Allergic rhinitis can be debilitating and many parents rely on antihistamines to relieve the symptoms, but are they safe for children?

Many South Africans suffer from severe allergies, specifically allergic rhinitis. 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.

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 produced by the body. They come in tablet, syrup, nasal spray or eye drop form and are divided into first-, second- and third-generation categories. “First-generation antihistamines are the older, sedating types of antihistamine. These need frequent dosing throughout the day and can make children ‘bad tempered’,” says Morris. Second-generation antihistamines are less sedating. These are even safe to take during pregnancy and when breastfeeding. Morris’ first recommendation, however, is third-generation, non-sedating antihistamines.

How harmless are they?

Toddlers as young as one year can use antihistamines, says Morris. Even babies can be administered a reduced dose. 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. Although 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.”

Third-generation antihistamines can also 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 bottom line

For seasonal allergies, there is nothing quite as effective as antihistamines. Inhaled steroid sprays work, says Morris, but need to be used continuously and may cause thrush. “Oral steroids may stunt growth, cause cataracts, glaucoma and infections and even trigger stomach ulcers. So, they should not be used for prolonged periods in children,” he adds. “Homeopathy, herbal treatments and acupuncture seem less effective and results of international clinical studies have been disappointing.” Antihistamines have a good safety profile, and are almost all available over the counter without prescription. Plus, there are good generics available in South Africa. “However, they should only be used at the recommended dose. 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.

Marina Zietsman