Antihistamine Use in Pediatric Patients

Introduction to Antihistamine Recommendations

The American Academy of Dermatology recommends that antihistamines should not be routinely used in children with atopic dermatitis, as there is insufficient evidence for efficacy; however, second-generation antihistamines are the preferred agents for allergic rhinitis and urticaria in children ≥6 months 1, 2

The American Academy of Dermatology and the American Academy of Allergy, Asthma, and Immunology recommend that second-generation antihistamines, such as cetirizine and loratadine, are preferred for children 6 months to under 2 years due to their well-tolerated safety profiles 2, 4
The American Academy of Pediatrics recommends that first-generation antihistamines, such as diphenhydramine and chlorpheniramine, should be avoided in children under 6 years except for anaphylaxis due to 69 fatalities reported between 1969-2006 in children ≤6 years, with 41 deaths in children under 2 years 3, 4

The American Academy of Dermatology recommends that antihistamines are not recommended for routine management of atopic dermatitis, as evidence from 16 randomized controlled trials shows non-sedating antihistamines are ineffectual in AD management 1, 5, 6
The American Academy of Allergy, Asthma, and Immunology recommends that intranasal corticosteroids are the most effective medications for allergic rhinitis in children, superior to antihistamines, and that second-generation antihistamines are well-tolerated alternatives with good safety profiles 2, 4
The American College of Chest Physicians recommends that antihistamines have minimal to no efficacy in relieving cough in children, and that a systematic review showed antihistamine and decongestant combinations were no more effective than placebo in reducing acute cough in children 8

The American Academy of Dermatology and the American Academy of Allergy, Asthma, and Immunology recommend that first-generation antihistamines, such as diphenhydramine and chlorpheniramine, should be used with caution in children due to common adverse effects, including undesired sedation, anticholinergic symptoms, and convulsions 1, 3, 5
The American Academy of Pediatrics recommends that second-generation antihistamines, such as cetirizine and loratadine, are generally well-tolerated with excellent safety profiles in children over 6 months, but possible sedation may occur with higher than usual doses 2, 4

The American Academy of Dermatology recommends that cetirizine requires 50% dose reduction in moderate renal impairment and should be avoided in severe renal impairment 3
The American Academy of Allergy, Asthma, and Immunology recommends that consult product information for other antihistamines in patients with renal impairment 1