:
Breathing through your nose while exercising outdoors reduces the number of allergens you inhale.
Competitive athletes need to work closely with a doctor and sports governing associations to measure the appropriate dosage of antihistamines. Even though there is no scientific evidence that antihistamines impact sports performance, the sports science community believes there’s reason to study them further. So, for now, even a tiny amount in the bloodstream is grounds for disqualification. Everyday athletes should beware that allergy medicines carry many side effects. Always consult with a physician if you plan to take prescription allergy medication. No matter what, just keep running! Summer will be here before you know it.