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Risk of first-generation H1-antihistamines: a GA2LEN position paper

  1. M. K. Church1,2,
  2. M. Maurer1,
  3. F. E. R. Simons3,
  4. C. Bindslev-Jensen4,
  5. P. Van Cauwenberge5,
  6. J. Bousquet6,
  7. S. T. Holgate2,
  8. T. Zuberbier1

Article first published online: 8 FEB 2010

DOI: 10.1111/j.1398-9995.2009.02325.x

Issue

Allergy

Allergy

Volume 65, Issue 4, pages 459–466, April 2010

Additional Information

How to Cite

Church, M. K., Maurer, M., Simons, F. E. R., Bindslev-Jensen, C., Van Cauwenberge, P., Bousquet, J., Holgate, S. T. and Zuberbier, T. (2010), Risk of first-generation H1-antihistamines: a GA2LEN position paper. Allergy, 65: 459–466. doi: 10.1111/j.1398-9995.2009.02325.x

Author Information

  1. 1

    Department of Dermatology and Allergy, Charité– Universitätsmedizin Berlin, Germany

  2. 2

    Infection, Inflammation and Immunity, University of Southampton, Southampton, UK

  3. 3

    Section of Allergy and Clinical Immunology, Department of Pediatrics and Child Health, University of Manitoba, Winnipeg, MB, Canada

  4. 4

    Department of Dermatology, Odense University Hospital, Odense, Denmark

  5. 5

    Department of Otorhinolaryngology, Ghent University, Ghent, Belgium

  6. 6

    Clinique des Maladies Respiratoires, University Hospital, Montpellier, France

*Torsten Zuberbier, MD, Secretary General of GA2LEN, Charité–Universitätsmedizin Berlin, Allergie-Centrum-Charité, Charitéplatz 1, D-10117 Berlin, Germany. Tel.: +49 30 450 518135 Fax: +49 30 450 518919 E-mail: torsten.zuberbier@charite.de

  1. Edited by: Thomas Bieber

Publication History

  1. Issue published online: 1 MAR 2010
  2. Article first published online: 8 FEB 2010
  3. Accepted for publication 11 December 2009

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Keywords:

  • adverse event;
  • allergic rhinitis;
  • cognitive function;
  • sedation

To cite this article: Church MK, Maurer M, Simons FER, Bindslev-Jensen C, van Cauwenberge P, Bousquet J, Holgate ST, Zuberbier T. Risk of first-generation H1-antihistamines: a GA2LEN position paper. Allergy 2010; 65: 459–466.

Abstract

Background:

First-generation H1-antihistamines obtained without prescription are the most frequent form of self-medication for allergic diseases, coughs and colds and insomnia even though they have potentially dangerous unwanted effects which are not recognized by the general public.

Aims:  To increase consumer protection by bringing to the attention of regulatory authorities, physicians and the general public the potential dangers of the indiscriminate use first-generation H1-antihistamines purchased over-the counter in the absence of appropriate medical supervision.

Methods:  A GA2LEN (Global Allergy and Asthma European Network) task force assessed the unwanted side-effects and potential dangers of first-generation H1-antihistamines by reviewing the literature (Medline and Embase) and performing a media audit of US coverage from 1996 to 2008 of accidents and fatal adverse events in which these drugs were implicated.

Results:  First-generation H1-antihistamines, all of which are sedating, are generally regarded as safe by laypersons and healthcare professionals because of their long-standing use. However, they reduce rapid eye movement (REM)-sleep, impair learning and reduce work efficiency. They are implicated in civil aviation, motor vehicle and boating accidents, deaths as a result of accidental or intentional overdosing in infants and young children and suicide in teenagers and adults. Some exhibit cardiotoxicity in overdose.

Conclusions:  This review raises the issue of better consumer protection by recommending that older first-generation H1-antihistamines should no longer be available over-the-counter as prescription- free drugs for self-medication of allergic and other diseases now that newer second- generation nonsedating H1-antihistamines with superior risk/benefit ratios are widely available at competitive prices.

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