The role and choice criteria of antihistamines in allergy management – expert opinion

Abstract

Allergic diseases are the most common chronic conditions lasting throughout the patient’s life. They not only cause significant deterioration in the quality of life of patients but also lead to significant absenteeism and reduced productivity, resulting in very high costs for society. Effective and safe treatment of allergic diseases is therefore one of the main challenges for public health and should be carried out by all the specialists in family medicine, internists and paediatricians in collaboration with allergists, otorhinolaryngologists and dermatologists. Antihistamines are most commonly used in the treatment of allergies. Several dozen drugs are available on the pharmaceutical market, and their generic forms are advertised widely as very effective drugs for the treatment of allergic diseases. What is the truth? What are the data from clinical trials and observational studies? Are all drugs equally effective and safe for the patient? According to a panel of experts representing various fields of medicine, inappropriate treatment of allergies can be very risky for patients, and seemingly equally acting medications may differ greatly. Therefore, a panel of experts gathered the latest data from the entire scientific literature and analysed the latest standards and recommendations prepared by scientific societies. This paper provides a summary of these studies and highlights the importance for the patient of the proper choice of drug to treat his allergies.

No Time for Lullabies: Tracing down Pharmacological Effects & Uses of H1-Antihistamines in Children Younger than 6 Years

“… 11 Sedation, drowsiness, fatigue, and decreased concentration were reported at therapeutic dosages. 12 Due to the lack of safety of Chloramphiniramine, it is not recommended in newborns or infants. Children, especially those younger than 6 years old may experience paradoxical hyperexcitability.…”

Turkish Guidelines for Diagnosis and Treatment of Allergic Rhinitis (ART)

“…First generation H1 antihistamines are lipophilic. In addition to crossing the blood brain barrier and binding to histamine receptors, they block muscarinic, adrenergic (or adreno-ceptors) and dopaminergic receptors, causing sedation and cardiovascular, urinary and gastrointestinal adverse effects ( 493 , 494 ). New molecules have been investigated owing to these undesirable adverse effects, and second generation antihistamines have been developed which have limited penetration into the central nervous system (CNS) as well as a high selectivity to the H1 receptors ( 495 ).…”

“…Allergic symptoms begin 6-12 hours after exposure to the allergen, and peak at 12-24 hours. Apart from nasal symptoms, oral antihistamines are effective in ocular itching, irritation and redness, oral and pharyngeal symptoms, and all dermatological symptoms ( 492 , 493 ). Topical nasal H1 antihistamines are also available, and their effectiveness is similar to that of oral formulations.…”

<p>Using Patient Profiles To Guide The Choice Of Antihistamines In The Primary Care Setting In Malaysia: Expert Consensus And Recommendations</p>

“…For elderly patients, with emphasis on those with dementia, the use of sedating antihistamines should be avoided to reduce the risk of agitation and delirium 70. Patients with dementia will also benefit from once-daily dosing, which provides convenience and improves treatment compliance 9. The authors recommend prescribing only non-sedating antihistamines to elderly patients to prevent the risk of falls.…”