Cetirizine versus diphenhydramine in the prevention of chemotherapy-related hypersensitivity reactions

Abstract

Objective This study evaluated the role of cetirizine compared to diphenhydramine as premedications for patients receiving paclitaxel, cetuximab, and rituximab infusions. Historically, diphenhydramine has been linked with more sedation in comparison to cetirizine; however, it is unknown if cetirizine can replace diphenhydramine in the prevention of hypersensitivity reactions in patients receiving chemotherapy. Methods This is a retrospective study designed to assess infusion reactions occurring in patients receiving diphenhydramine or cetirizine premedication for rituximab, paclitaxel, or cetuximab therapies. Infusion reactions were defined as various symptoms such as flushing, itching, alterations in heart rate and blood pressure, and dyspnea plus the clinical setting of a concurrent or very recent infusion. Results A total of 207 patients were evaluated in this study with 83 patients receiving cetirizine and 124 diphenhydramine patients. Overall, the percentage of patients with at least one chemotherapy-related infusion event in the cetirizine group was 19.3% (95% CI 11.4–29.4) compared to diphenhydramine group 24.2% (95% CI 17.0–32.7), P = 0.40. Of the patients who received cetirizine and then experienced an event in the first cycle, 41.7% (95% CI 13.7–74.3) of the events were due to paclitaxel, 50.0% (95% CI 19.4–80.6) were due to rituximab, and 8.3% (95% CI 0.1–43.6) were due to cetuximab. Of the patients who received diphenhydramine and then experienced an event in the first cycle, 26.1% (95% CI 5.7–51.4) were due to paclitaxel, 73.9% (95% CI 48.6–94.3) were due to rituximab and none due to cetuximab. Conclusion Cetirizine appears to be a viable substitute for diphenhydramine for the prevention of infusions reactions with cetuximab, paclitaxel, and rituximab infusions in adults. Prospective studies are needed to determine the efficacy and safety of cetirizine compared with diphenhydramine in the prevention of chemotherapy-related infusion reactions.

A randomized double-blind feasibility study comparing cetirizine and diphenhydramine in the prevention of paclitaxel-associated infusion-related reactions: the PREMED-F1 study

“…There are strengths and limitations to our design. Though oncology clinics may have already adopted different strategies to decrease side-effects from diphenhydramine based on experience or changes in practice, this prospective randomized trial design offers stronger internal validity compared with retrospective or observational designs [ 12 , 13 ]. The performance of recruitment for eligible patients was higher than previously reported (73 vs 60%, respectively) [ 26 ].…”

“…It is also the dosage that is recommended in the monograph [ 4 ]. Oral cetirizine 10 mg was selected as a comparator namely for the advantageous pharmacokinetics and pharmacodynamics properties found at this dose and the real-life experience described by Durham et al in more than 35 paclitaxel-naïve patients [ 13 , 15 , 16 ].…”

“…Although the study was underpowered, no IRR occurred in patients receiving loratadine. More recently, Durham et al compared oral cetirizine with intravenous or oral diphenhydramine as premedication for paclitaxel, rituximab, or cetuximab-based chemotherapy [ 13 ]. In patients receiving paclitaxel, IRR rates were comparable between cetirizine (used in 38 patients) and diphenhydramine (used in 62 patients) [ 13 ].…”

“…More recently, Durham et al compared oral cetirizine with intravenous or oral diphenhydramine as premedication for paclitaxel, rituximab, or cetuximab-based chemotherapy [ 13 ]. In patients receiving paclitaxel, IRR rates were comparable between cetirizine (used in 38 patients) and diphenhydramine (used in 62 patients) [ 13 ]. Although these results are promising, the retrospective design of these studies and the small sample sizes limit the generalizability of this practice.…”

CSACI position statement: Newer generation H1-antihistamines are safer than first-generation H1-antihistamines and should be the first-line antihistamines for the treatment of allergic rhinitis and urticaria

“…Perceived quicker onset of action of older AHs is often cited as a reason why patients and practitioners choose first-generation medications, however this perception has been proven inaccurate in clinical studies [33, 41]. Indeed, in a double-blind placebo controlled trial, both cetirizine and loratadine were found to have significantly faster onset of action, potency, and duration of action when compared to chlorpheniramine [42].…”