From the Guidelines
Hydroxyzine can be used for allergies, but its use should be approached with caution due to its potential for sedation, performance impairment, and anticholinergic effects. Hydroxyzine is a first-generation antihistamine that works by blocking histamine receptors, which helps reduce allergy symptoms like itching, hives, runny nose, and sneezing 1. However, it is associated with significant sedative effects, including drowsiness and performance impairment, which can be undesirable and potentially dangerous 1. The medication is available in different forms, including tablets, capsules, and syrup, with typical adult doses ranging from 25-100 mg 3-4 times daily. For children, dosing is weight-based and should be determined by a healthcare provider.
Some key points to consider when prescribing hydroxyzine for allergies include:
- The potential for sedation and performance impairment, which can be exacerbated by concomitant use of other CNS-active substances, such as alcohol, sedatives, hypnotics, or antidepressant medication 1
- The risk of anticholinergic effects, including dryness of mouth and eyes, constipation, inhibition of micturition, and an increased risk for provocation of narrow angle glaucoma 1
- The potential for impaired learning and school performance in children, as well as driving impairment in adults 1
- The need to approach use with caution in older adults, who are more sensitive to the psychomotor impairment promoted by first-generation antihistamines and are at increased risk for complications such as fractures and subdural hematomas caused by falls 1
While hydroxyzine can be effective for allergies, it is not typically a first-line treatment and is usually prescribed when other antihistamines haven't provided adequate relief or when the sedative effect is beneficial for patients with allergy-related sleep disturbances 1. Additionally, the use of sedating antihistamines as monotherapy is now less common due to concerns about reduced concentration and performance, but they can be effective and well tolerated by some individuals 1.
From the FDA Drug Label
For use in the management of pruritus due to allergic conditions such as chronic urticaria and atopic and contact dermatoses and in histamine-mediated pruritus: adults, 25 mg t.i.d. or q.i.d. ; children under 6 years, 50 mg daily in divided doses; children over 6 years, 50 to 100 mg daily in divided doses.
Yes, hydroxyzine can be used for allergies, specifically for the management of pruritus due to allergic conditions such as:
- Chronic urticaria
- Atopic dermatoses
- Contact dermatoses
- Histamine-mediated pruritus 2
From the Research
Hydroxyzine for Allergies
- Hydroxyzine is an antihistamine that can be used to treat allergies, but it may not be suitable for everyone due to the risk of hypersensitivity reactions 3.
- According to a study published in 2013, hydroxyzine was one of the most common oral antihistamine preparations reported to cause reactions, including urticaria, angioedema, anaphylaxis, and fixed drug eruption 3.
- The study also found that reactions to one antihistamine preparation may not always occur with other members of the same class, and diagnosis is based on clinical suspicion and may be verified by challenge testing 3.
- Another study published in 2021 found that antihistamines, including hydroxyzine, can cause new-onset seizures, especially in patients with normal renal function who are taking therapeutic doses 4.
- The 2021 study suggested that antihistamines should be considered a possible cause of new-onset seizures, given their widespread use as over-the-counter drugs 4.
Precautions and Considerations
- Patients should be aware of the potential risks and benefits of using hydroxyzine for allergies, and should consult with their healthcare provider before starting treatment 3, 4.
- Healthcare providers should be cautious when prescribing hydroxyzine, especially in patients with a history of hypersensitivity reactions or seizure disorders 3, 4.