F. Bruder Stapleton, MD reviewing De Bruyne P et al. Arch Dis Child 2016 Jun 22.

Only limited evidence supports use of commonly used first-generation antihistamines, which may have adverse side effects.

First-generation antihistamines are marketed for a number of allergic and nonallergic indications in children. Investigators from Belgium reviewed the literature from four major publication databases to assess evidence supporting use of three of these antihistamines — alimemazine, cyproheptadine, and dimethindene maleate — and to identify potential adverse drug reactions.

For alimemazine, licensed in some European countries for various indications in children, randomized, controlled trials examining efficacy for sleep disorders showed conflicting results. No randomized, placebo-controlled trials examined the use of alimemazine for pruritus. One randomized, controlled trial in children found benefit for reducing post-fundoplication emesis. For cyproheptadine, used to treat allergic rhinitis, cold urticaria, pruritus, migraine, and appetite stimulation, only one small randomized, controlled trial was found, which did not show benefit over comparators. For dimethindene maleate, used for pruritus treatment, only one randomized, controlled trial was identified and showed a reduction in the severity of itching. Use of these three classes of antihistamines for all indications was associated with adverse drug reactions, sedation being the most common.

CITATION(S):

De Bruyne P et al. Are antihistamines effective in children? A review of the evidence. Arch Dis Child 2016 Jun 22; [e-pub]. 

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