Antihistamines In Children Research Articles

First-Generation Antihistamines and Seizures in Young Children

The widespread use of antihistamines in children for treatment of common cold symptoms and their central nervous system effects, like drowsiness, underscore the importance of being aware of the associated risks. To assess associations between prescriptions of first-generation antihistamines and seizures in children using a comprehensive and nationwide dataset. This cohort study used a self-controlled case-crossover design. Data were obtained from the National Health Insurance Service database in Korea. Children born between January 1, 2002, and December 31, 2005, who visited the emergency department for seizure events (International Statistical Classification of Diseases and Related Health Problems, Tenth Revision, codes R56.8, G40, and G41) during the follow-up period were included. Follow-up was completed on December 31, 2019, and data were analyzed from June 3, 2023, to January 30, 2024. First-generation antihistamine prescription. Primary outcome consisted of an index seizure event. Odds ratios (ORs) for seizure events were estimated using a conditional logistic regression model, comparing first-generation antihistamine prescription 1 to 15 days before seizure (hazard period) against control period 1 (31-45 days before the event) and control period 2 (61-75 days before the event) using the same period windows. Stratified analyses were conducted to examine the association with individual participant characteristics. Of 11 729 children who had a seizure event, 3178 (1776 [55.9%] boys) were identified as having been prescribed antihistamines during the hazard or the control period, but not both. Seizure events were predominantly observed in children aged 6 to 24 months (985 [31.0%]) and 25 months to 6 years (1445 [45.5%]). During the hazard period, 1476 first-generation antihistamine prescriptions were recorded, in contrast to 1239 and 1278 prescriptions during control periods 1 and 2, respectively. After multiple confounder adjustments, first-generation antihistamine prescription was associated with an increased seizure event risk during the hazard period (adjusted OR [AOR], 1.22 [95% CI, 1.13-1.31]). Stratified subgroup analyses showed consistent results, particularly in children aged 6 to 24 months who were prescribed first-generation antihistamines having a higher risk (AOR, 1.49 [95% CI, 1.31-1.70]) than children aged 25 months to 6 years (AOR, 1.11 [95% CI, 1.00-1.24]; P = .04 for interaction). Furthermore, sensitivity analyses, including adjustment for exposure window periods, evaluation of new first-generation antihistamine prescriptions, comparison of control points from the same period 1 year prior, and exclusion of individuals using combination drugs, confirmed a similarly high risk. In this cohort study, prescriptions for first-generation antihistamines were associated with a 22.0% higher seizure risk in children, especially in those aged 6 to 24 months. These findings emphasize the need for careful and judicious prescription of first-generation antihistamines in young children and underline the need for further research to elucidate associations between antihistamine prescriptions and seizure risk.

Antihistamines for motion sickness.

Antihistamines for motion sickness.

Separating Fact from Fiction in the Diagnosis and Management of Food Allergy

Separating Fact from Fiction in the Diagnosis and Management of Food Allergy

Efficacy and safety of antihistamines in children with atopic dermatitis

Atopic dermatitis is one of the most common inflammatory diseases. This disease is characterized by severe itching, recurrent eczematous lesions and has a heterogeneous clinical picture. AD occurs in all countries, in both sexes, in different age groups. There has been a steady increase in the incidence of AD detection over the past three decades. The prevalence of AD symptoms in various regions of the Russian Federation (RF) ranged from 6.2 to 15.5%. There is no generally accepted classification of AD, the working classification of AD reflects the age dynamics, clinical and morphological forms, severity and stages of the course of the disease. Treatment of AD should be patient-centered and should include prevention of individual trigger factors, restoration of the skin barrier, and a stepwise and gradual approach to reduce inflammation based on the severity of the disease. mGCS are the first-line treatment for exacerbations of AD. Topical calcineurin inhibitors are tacrolimus and pimecrolimus. Pimecrolimus is indicated for the treatment of mild to moderate AD, and tacrolimus is indicated for moderate to severe AD. Tacrolimus and pimecrolimus are characterized by low systemic absorption, they do not cause skin atrophy and do not affect the function of the hypothalamic-pituitary-adrenal system. Systemic corticosteroids should be used only in exceptional cases for short-term treatment of an exacerbation or when starting another systemic therapy. The therapeutic value of 1st generation antihistamines lies in their sedative properties by normalizing nighttime sleep and reducing the intensity of itching. Dimetindene maleate is an effective and safe treatment for relieving symptoms of pruritus and normalizing sleep in patients with AD. Dimetindene maleate has a high safety profile and can be prescribed from 1 month of age.

Efficacy and tolerability of the updosing of second-generation non-sedating H1 antihistamines in children with chronic spontaneous urticaria.

Chronic urticaria (CU), daily wheals or angioedema that lasts more than 6 weeks, is a common skin disease; CU is classified as spontaneous (no specific eliciting factor involved) or inducible (specific eliciting factor involved). Recent EAACI guidelines for management of CSU recommend second-generation non-sedating H1 antihistamines (sgAH1 s) as initial treatment in children (weight-adjusted) as in adults, followed by increased doses (up to 4 times) if the standard dose is not effective. The efficacy and tolerability of fourfold updosing in adults are known, but there is little documentation regarding updosing in the pediatric population. This retrospective study evaluates the efficacy and tolerability of the updosing of sgAH1 s in children with CSU in a tertiary care pediatric hospital. The electronic charts of patients diagnosed with CSU and referred to the Allergy Unit of Meyer Children's University hospital were reviewed during a period of 4 years. For each patient, an examination of demographic characteristics, diagnostic workup, efficacy, and tolerability of the treatment was performed. Disease activity was monitored using UAS7. Sixty-six cases of CSU were identified, and all of them were treated initially with a standard dose of sgAH1 s, followed by increased doses up to fourfold when standard dosing was not effective. 44/66 patients (66.7%) treated with sgAH1 s responded: 25 with a standard dose, 16 with a double, 2 with threefold dose, and 1 with fourfold dose. 12/66 (18.2%) patients began a therapy with omalizumab. As for the remaining patients, 10/66 (15.1%), they are still undergoing therapy with sgAH1 s because of the relapse of the symptoms after the stepped-down dosage. Regarding tolerability, 9/66 (13.6%) patients treated with sgAH1 s experienced side effects: three that required treatment change and six that did not. Our data were consistent with the tolerability of updosing of sgAH1 s in children with CSU, although the efficacy appears to be limited to double the standard dose.

Antihistamines: ABC for the pediatricians.

Antihistamines are currently one of the most commonly administered drugs in children. They are used to treat symptoms that depend on histamine release, namely allergic diseases, such as rhinitis, asthma, urticaria, and anaphylaxis. It is possible to distinguish first- and second-generation antihistamines. Pharmacological effects and therapeutic indications are similar, but second-generation antihistamines have fewer adverse effects because they are more selective for peripheral H1 receptors. Although they have been on the market for several years, there are still many adverse effects linked to the antihistamine safety profile, especially in the first years of life. Thus, many antihistamines are prescribed off-label, especially in children younger than 2years of age, which is the age-group where most of the data on drug safety are lacking and many antihistamines are not recommended. This article aims to provide a practical update on the use of antihistamines in children.

Lertal®, a multicomponent nutraceutical, could reduce the use of antihistamines in children with allergic rhinoconjunctivitis.

Antihistamines are the cornerstone treatment of allergic rhinitis (AR). To quantify the antihistaminic consume is particularly relevant in clinical practice, since a remarkable use is usually associated with severe symptoms. The aim of the study was to measure the use of antihistamines in two groups of children suffering from AR. The first group took a course of a nutraceutical (Lertal®) before the observation (active group, AG); a second one was considered as control (control group, CG). Both groups took antihistamines on demand. The children were visited at baseline and after 1 year. The number of days of antihistaminic use was the primary outcome. Children in AG had a significant reduced number of antihistamines use in comparison with CG (p=0.008). In conclusion, the current study showed that a course with a multicomponent nutraceutical could reduce the use of symptomatic antihistamines in children with allergic rhinoconjunctivitis. (www.actabiomedica.it)

Clinical observation of nasal spray allergen blocker combined with antihistamines in treatment of allergic rhinitis children

Objective:To investigate the clinical effect and safety of nasal spray allergen blocker combined with antihistamines in children with allergic rhinitis. Method:Eighty-four children with mild-severe allergic rhinitis were randomly divided into observation group（42 cases） and control group（42 cases）. Children in control group were treated with azelastine hydrochloride nasal spray, while children in observation group added with nasal spray allergen blocker on the basis of control group. Both groups were treated for 4 weeks. The changes of symptoms and signs integral in both groups were compared and analyzed after 1, 2 and 4 weeks treatment. And Clinical efficacy and adverse reactions between two groups were compared after treatment. Result:Among 4 weeks treatment, the symptoms and signs integral of the two groups showed a significant decreasing trend（P<0.01）. The reduction in the observation group was greater than that in the control group, there were statistical differences in the variation trends of symptoms and signs integral between the two groups（P<0.01, P<0.05）. And there were significant differences in symptoms and signs integral between the two groups（P<0.05）. The total effective rate of observation group（90.5%） was significantly higher than that of control group（64.3%）（P<0.05）. There was no statistically significant difference in the incidence of adverse reactions between the two groups（9.5%vs 4.8%, P>0.05）. Conclusion:The effect of nasal spray allergen blocker combined with antihistamines on allergic rhinitis children is remarkable. They can alleviate the symptoms and signs of allergic rhinitis with rapidity and safety.

Second-generation antihistamines: a study of poisoning in children

Background and objectives: The toxicity of second-generation antihistamines after an overdose by a child is still unknown. The objective of this study is to use data from Poisons Centres in France to describe the toxicity profile of second-generation antihistamines for children and to compare the severity of poisoning observed from these with a first-generation antihistamine.Method: This was a retrospective, multi-centre and observational study focusing on human cases of single-substance exposure to a second-generation antihistamine and to mequitazine, reported between 1 January 2001 and 31 December 2016 in Poisons Centres in France.Results: From a total of 9403 children included, 5980 were exposed to a second-generation antihistamine and 3423 were exposed to mequitazine. The severity of exposure to second-generation antihistamines in children is low: among the children followed until a known outcome, 9% of children were symptomatic and in 97% of cases, the symptoms shown were of a minor-level severity (primarily drowsiness or restlessness). Depending on the substance, children who ingested doses 16 to 69 times the maximum recommended therapeutic dose remained asymptomatic. No deaths or severe symptoms were observed. No cases of lengthening of the QT interval or arrhythmias were identified. Mequitazine led to more symptoms than other substances (14.8% symptomatic children vs. 7.5%, Odd ratio (OR): 2.3 (2.0–2.6), p < 0.0001), more symptoms of moderate intensity (1.4 vs. 0.2%, OR: 8.3 (4.1–18.5), p < 0.0001) and more hospitalisation (19.1 vs. 8.7%, OR: 2.5, 95% CI: (2.2–2.8), p < 0.0001).Conclusion: The severity of poisoning from second-generation antihistamines appears to be low among children and considerably lower than poisoning caused by mequitazine.

Antihistamines in pediatric allergology

Allergic diseases without a doubt have become one of the biggest problems of pediatrics in recent decades. One of the evidence of this is the maximum occupancy of halls at the IV All-Russian Congress of the Association of Pediatric Allergists and Immunologists of Russia. The symposium «Antihistamines in children’s allergology» was among the most popular.

Adverse drug reactions of systemic antihistamines in children in the Netherlands.

Antihistamines are used for the treatment of allergic rhinitis, allergic conjunctivitis, chronic spontaneous urticaria and atopic eczema. To study the reports of adverse drug reactions (ADRs) in children using antihistamines to provide prescribers with an overview of the possible toxicity. We studied ADRs in children reported to the Netherlands Pharmacovigilance Centre Lareb in the years 1991-2014, assessed the Naranjo score and, when possible, computed the reporting OR. Serious ADRs included one death (malignant neuroleptic syndrome), cardiac arrhythmia (one case) and convulsions (three cases). Skin eruptions, headache and somnolence were the most frequently reported ADRs. Aggression and agitation were also reported. Toxicity can occur with second-generation antihistamines. The main toxicity relates to skin eruptions and central nervous system problems.

The use of antihistamines in children

Antihistamines are commonly used in paediatric medicine mainly for the treatment of allergic conditions. First generation antihistamines have been in use for many years, despite limited research studies supporting their use. Second generation antihistamines have been investigated for both efficacy and safety in paediatrics. An optimal understanding of their effects and pharmacology are required for optimal use in each patient. In this review we discuss the indications for use, as well as efficacy and safety of both old and newer antihistamines for the paediatric population.

Antihistamines for the common cold.

The common cold is an upper respiratory tract infection, most commonly caused by a rhinovirus. It affects people of all age groups and although in most cases it is self limiting, the common cold still causes significant morbidity. Antihistamines are commonly offered over the counter to relieve symptoms for patients affected by the common cold, however there is not much evidence of their efficacy. To assess the effects of antihistamines on the common cold. We searched CENTRAL (2015, Issue 6), MEDLINE (1948 to July week 4, 2015), EMBASE (2010 to August 2015), CINAHL (1981 to August 2015), LILACS (1982 to August 2015) and Biosis Previews (1985 to August 2015). We selected randomised controlled trials (RCTs) using antihistamines as monotherapy for the common cold. We excluded any studies with combination therapy or using antihistamines in patients with an allergic component in their illness. Two authors independently assessed trial quality and extracted data. We collected adverse effects information from the included trials. We included 18 RCTs, which were reported in 17 publications (one publication reports on two trials) with 4342 participants (of which 212 were children) suffering from the common cold, both naturally occurring and experimentally induced. The interventions consisted of an antihistamine as monotherapy compared with placebo. In adults there was a short-term beneficial effect of antihistamines on severity of overall symptoms: on day one or two of treatment 45% had a beneficial effect with antihistamines versus 38% with placebo (odds ratio (OR) 0.74, 95% confidence interval (CI) 0.60 to 0.92). However, there was no difference between antihistamines and placebo in the mid term (three to four days) to long term (six to 10 days). When evaluating individual symptoms such as nasal congestion, rhinorrhoea and sneezing, there was some beneficial effect of the sedating antihistamines compared to placebo (e.g. rhinorrhoea on day three: mean difference (MD) -0.23, 95% CI -0.39 to -0.06 on a four- or five-point severity scale; sneezing on day three: MD -0.35, 95% CI -0.49 to -0.20 on a four-point severity scale), but this effect is clinically non-significant. Adverse events such as sedation were more commonly reported with sedating antihistamines although the differences were not statistically significant. Only two trials included children and the results were conflicting. The majority of the trials had a low risk of bias although some lacked sufficient trial quality information. Antihistamines have a limited short-term (days one and two of treatment) beneficial effect on severity of overall symptoms but not in the mid to long term. There is no clinically significant effect on nasal obstruction, rhinorrhoea or sneezing. Although side effects are more common with sedating antihistamines, the difference is not statistically significant. There is no evidence of effectiveness of antihistamines in children.

Antihistamine use in children

This review provides an overview of the use of antihistamines in children. We discuss types of histamine receptors and their mechanism of action, absorption, onset and duration of action of...

Rupatadine oral solution improves rhino‐conjunctive symptoms control in children with 6‐11 years weighing ≥25 kg with persistent allergic rhinitis

Background Clinical trials with the newer 2nd generation antihistamines in children under the age of 12 years have been performed previously but further studies are needed in order to show efficacy and safety in the most unfavourable clinical conditions such as persistent allergic rhinitis (PER). Rupatadine oral solution was developed for children with allergic rhinitis in view of its rapid onset of action and its lack of relevant side effects. These advantages were confirmed previously in a phase III study in children 6-11 years. Objective To assess the efficacy and safety of rupatadine (RUP) oral solution in a subgroup of children between 6 and 11 years weighing ≥25 kg with PER. Methods A subanalysis was performed from a previous placebocontrolled study carried out in patients between 6-11 years diagnosed as PER according to ARIA criteria. This analysis included patients with a positive prick test, weight ≥25 kg and basal nasal symptoms score (including rhinorrhea, nasal blockage, sneezing and nasal itching assessment) ≥24 obtained in 4 days throughout the 2-week screening period. Patients were allocated to treatment with either RUP oral solution (1 mg/ml) or placebo during 6 weeks. The dose was 5 ml of oral solution. The main efficacy endpoint was the change from baseline of the nasal (4TSS) and global symptoms (5TSS) score at 4 and 6 weeks of treatment. Furthermore the assessment of children’ sq uality of life at 4, 6w eeks by means of PRQLQ was also evaluated.

Nuggets of Knowledge: Sedating antihistamines in children – not a good choice

Nuggets of Knowledge: Sedating antihistamines in children – not a good choice

Safety of antihistamines in children: need for approval of new second‐generation antihistamines for young children in Japan

SummaryIn Japan, loratadine, fexofenadine, cetirizine and epinastine are currently approved for paediatric use. However, none of these drugs is officially approved for use in children aged under 2 years, and therefore older second‐generation antihistamines such as ketotifen and oxatomide are sometimes prescribed for these patients. Because ketotifen and oxatomide have relatively strong sedative effects, one should be cautious when using these antihistamines in young children. In fact, there are reports describing the development of West syndrome, an intractable epilepsy, in 4‐month‐old infants taking these drugs. Recent clinical trials in Japanese children with allergic rhinitis have shown no serious adverse effects associated with several new second‐generation antihistamines, supporting previous overseas reports. New second‐generation antihistamines should be approved in the near future for young children in Japan.

Evaluation of Treatment Satisfaction in Children with Allergic Disease Treated with an Antihistamine

Histamine H(1)-receptor antagonists (antihistamines) have been shown to be efficacious and safe in children and are recommended as first-line treatment for the symptoms of allergic rhinitis and urticaria. No published study to date has directly compared satisfaction with the different antihistamines in children in a real-life clinical setting. This study aimed to investigate parent and physician satisfaction with the efficacy and tolerability of oral antihistamine treatment in children and to compare satisfaction between levocetirizine and the other antihistamines used by children in this cohort. This was an international Observational Survey in Children with Allergic Rhinitis (OSCAR). Children aged 2-12 years, with a history of an allergic condition leading to a consultation, were enrolled from 424 primary-care/specialist allergy clinics across Bulgaria, India, Portugal, Romania, Russia, South Korea and Spain. At the consultation, parents and physicians of eligible children completed questionnaires evaluating their satisfaction with specific antihistamines currently employed for management of the child's allergic condition, as well as their intention for future use of that treatment. Parents' satisfaction scores for efficacy, tolerability and global satisfaction with the antihistamine used were primary study outcomes, while physicians' satisfaction scores for the same measures were secondary outcomes. Other secondary outcomes were parents' rating of the impact of the antihistamine treatment on their child's sleep and school performance, and parents' and physicians' willingness to use/recommend the same antihistamine in the future. A total of 4581 patients were enrolled; 3048 (66.5%) had allergic rhinitis (55.9% persistent allergic rhinitis and 44.1% intermittent allergic rhinitis), and 663 (14.5%) had urticaria as primary conditions. Additionally, 2465 patients (53.8%) suffered from other allergic diseases, including allergic asthma (33.3%), atopic dermatitis (17.6%), food allergy (5.3%), other allergies (5.0%) and drug hypersensitivity (2.0%). Parents' and physicians' satisfaction scores were closely concordant and demonstrated significantly greater global satisfaction for the second-generation antihistamines than for the first-generation antihistamines. Levocetirizine (n = 2339) and fexofenadine (n = 42) generally scored highest for efficacy, tolerability and global satisfaction, as well as for impact on the child's ability to function at school, quality of school activities and quality of sleep. Furthermore, >97% of parents and physicians indicated their desire to continue or recommend the use of levocetirizine in the future. Somnolence, the most commonly reported adverse event in this survey, was observed predominantly in patients treated with first-generation antihistamines. Among second-generation antihistamines, reports of somnolence were most frequent in the cetirizine group. Second-generation antihistamines have a better risk:benefit ratio than first-generation antihistamines, indicating that the latter should be avoided or their use limited in children whenever possible. Levocetirizine and fexofenadine were perceived by parents and physicians to produce significantly higher treatment satisfaction than the majority of the other antihistamines with respect to overall efficacy and tolerability, and impact on the child's sleep and school activities. The newer antihistamine levocetirizine seems to be a preferred and appropriate future treatment choice for children with allergic diseases.

The Cochrane Library and acute otitis media in children: an overview of reviews

AbstractBackgroundThis overview critically evaluates the available evidence The Cochrane Library offers on the treatment of acute otitis media (AOM). AOM is one of the most common clinical problems in childhood with peak incidence occurring in the first two years of life.ObjectivesTo summarize Cochrane reviews that assess the effects of treatments for AOM in children.MethodsThe Cochrane Library was searched using the terms ‘otitis media’ and ‘ear infection’. Those reviews focusing on the treatment of AOM in children were included. Data on patient relevant outcomes (pain, treatment failure, AOM recurrence, and adverse events) were extracted by two authors.Main ResultsFive reviews were included in this overview. In the first review, antibiotics were compared with placebo. Although it appeared from the reports reviewed that antibiotics have marginal efficacy (number needed to treat = 12; number needed to harm = 12), because the reviewed studies included mostly older children with mild AOM, the results can not be generalized to young children or to children with severe AOM. In the second review, short (&lt;7 days) and long courses of antibiotics were compared. Although the data were limited, shorter courses resulted in an increased likelihood of treatment failure [odds ratio (OR): 1.34, 95% confidence interval (CI): 1.16, 1.55]. In the third review, once‐daily administration of antibiotics was compared with two‐ or three‐times‐daily administration. Although no significant differences were noted, the quality of the original data on which the review was based was less than optimal. In the fourth review, decongestants and/or antihistamines were compared with placebo. Decongestants and antihistamines provided no appreciable benefit and were associated with significant adverse events (OR: 7.34, 95% CI: 1.67, 32.25). In the fifth review, topical analgesic drops and placebo were compared in two small studies. Use of analgesic drops was associated with significant reductions in pain level (OR: 3.07, 95% CI: 1.33, 7.05 for pain reduction of ≥ 50%).Authors' ConclusionsAdditional well‐designed trials in children of various age groups with AOM are needed to determine the efficacy of 1) standard‐course antibiotic treatment, 2) short‐course vs standard‐course antibiotic treatment, and 3) topical analgesia. Limited evidence suggests that the use of decongestants and/or antihistamines in children with AOM should be avoided. Copyright © 2009 The Cochrane Collaboration. Published by John Wiley &amp; Sons, Ltd. The Cochrane Collaboration

New oral H1 antihistamines in children: facts and unmeet needs

Second-generation antihistamines differ from first-generation ones because of their elevated specificity and affinity for peripheral H1-receptors and because of their lower penetration to the central nervous system, having fewer sedative effects as a result. Over the last few years, new compounds with different pharmacokinetic properties have been synthesized. More recent improvements of the molecules, generally in the form of active metabolites, led to the synthesis of new-generation antihistamines. Recommendations on the minimum criteria that would have to be met for compounds to be classified as new-generation antihistamines have been recently established by a consensus statement. In the past, the pharmacokinetics and pharmacodynamics of H1 antihistamines have not been optimally investigated in the pediatric population, especially in infants and young children. The pharmacology of second-generation H1 antihistamines has been investigated relatively deeper than old antihistamines in children. In the pediatric population, clinical studies with new-generation antihistamines are still limited in number and, with rare exceptions, of brief duration. Comparative trials on the efficacy and safety between different compounds are also lacking. Properly designed, long-term trials with new-generation H1 antihistamines need to be performed in single age groups, in order to better define the effects of these drugs in all pediatric population.