AAAAI physician survey: Current antihistamine use in the clinical setting

First-generation antihistamines (FGAs) are less selective for histamine receptor binding than second-generation antihistamines (SGA), with a resulting increased risk for untoward effects. Real-world use data by allergists and immunologists of FGAs versus SGAs is lacking in the literature.

We assessed FGA versus SGA preference patterns and clinical uses by practicing allergists and immunologists in the United States.

An anonymous survey was distributed by the AAAAI Practice, Diagnostics, and Therapeutics Committee to practicing member allergists and immunologists.

A total of 702 surveys were distributed with 85 respondents (12.1% response rate). Respondents practiced most commonly in private practice (55%, n = 45) and academic settings (34.57%, n = 28). Situation/location-specific preferences for using FGAs versus SGAs were reported: for in-office challenges, 66.67% (n = 50) preferred SGAs. Further, 64.47% (n = 49) preferred SGAs for home allergy action plans and 58.44% (n = 45) for school allergy action plans. Regarding complementary use in eczema, 44.74% (n = 34) preferred SGAs, 15.79% (n = 12) preferred FGAs, and 39.47% (n = 30) reported using both. There was a significant difference in preference between FGAs and SGAs based on years in practice, with those practicing for <10 years more likely to prefer SGAs.

Variable use of FGAs versus SGAs exists among practicing allergists, demonstrating the need to improve education on the safety benefits of SGAs and highlight areas where they may be more useful than perceived.