ANTIHISTAMINES DISCOURAGED IN CHILDREN

Nearly everyone has taken an antihistamine at some time in their life. Antihistamines  have dozens of uses and as such are readily available commercially and have evolved and improved over time. Antihistamines are divided into several “classes” based on the mechanism by which they work and are designated as first generation and second generation based whether they are sedating or non-sedating. Non-sedating antihistamines are preferred now because of the potential problem sedation causes, especially in pediatric patients. To clarify the antihistamine situation, below is a list of commonly used first and second generation antihistamines:

FIRST GENERATION ANTIHISTAMINES:       SECOND GENERATION ANTIHISTAMINES:

     Benadryl                                                            Allegra

     Chlortrimeton                                                   Claritin

     Meclizine/Hydroxyzine                                   Zyrtec

     Promethazine                                                    Xyzal 

Lately, experts in pediatric infectious disease and allergy and immunology have vigorously tried to re-educate physicians to prescribe second generation antihistamines over first generation because of the adverse effects children so often experience. 

Drowsiness, sleepiness, oversedation, seizures, ADHD, learning difficulties, and even coma are some of the harms that beset 1st generation, sedating antihistamines. 

Second generation antihistamine cetirizine (Zyrtec) has become the preferred antihistamine for hay fever, hives, and anaphylaxis. It is hoped that first generation use will wane and doctors will  become more familiar prescribing 2nd generation drugs. 

To that end, several large medical-school-affiliated hospitals nationwide have adopted an antihistamine re-education program to train ER physicians, pediatricians, and family doctors to prescribe second generation antihistamines over first generation because of their potentially harmful adverse effects. Most, if not all, of these drugs are OTC so pharmacists, nurses, and the public were targets of the program as well. 

If you’ve ever taken Benadryl, chlortrimeton, or Atarax you know what I’m talking about. Drowsiness and sedation are overpowering in some cases making driving or operating machinery risky. We should be encouraged to use the better, safer, newer, non-sedating drugs instead. 

Reference: Vargas B. Slashing the Use of Harmful Antihistamines in Pediatric Patients. Medscape 2026 February 13.