Unforeseen risks of commonly used allergy medication pose significant concerns for health professionals, according to experts.
In a recent review, the use of diphenhydramine, best known by the brand name Benadryl, for treating allergies has been called into question. The review states that diphenhydramine poses disproportionate risks, especially for children and older adults, compared to newer antihistamines [1][2][3].
Despite this, more than 1.5 million prescriptions are still written annually for diphenhydramine. However, the review authors emphasize that there is no strong clinical data to suggest that diphenhydramine works better than other options [1].
Instead, they recommend alternatives like loratadine (Claritin), cetirizine (Zyrtec), or fexofenadine (Allegra) to alleviate allergy symptoms [1]. These second-generation antihistamines cause less drowsiness and have a better side effect profile while effectively managing allergy symptoms [1][2][3].
Cetirizine, for instance, is FDA-approved, effective for allergy symptoms, and typically causes less sedation than diphenhydramine, making it preferable for children and adults [1][3][4]. Loratadine and fexofenadine are non-drowsy options suitable for long-term use, relieving sneezing, itchy eyes, and other allergic symptoms with minimal sedation [2].
Levocetirizine, chemically related to cetirizine, offers similar effectiveness with potentially even less sedation and comes in formulations suitable for children ages 6 and up [2]. These second-generation antihistamines are generally safe for children over 2 years old when used as prescribed and have fewer side effects such as fatigue or dry mouth instead of pronounced drowsiness [2][3].
In children, the risks can be even more pronounced, with cases of accidental overdose, paradoxical reactions, and even death, particularly with pediatric formulations. The review highlights a possible link between long-term diphenhydramine use and dementia. In older adults, the drug can stay in the body for up to 18 hours, resulting in lingering sleepiness, disorientation, and an increased risk of falling [1].
The review authors suggest that diphenhydramine should be moved behind the counter to allow pharmacists to guide patients towards second-generation alternatives. Dr. James Clark, the lead author of the review, recommends the safer alternatives for treating allergy symptoms [1].
Dr. Manuela Murray, an allergist at Massachusetts General Hospital, also agrees with this stance. She states that diphenhydramine is not effective for treating cold symptoms and is not a safe sleep aid. She recommends saline drops and suctioning as better alternatives for infants [2].
Dr. Alyssa Kuban, another allergist, agrees that diphenhydramine is often overused for symptoms it does not effectively treat. She recommends over-the-counter cetirizine for treating children with hives, seasonal allergies, or an itchy rash [2].
The American Pharmacists Association encourages patients and parents/caregivers to ask their pharmacist for the most appropriate treatment recommendation with the least amount of side effects [1]. The Consumer Healthcare Products Association notes that common side effects associated with products containing diphenhydramine are disclosed on the label, but they are not intended for long-term use [1].
In a recent review published in February, the authors called for the removal of diphenhydramine from over-the-counter and prescription markets in the United States [1]. Dr. Manuela Murray recommends that diphenhydramine should only be used under the guidance of a medical professional [2].
In conclusion, for safer allergy treatment in both children and adults, second-generation antihistamines like cetirizine, loratadine, fexofenadine, and levocetirizine are preferred over diphenhydramine. These provide effective relief with reduced sedation and better tolerability [1][2][3][4].
- Given the concerns surrounding its use, particularly for children and older adults, some medical professionals advocate for alternatives like health-and-wellness products such as cetirizine, loratadine, fexofenadine, and levocetirizine in managing allergy symptoms.
- The Medical Association points out that second-generation antihistamines like cetirizine, loratadine, fexofenadine, and levocetirizine, offer better side effect profiles, cause less drowsiness, and are suitable for long-term use compared to the use of diphenhydramine.
- Therapies-and-treatments, such as CBD oil, have been suggested as potential complementary options for managing chronic diseases and mental-health conditions, but more research is needed to confirm their efficacy and long-term safety.
- The review authors emphasize the need for more attention toward health-and-wellness issues like sleep hygiene and mental health, alongside traditional allergy treatment, to ensure overall well-being and quality of life.
