From the Guidelines
Antihistamines should not be used as a first-line treatment for coughs in children due to their limited efficacy and potential for adverse events, as suggested by the most recent study 1. When considering the role of antihistamines in treating coughs, it's essential to prioritize their effectiveness and safety. The most recent study 1 highlights the lack of efficacy and potential morbidity and mortality of over-the-counter (OTC) medications, including antihistamines, for young children.
Key Points to Consider
- Antihistamines are not effective for coughs caused by viral infections, bronchitis, or other non-allergic conditions.
- First-generation antihistamines like diphenhydramine (Benadryl) and chlorpheniramine (Chlor-Trimeton) may help reduce coughing by drying up secretions and blocking histamine, but they can cause side effects such as drowsiness, dry mouth, blurred vision, and urinary retention.
- Second-generation antihistamines like cetirizine (Zyrtec) and loratadine (Claritin) may also help with allergy-related coughs while causing less drowsiness.
- The use of OTC cough medications, including antihistamines, should be balanced with the risk of adverse events, which includes reported death from toxicity in young children, as noted in 1 and 1.
Recommendations
- For children with acute cough, honey may offer more relief for cough symptoms than no treatment, diphenhydramine, or placebo, but it is not better than dextromethorphan, as suggested by 1.
- Avoid using codeine-containing medications for children with acute cough due to the potential for serious side effects, including respiratory distress, as recommended by 1.
- The use of antihistamines for cough treatment should be approached with caution, and alternative treatments should be considered, especially in children, due to the potential risks and limited benefits, as highlighted by the most recent study 1.
From the Research
Antihistamine Role in Cough Treatment
- Antihistamines are often used to treat coughs, but their effectiveness is still a topic of debate 2, 3, 4.
- Studies have shown that antihistamines are no more effective than placebo in relieving symptoms of acute cough in both adults and children 2, 3, 4.
- However, some antihistamines, such as loratadine, have been shown to be effective in treating cough associated with allergic rhinoconjunctivitis 5.
- Antihistamine-decongestant combinations have been shown to be effective in relieving cough symptoms in adults, but not in children 2, 3.
- The use of antihistamines in children with non-specific cough has to be balanced against the risk of adverse events, especially in very young children 3.
Specific Antihistamines and Their Effects
- Diphenhydramine has been shown to impair psychomotor performance and cognitive function, but is still effective in treating acute allergic reactions 6.
- Loratadine and desloratadine are nonsedating, but less efficacious than cetirizine or fexofenadine 6.
- Cetirizine has the fastest onset of action among the newer antihistamines, but has a higher incidence of sedation than placebo 6.
- Fexofenadine does not impair psychomotor or cognitive skills and shows no dose-related increase in sedation, but has a slower onset of action than diphenhydramine and cetirizine 6.