Although antihistamines are first-line treatment for allergic rhinitis and are effective at combating the majority of nasal and ocular symptoms associated with this disease, they are traditionally considered to be less effective at dealing with nasal congestion. Combination therapy with antihistamines and antileukotrienes has been shown to be an alternative treatment strategy in dealing with nasal symptoms, including congestion. However, recent studies have suggested that some of the newer antihistamines are effective in reducing nasal congestion in allergic rhinitis when used alone. For example, fexofenadine has been shown to have a beneficial effect on nasal congestion in a number of clinical studies investigating its efficacy and safety, as well as in combination therapy studies. This paper aims to review the available literature looking at combinations of antihistamines and antileukotrienes and single antihistamine therapy for reducing nasal congestion in allergic rhinitis, using subjective symptom scoring and/or objective measurements.