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Review
. 2019 Oct 1:15:61.
doi: 10.1186/s13223-019-0375-9. eCollection 2019.

CSACI position statement: Newer generation H1-antihistamines are safer than first-generation H1-antihistamines and should be the first-line antihistamines for the treatment of allergic rhinitis and urticaria

Michael N Fein  1 , David A Fischer  2   3 , Andrew W O'Keefe  4 , Gord L Sussman  5
Affiliations
Review

CSACI position statement: Newer generation H1-antihistamines are safer than first-generation H1-antihistamines and should be the first-line antihistamines for the treatment of allergic rhinitis and urticaria

Michael N Fein et al. Allergy Asthma Clin Immunol. .

Abstract

Oral H1-antihistamines (AHs) are the most commonly used therapy to treat allergic rhinitis and chronic urticaria. Older, first-generation AHs (e.g. diphenhydramine, hydroxyzine) have significant and common side effects including sedation, impairment with decreased cognitive function, poor sleep quality, dry mouth, dizziness, and orthostatic hypotension. These drugs have also been found to result in death from accidents, intentional or unintentional overdoses, and sudden cardiac death. The unfavourable risk-benefit profile of first-generation AHs led to the development of newer, less-sedating second- and third-generation AHs, which first became available in Canada in the 1980s. High-quality trials have proven that newer generation AHs are superior in safety compared to older first-generation AHs. On average, they have improved potency and efficacy. Second- and third-generation AHs are the recommended first-line treatment for mild allergic rhinitis and acute and chronic urticaria. Despite this evidence, older first-generation AHs continue to be over-utilized because of their over-the-counter (OTC) status and long history of use. The Canadian Society of Allergy Clinical Immunology (CSACI) recommends that newer generation AHs should be preferred over first-generation AHs for the treatment of allergic rhino-conjunctivitis and urticaria. To promote this recommendation, education of health professionals and the public is necessary. Further, given the dangers of older first-generation AHs, we believe they should be used only as a last resort with eventual consideration given to having them only available behind the counter in pharmacies.

Keywords: CSACI position statement; Diphenhydramine; H1-antihistamines; Histamine.

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Conflict of interest statement

Competing interestsDr. Michael N Fein is an Assistant Professor, Division of Clinical Immunology and Allergy, McGill University. He has been a member of an Advisory Board or received grants or honoraria from: Novartis, ALK, Aralez, and Stallergenes. Dr. David A Fischer is an Adjunct Professor, Division of Allergy and Clinical Immunology, Western University and President of the Canadian Society of Allergy and Clinical Immunology. He has received consulting fees and honoraria from ALK, AstraZeneca, Aralez, Merck, Mylan, Pfizer, Novartis, Pediapharm, Sanofi and Teva. Dr. Andrew O’Keefe is a Clinical Assistant Professor, Faculty of Medicine, Memorial University. He has received consulting fees and honoraria from CSL Behring, Pediapharm, Novartis, and Shire. Dr. Gord Sussman has been a member of an Advisory board or received grants or honoraria from: Novartis, Aralez, CSL Behring, Pediapharm, Genentech, DBV Technologies, GSK, AImmune, AstraZeneca, Stallergenes, Merck, Pfizer, Dyax, Biocryst, Green Cross, Kendrion, Shire, Regeneron and Leo Pharma. He has participated in or is participating in a clinical trial: Novartis, CSL Behring, Genentech, DBV Technologies, GSK, AImmune, AstraZeneca, Stallergenes, Merck, Pfizer, Dyax, Biocryst, Green Cross, Kendrion, Shire, Regeneron and Leo Pharma.

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