Little wonder drug

Antihistamines help to alleviate allergy symptoms, but are they safe for children?
By Marina Zietsman

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At any given time of the year, many South Africans suffer from severe allergies, specifically allergic rhinitis, when their nasal airways become inflamed. Whether caused by pollen, dust or certain animals, allergic rhinitis can be a debilitating condition, affecting the quality of life for sufferers. Because of the common occurrence of these allergy symptoms, many parents rely on antihistamines to relieve the symptoms. “They are recommended by physicians as the first line of therapy for childhood allergies, especially seasonal allergies,” says Dr Adrian Morris from the Allergy Clinic Cape Town and principal allergist at Surrey Allergy Clinic in the UK.
How they work
The body produces histamines to attack allergens, but these histamines cause sneezing, watery eyes, itching and congestion. Antihistamines in turn counter the histamines that our bodies produce. They can be taken as tablets, syrups, nasal sprays or eye drops. Antihistamines are also divided into categories according to how long they’ve been on the market – first-, second- and third-generation antihistamines. “First-generation antihistamines are the older, sedating types of antihistamine that need frequent dosing throughout the day and can make children ‘bad tempered’,” says Morris. Second-generation antihistamines are less sedating, and according to Morris they are even safe to take during pregnancy and when breast-feeding. Morris’ first recommendation, however, is third-generation, non-sedating antihistamines.
How harmless are they?
Morris says most antihistamines can be used by toddlers as young as one year old, and even babies can be administered a reduced dose, but he warns that apart from drowsiness, most first-generation antihistamines can cause weight gain, a dry mouth, urine retention, headaches, muscle spasms and confusion in some children. “Third-generation antihistamines are well tolerated, and though there are no absolute contraindications to their use, they should be used with caution in children with severe heart disease, liver and kidney disease, epilepsy and porphyria.”
Morris also points out that third-generation antihistamines can help to prevent allergies, not just treat symptoms. “Certain European clinical trials have shown that they slow the progression from eczema to asthma,” he says. “The Early Treatment of the Atopic Child (ETAC) group conducted a study that supports their recommendation for using antihistamines for 18 months from age six months to 2 years old on a daily basis to prevent allergies in high- allergy-risk children.”
The bottom line
There is nothing quite as effective as antihistamines for seasonal allergies. Inhaled steroid sprays work, says Morris, but need to be used continuously and may cause thrush. “Oral steroids should not be used for prolonged periods in children as they may stunt growth, cause cataracts, glaucoma and infections and even trigger stomach ulcers and diabetes,” he adds. “Homeopathy, herbal treatments and acupuncture seem less effective and results of international clinical studies have been disappointing.” He adds that antihistamines have a good safety profile, that they are almost all available over the counter without prescription and there are very good generics available in South Africa. “They should, however, only be used at the recommended dose and if prolonged use is needed (more than a few weeks), a doctor should review the symptoms to check that the antihistamine is the most appropriate treatment,” he concludes.

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