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Antihistamines: ABC for the pediatricians.

Giuseppe Fabio Parisi1, Amelia Licari2, Maria Papale1

  • 1Department of Clinical and Experimental Medicine, University of Catania, Catania, Italy.

Pediatric Allergy and Immunology : Official Publication of the European Society of Pediatric Allergy and Immunology
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PubMed
Summary

Antihistamines are common pediatric allergy treatments. While second-generation options offer better safety, many are used off-label in young children due to limited data, necessitating a practical update on their use.

Keywords:
H1 receptorsantihistamineschildrenhistaminepediatrician

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Area of Science:

  • Pediatric Pharmacology
  • Allergy and Immunology
  • Drug Safety

Background:

  • Antihistamines are widely used in children for allergic conditions like rhinitis, asthma, urticaria, and anaphylaxis.
  • First- and second-generation antihistamines exist, with the latter generally having fewer adverse effects due to greater H1 receptor selectivity.
  • Despite their common use, antihistamine safety profiles, particularly in infants and toddlers, remain a concern, leading to frequent off-label prescribing.

Purpose of the Study:

  • To provide a practical, updated overview of antihistamine use in pediatric populations.
  • To address the challenges and safety considerations associated with antihistamine prescribing in young children, especially those under two years of age.

Main Methods:

  • Review of current literature on antihistamine pharmacology and clinical use in children.
  • Analysis of safety data and off-label prescribing trends for antihistamines in pediatric age groups.
  • Focus on differentiating first- and second-generation antihistamines and their respective safety profiles.

Main Results:

  • Second-generation antihistamines are preferred for their improved safety and selectivity for peripheral H1 receptors.
  • Significant data gaps exist regarding antihistamine safety in children under two years old.
  • Off-label use of antihistamines is common in this younger age group, highlighting a need for evidence-based guidance.

Conclusions:

  • A practical update on antihistamine use in children is crucial, especially considering off-label prescribing in infants and toddlers.
  • Further research is needed to establish robust safety data for antihistamines in the youngest pediatric populations.
  • Clinicians should exercise caution and adhere to updated guidelines when prescribing antihistamines to children, particularly those under two.