Allergic Rhinitis and Urticaria Treatment with H1 Antihistamines

First-generation, relatively sedating oral H1 antihistamines such as diphenhydramine and chlorpheniramine have no role in the out-of-hospital management of children with allergic rhinitis diseases. Most of the older H1 antihistamines, although available in palatable liquid formulations, have not been optimally studied in infants or allergy in children.

Second-generation, relatively non-sedating, H1 antihistamines such as cetirizine, desloratadine, fexofenadine, levocetirizine, and loratadine have an improved safety profile compared to their predecessors. Long-term safety studies have been performed with cetirizine, levocetirizine, and loratadine. These medications are first-line treatment for the management of allergic rhinoconjunctivitis in children, as shown in Table 1 below. Topical intranasal or ophthalmic H1 antihistamines have a more rapid onset of action than oral H1 antihistamines, but require administration several times per day.

Table 1.

Second-generation oral H1 antihistamines are also first-line medications for the treatment of acute and chronic urticaria in children (Table 2). They are not effective in asthma; however, when needed for the management of concurrent allergic disorders such as allergic rhinitis or urticaria, they do no harm in asthma and may contribute to allergic rhinitis symptoms relief.

Table 2