Antihistamine Selection for Young Children with Allergies

Evidence-Based Rationale

Second-generation antihistamines, such as cetirizine, have been shown to be well tolerated with an excellent safety profile in young children, according to the American Academy of Allergy, Asthma, and Immunology 1
The American Academy of Allergy, Asthma, and Immunology recommends second-generation antihistamines (cetirizine, desloratadine, fexofenadine, levocetirizine, and loratadine) for young children due to their good safety profiles 1

For a 1-year-old, the typical weight-based dosing of cetirizine is 0.25 mg/kg twice daily, which equals 2.5 mg twice daily for a 10 kg child, as recommended by the American Academy of Pediatrics 2
Cetirizine is available in an oral solution formulation for ease of administration in young children, according to the American Academy of Pediatrics 2

The American Academy of Allergy, Asthma, and Immunology advises against the use of over-the-counter (OTC) cough and cold combination products in children under 2 years due to the risk of overdose and toxicity 1
In cases of renal impairment, the dose of cetirizine should be adjusted, with a recommended halving of the dose in moderate renal impairment, as suggested by the National Kidney Foundation 3
Cetirizine should be discontinued 5-7 days before allergy testing, as recommended by the American Academy of Allergy, Asthma, and Immunology 3
Antihistamines, including cetirizine, are not recommended for the treatment of acute anaphylaxis and should never be used alone for severe allergic reactions, according to the American Heart Association 2