Comparing Second-Generation Antihistamines for Allergic Rhinitis

Efficacy Comparison

The American Academy of Allergy, Asthma, and Immunology recommends cetirizine as a superior option to loratadine for decreasing mean rhinitis symptom scores in seasonal allergic rhinitis, with a significant reduction in symptom scores 1, 2

The American College of Allergy, Asthma, and Immunology notes that fexofenadine, loratadine, and desloratadine do not cause sedation at recommended doses, whereas cetirizine may cause sedation at recommended doses 2, 3
Cetirizine 10 mg may be associated with mild drowsiness (13.7% for patients age 12+ years) compared with placebo (6.3%), but typically without performance impairment 1, 4

The American Academy of Allergy, Asthma, and Immunology states that intranasal corticosteroids are more effective than oral antihistamines for overall control of allergic rhinitis symptoms, particularly nasal congestion 5, 6, 7
For patients with both allergic rhinitis and asthma, the American Thoracic Society suggests considering leukotriene receptor antagonists (e.g., montelukast) 8, 9
Second-generation antihistamines are generally preferred over first-generation antihistamines due to less sedation, performance impairment, and anticholinergic effects 2, 3, 9

The American Academy of Allergy, Asthma, and Immunology recommends that both fexofenadin and levocetirizine are effective in reducing symptoms of allergic rhinitis, including sneezing, runny nose, itchy nose/throat, and itchy/watery eyes 10, 11, 12
Both medications maintain their efficacy over 24 hours, making them suitable for once-daily use 11, 12
The American College of Allergy, Asthma, and Immunology notes that corticosteroid nasal sprays are the most effective treatment for controlling all symptoms of allergic rhinitis, including nasal congestion, and should be prioritized over single-agent antihistamines 10, 11

The American Academy of Allergy, Asthma, and Immunology states that fexofenadin does not cause drowsiness at recommended doses, with a side effect profile similar to placebo 10
Both medications have a good safety profile in children, and are recommended over first-generation antihistamines 10

Continuous treatment is more effective than intermittent treatment for seasonal or perennial allergic rhinitis, according to the American Academy of Allergy, Asthma, and Immunology 11, 12