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This warning comes from a national task force of allergist-immunologists who have issued new peer-reviewed medical guidelines for the diagnosis and management of rhinitis.
"There is very disturbing evidence that first-generation antihistamines can play a role in fatal automobile accidents and occupational injuries," said lead editor Mark S. Dykewicz, M.D., associate professor of internal medicine and director of the training program in allergy and immunology at the School of Medicine. "In fact, data suggest that there is higher risk for occupational accidents from first-generation antihistamines than from use of narcotics and prescription sedatives. These older antihistamines have also been shown to impair children's learning and school performance."
Allergic rhinitis, also known as hay fever, is the most common form of rhinitis and affects 20 million to 40 million Americans annually, including 10 to 30 percent of adults and up to 40 percent of children. Symptoms often include nasal congestion, sneezing, itching of the nose and postnasal drainage. The cost of rhinitis is estimated to exceed $10 billion annually in the United States, including direct costs of medical care and indirect costs from decreased workplace productivity and lost work days.
"Although sometimes mistakenly viewed as a trivial disease, symptoms of allergic and non-allergic rhinitis may significantly impact a person's quality of life, causing fatigue, headache and difficulty functioning in work and school," Dykewicz said.
These problems are compounded by the use of so-called first generation antihistamines in many over-the-counter and some prescription allergy, sinus and cold treatments. These older antihistamines can cause not only sedation, but also impairment in thinking that may be dangerous. Similar to the effects of alcohol, first generation antihistamines may cause delayed reaction times, problems focusing on tasks and decreased memory. Studies show that people often have these problems yet don't sense them because they don't feel "sleepy."
The new practice parameters recommend that second generation antihistamines that are associated with less risk or no risk of these side effects usually should be considered first-line therapy for allergic rhinitis before sedating antihistamines. Second generation antihistamines include Allegra, Claritin, Hismanal and Zyrtec. The first intranasal antihistamine, Asteli, also is a preferred medication.
The guidelines also cite evidence that rhinitis treatment, including use of antihistamines, oral decongestants and some prescription and non-prescription nose sprays, can improve asthma that frequently co-exists with rhinitis. Over-the-counter antihistamine preparations still have warning labels to individuals with asthma against taking these drugs. Yet more recent studies have demonstrated that antihistamines are not harmful to most people with asthma and can be beneficial. Some second generation antihistamines even appear to have some mild anti-asthma effects, resulting in a significant reduction in asthma symptoms and improvement in lung function.
The new guidelines also discourage the use of cortisone steroid injections for seasonal hay fever, as prescribed by some physicians. Although one injection can provide relief for up to three or four weeks, the guidelines note that the potential for hormonal and other side effects is much greater than with safer alternatives, such as nasal cortisone sprays or, if needed for severe nasal symptoms, three to seven-day courses of oral cortisone medications. Other recommended treatments include cromolyn and antihistamine nose sprays, oral decongestant tablets and, in selected individuals, allergy vaccinations (immunotherapy).
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