What are non-drowsy antihistamines (anti-histamine) for pediatric use?

From the Guidelines

For children, the most suitable non-drowsy antihistamines are fexofenadine, loratadine, and desloratadine, as they do not cause sedation at recommended doses, according to 1. These second-generation antihistamines are available in child-friendly formulations and are effective for treating allergic symptoms like sneezing, itching, runny nose, and hives. Key points to consider when prescribing these medications include:

• For children 2-5 years old, typical dosing is fexofenadine 30mg twice daily or loratadine 5mg once daily, as cetirizine may cause sedation at recommended doses, as noted in 1.
• Children 6 years and older can usually take loratadine 10mg or fexofenadine 30mg twice daily or 60mg once daily.
• Always check the product label for age-specific dosing and consult with a pediatrician before starting any medication, as emphasized in 1.
• These medications typically take 1-2 hours to start working and should be given at the same time each day for best results.
• Side effects are generally mild but may include headache, dry mouth, or rarely, irritability, as mentioned in 1. It is essential to prioritize the safety and efficacy of these medications, especially in young children, and to be aware of the potential risks associated with other types of antihistamines and cold medications, as discussed in 1.

From the FDA Drug Label

Purpose Antihistamine PURPOSE Antihistamine

Non-drowsy antihistamines for kids are available, and options include:

• Loratadine (PO) 2
• Cetirizine (PO) may cause drowsiness in some children, but it is not explicitly stated as non-drowsy 3 It is recommended to consult a pediatrician or healthcare professional to determine the best option for a child.

From the Research

Non-Drowsy Antihistamines for Kids

• The available studies do not specifically focus on non-drowsy antihistamines for kids, but they do provide information on various antihistamines and their effects on adults and their potential use in children 4, 5, 6, 7, 8.
• Some antihistamines that are considered non-drowsy include cetirizine, desloratadine, fexofenadine, levocetirizine, and loratadine 4, 5, 6, 7, 8.
• A study comparing the effect of cetirizine, desloratadine, fexofenadine, levocetirizine, and loratadine on histamine-induced skin reaction found that levocetirizine had the greatest reduction in skin reaction, followed by cetirizine, fexofenadine, and then loratadine and desloratadine 4.
• Another study found that fexofenadine had the earliest onset of action, while levocetirizine showed maximum inhibition of wheal response after three and six hours 8.
• It is essential to note that while these antihistamines are considered non-drowsy, they may still cause drowsiness in some individuals, especially children, and the dosage and administration should be carefully considered 5, 6.

Comparison of Non-Drowsy Antihistamines

• The following antihistamines have been compared in various studies:

• Cetirizine: considered non-drowsy, but may cause drowsiness in some individuals 4, 5, 6, 7.
• Desloratadine: considered non-drowsy, but may cause drowsiness in some individuals 4, 5, 7, 8.
• Fexofenadine: considered non-drowsy, with the earliest onset of action 5, 6, 7, 8.
• Levocetirizine: considered non-drowsy, with maximum inhibition of wheal response after three and six hours 4, 8.
• Loratadine: considered non-drowsy, but may cause drowsiness in some individuals 4, 5, 6, 7.

Considerations for Use in Children

• The available studies do not provide specific information on the use of non-drowsy antihistamines in children, and it is essential to consult with a healthcare professional before administering any medication to a child 4, 5, 6, 7, 8.
• The dosage and administration of antihistamines in children should be carefully considered, as they may be more susceptible to drowsiness and other side effects 5, 6.