the antihistamines: treating allergies, hay fever, and hives

Contents

2: OurRecommendations

3: Welcome

6: WhatAreAntihistaminesandWhoNeedsThem?

9: ChoosinganAntihistamine—OurBest BuyPicks

14: TheEvidence

17: 5TipstoTalkingWithYourDoctor

18: HowWePickedtheBest BuyAntihistamines

19: SharingthisReport

19: AboutUs

20: References

UsingtheAntihistaminestoTreat:

Allergies,HayFever,&HivesCOMPARINGEFFECTIVENESS,SAFETY,ANDPRICE

USINGTHEANTIHISTAMINESTOTREAT:ALLERGIES,HAYFEVER,ANDHIVESCONSUMERREPORTSBESTBUYDRUGS 2

Thisreportevaluatessevenneweror“second-generation”antihistaminemedicationsthatarewidelyusedtorelievethesymptomsofhayfever(atypeofallergicrhinitis),hives(urticaria),andotherallergies.Studieshavefoundthesedrugstobeequallyeffectiveandgenerallysafe,buttheycanbemisused.

Somepeoplewhotakeallergy

medicinesdonothaveallergies,soyou

shouldseeyourdoctorforadiagnosis

beforetakingantihistaminesona

regularbasis.

Thenewerantihistaminescauselessdrowsinessthantheolderones,whichincludenonprescriptiondrugssuchasBenadrylAllergy,Chlor-TrimetonAllergy,andDimetappAllergy.Butthenewerdrugsarenomoreeffectivethantheolderonesatrelievingsymptoms.

Themonthlycostforthenewermedicinesvariesfromabout$8tomorethan$200,sopricemightbeanimportantfactorinyourchoice.Thisreportshowshowyoucouldsavehundredsofdollarsayearormoreifyoucurrentlytakeanexpensivebrand-nameantihistamine.Takingdosingconvenience,cost,andeffectivenessandsafetyintoaccount,wehaveselectedthefollowingasConsumer Reports Best Buy Drugs:

■■ Cetirizine10mgtablets

■■ Loratadine10mgtablets

■■ Loratadinedissolving10mgtablets

■■ Loratadineliquid10mg

■■ Alavertdissolving10mgtablets

Allarelow-costgenericsavailablewithoutaprescriptioninpharmaciesandotherstoresthatsell

medications.Theyhavebeenshowntoeffectivelyrelievesymptomsofhayfever,hives,andotherallergies.Cetirizineisalsoavailableover-the-counterinsoftgelcapsuleandliquidformulationsforpeoplewhoneedthose.Youshouldalsobeawarethatsomepeoplemayrespondwelltooneantihistaminewhilegettingnobenefitfromanother.SoifourBest Buypicksdonotworkforyou,thentryoneoftheotherantihistamines.

Yourinsurancemightnotfullycoverantihistaminesormightchargeyouahigherthanusualco-payment.Checkwithyourinsurerorhealth-planadministratoraboutitspolicyonantihistamines.

OurRecommendations


Thisreportonaclassofdrugstotreathayfever(atypeofallergicrhinitis),hives(urticaria),andotherupper-respiratorysymptomstriggeredbyallergiesispartofaConsumerReportsprojecttohelpyoufindsafe,effectivemedicinesthatgiveyouthemostvalueforyourhealth-caredollar.Tolearnmoreabouttheprojectandotherdrugswe’veevaluated,gotowww.CRBestBuyDrugs.org.

Hivesareredweltsonthesurfaceoftheskinthatareoftenitchy.Theyareusuallyanallergicreactiontofoodormedicine,butothersubstancesandfactors,includingstress,cantriggerthemtoo.About20percentofpeoplewillgethivesatsomepointintheirlives,accordingtoUpToDate,aphysicianwebsite.Hivesareusuallyharmlessanddisappearontheirown,butiftheybecomesevere,anantihistaminemightbeappropriate.

Hayfeverisatypeofallergicrhinitis,anallergicreactiontriggeredwhenapersonbreathesinsomethingtheyareallergicto,suchasdust,dander,orinthecaseofhayfever,pollen.About20percentofpeopleofallagessufferfromhayfever,accordingtoUpToDate.

Themostcommonsymptomsincludenasalcongestion,arunnynose,sneezing,anditchyandwateryeyes.Nonprescriptionallergymedicineisavailableindrugandgrocerystores.Thesecomeinavarietyofforms,includingpills,liquidsolutions,nasalsprays,andskincreams.Mostofthepillscontaintheactiveingredientschlorpheniramine(e.g.Chlor-TrimetonAllergy);clemastine(Tavist);brompheniramine(Dimetapp);ordiphenhydramine(BenadrylAllergy).Thosedrugsareconsidered“first-generation”antihistaminesandhavebeenavailablefordecades.

Thisreportfocuseson“second-generation”antihistamines,whichincludefiveoralmedicinesand

twonasalsprays.Alloftheoraldrugsareavailableasgenerics,andthreeareavailableasnonprescriptionover-the-counter(OTC)drugs.Thenasalspraysareavailableasbrand-nameandgenericprescriptionmedicines.Thedrugscoveredinthisreportare:

Youmightrecognizethebrandnamesoftheoralmedicines—Allegra,Claritin,Clarinex,Zyrtec,andXyzal.Allhavebeenwidelyadvertised.Andtheirusehasbecomewidespread,exceeding(thoughnoteliminating)theuseoffirst-generationantihistamines.

Themainreasonfortheirpopularityisthattheycauselesssedationanddrowsiness.Butthoseproblemscanstilloccurwhentakingthenewermedications,especiallyathigherdoses.Thesedativeeffectoffirst-generationantihistaminesisn’tjustannoyingorinconvenient;itcanbedangerous.Studieshaveconsistentlyfoundthatpeopletakingtheolderantihistaminesareatahigherriskforautoaccidentsandotherincidentsathomeandwork.Labelsonthese

Welcome

GenericName

BrandName(s)

AvailableasaPrescriptionGenericDrug?

AvailableasanOTCDrug?

Azelastinenasalspray/pump

Astelin,Astepro

Yes No

Cetirizine Zyrtec Yes Yes

Desloratadine Clarinex Yes No

Fexofenadine Allegra Yes Yes

Levocetirizine Xyzal Yes No

Loratadine Claritin,Alavert

Yes Yes

Olopatadinenasalspray

Patanase No No


drugswarnpeoplenottodriveoroperatemachinerywhileusingthem.Inaddition,mostofthenewerantihistaminesneedtobetakenjustonceadaywhiletheolderonesmustbetakentwoormoretimesadaybecausetheireffectwearsoffmorequickly.

Evenso,there’sbeenalong-standingdebateaboutjusthowmuchbetterthenewerdrugsareandwhetherthey’reworththeextracost.There’snoeasyanswer.Mostdoctorsadvisetheirpatientstousethenewerpills,whileothersthinktheirpatientsdojustaswelltakingtheolder,nonprescriptiondrugs.Somepeoplerespondbettertotheolderantihistaminesthanthenewerones.Inaddition,apatientmightgetrelieffromanolderdrugwithoutmuchsedation,especiallyifhisorhersymptomsaremild.Beaware,however,thatstudieshavefoundaslowedreactiontimeamongsomepeopletakingtheolderantihistaminesevenwhentheydeniedfeelingdrowsy.

You,too,mightbesusceptibletothesedativeeffectofolderantihistaminesandrespondbettertothenewerdrugs.Youmightalsogetbettersymptomrelieffromanewerantihistamine,thoughouranalysisfoundtheyaren’tanymoreeffectivethanolderantihistamines.Andaswehavepreviouslynoted,thenewermedicinescanstillcausesomedrowsiness,especiallywhenhigherdosesaretaken.

Theavailabilityofloratadine(Alavert,Claritin,andgenerics),cetirizine(Zyrtecandgenerics),andfexofenadine(Allegraandgenerics)inlow-cost,nonprescriptionformulationschangesthecostandrisk/benefitdecision,aswediscusslaterinthisreport.Inaddition,someofthosemedicationsmaycostaslittleas$4foramonth’ssupplythroughgenericdrugprogramsrunbymajorchainstores,suchasKroger,Sam’sClub,Target,andWalmart.Foranevenbetterbargainifyouaregoingtobeonthosedrugslong-term,youmaybeabletogetathree-monthsupplyfor

aslittleas$10throughtheseprograms.Wenoteinthepricechartstartingonpage12whichantihistaminesareavailablethroughtheseprograms.Somestores,suchasCVSandWalgreens,requireamembershipfeetoparticipateandmightchargehigherprices.Theremightbeotherrestrictionstoo,socheckthedetailscarefullytomakesureyourdruganddosearecovered.

Mostantihistamines,newandold,arealsoavailableincombinationwithadecongestant,suchaspseudoephedrine.ThesecombinationproductswerenotincludedintheanalysisconductedbytheOregonHealth&ScienceUniversity’sDrugEffectivenessReviewProject,whichformsthebasisofthisreport,sowedonotincludetheminourreview.

Decongestantproductsshouldbeused

withcautionbypeoplewithhighblood

pressure,heartconditions,diabetes,

glaucoma,orprostatedisease.Consult

adoctorifyouarenotsurewhether

youshoulduseacombinationproduct.

Ifyoursymptomsaremild,anantihistaminemightbeallyouneed.Adoctorcanalsoevaluatewhetheryouneedothermedicines,includingprescriptiondrugs,torelieveyoursymptoms.Theyinclude:

■■ Asteroidoranantihistaminenasalspray

■■ Anewkindofallergydrugcalledaleukotrieneblocker.Therearethree:montelukast(Singulairandgeneric);zafirlukast(Accolate);andzileuton(Zyflo)

■■ Anothertypeofimmune-modifyingdrugcalledomalizumab(Xolair)

■■ Allergyshots(alsoknownasimmunotherapy)

Welcome


Thisreportdoesnotdiscussthosemedications.Ifyouaretakingthemorhavequestions,consultyourdoctor.

Havingsevereallergysymptomscouldbeasignofasthma.Mostpeople—butnotall—whohaveasthmaalsohaveunderlyingallergies.Technicallyspeaking,asthmaisaseparateconditionwhereinflammationandconstrictionofthebronchialtubesmakesitdifficulttobreathe.Butthetwoconditionscangohandinhand,especiallyinchildrenandteenagers.Asthmaismorecommonamongtheyoungandusuallydevelopsinchildhood.Butitcanalsostrikeadults.SeeTable2onpage8foraquickguideonhowtotellthedifference.Antihistaminesarenotacommontreatmentforchronicasthma.

Someantihistaminesareoccasionallyusedtotreatotherconditions,suchasmotionsicknessorvertigo.Inthisreportwefocusontheuseofsecond-generationantihistaminesonlyfortreatinghayfever,chronicallergysymptoms,andhives.

This report was updated in July 2013.

Welcome


Antihistaminesworkbyblockingthechemicalmessengerhistamine,themaintriggerofallergysymptomsinthenose,airways,andskin.Histamineisapartofthebody’snaturaldefensemechanisms.Itworksinpartbywideningbloodvessels.Thatactioncausescongestionandsneezing,andisalsowhatcausesred,itchyhivesonyourskinafter,say,abugbite.

Inpeoplewhohaveallergiesandallergy-inducedasthma(forreasonsstillnotentirelyclear),thebody’simmunesystemoverreactswhenexposedtootherwiseharmlesssubstancessuchaspollen,dustmites,moldspores,andanimaldander—it’stheirskinprimarily,butalsosalivaandurine,thattriggerstheallergicreaction.Excessiveamountsofhistaminearereleased,causingthesymptomsofanallergicreaction(seeTable1onpage7).Fortunately,mostallergicreactionsaremild,eveninpeoplewhosufferthemseasonallyorhavechronicallergies.

Butsevereallergicreactionsdooccurandcanbelife-threatening.Theyaremostlyreactionstoinsectstings,drugs,orfoods—nottomold,pollen,orotherhay-fevertriggers.Youmighthaveheardtheterm“anaphylacticshock.”Thisisatypeofallergicreactioninwhichalargeamountofhistamineisreleased,causingtheairwaysandbloodvesselstoconstrict,whichcanmakebreathingdifficultandcauseasignificantdropinbloodpressure.Suchreactionsaremedicalemergenciesthatgenerallyrequiretreatmentwithadrenalineinjectionsandintravenouscorticosteroids.

Thebestwaytopreventallergysymptoms,bothmildandsevere,istoavoidtheoffendingsubstance.Skintestscanhelpidentifywhatyouareallergicto.Butcompletelyavoidingthemisnotalwayspossible.Therealityisthatmostallergysufferersneedtotakemedicine,includingantihistamines.A2010ConsumerReportssurveyfoundthatpeoplewhosufferfromallergiesuseavarietyofmeasurestogetrelief,

includingavoidingthesubstancethey’reallergicto,andtakingbothnonprescriptionandprescriptionmedications.Youcanreadmoreaboutthesurveyresultsandthestrategiesthatpeoplesaidweremosthelpfulat:http://www.consumerreports.org/cro/2012/08/relief-from-springtime-allergies/index.htm.

Studieshavefoundthatsomepeoplewhogetprescriptionsforallergymedicinedonotactuallyhaveallergies.Ifyouaretakingantihistaminesorotherallergymedicineregularly,youshouldconsultadoctortomakesurethatyoudohaveallergies,andthatthemedicationisappropriateforyourcondition.

Ifadoctordeterminesthatyouhaveanallergy,treatmentisimportant.Mountingevidencehasfoundthatpeoplewithallergiesareatmuchhigherriskofdevelopingasthmaandsinusinfections(sinusitis).Andtheinflammationthataccompanies(andtosomedegreefosters)theallergicresponsecandamagetherespiratorysystemandmakeyoumoresusceptibletolunginfectionslikepneumonia.

So,onewaytothinkabout

antihistamines,andotherallergy

medicine,isthatthey’renotjustfor

symptomreliefbutmighthelpprevent

theprogressiontomoresevereand

potentiallylife-threateningproblems.

Ifyouknowyouhaveallergies,you’reastrongcandidateforantihistamines,andareprobablyalreadytakingone.Yourchoicesareabitmorecomplexifyouarenotsurewhetheryoursymptomsareduetoanallergy.Tables1and2onpages7and8willhelpyousortoutwhatcouldbecausingyoursymptoms.

WhatAreAntihistaminesandWhoNeedsThem?

http://www.consumerreports.org/cro/2012/08/relief-from-springtime-allergies/index.htm

http://www.consumerreports.org/cro/2012/08/relief-from-springtime-allergies/index.htm


Themostcommonmistakeisthinkingyouhaveallergieswhenyouactuallyhaveacold,bronchitis,acough,ormildflu.

Ifyouhaveoneofthoseconditions,youmightneedmorethananantihistamineforrelief.Manynonprescriptioncoldandflumedicinescontainanantihistaminealongwithotherdrugs.Theyincludefeverreducersandpainrelieverssuchasaspirin,acetaminophen,andibuprofen.

Youcouldalsohaveamoreseriouscondition.Someolderpeoplewhohaveapersistentcough,troublebreathing,orboth,mightbeintheearlystagesofheartfailureoremphysema,forexample.

Youshouldseeadoctorifyoursymptomscontinue.Allergy-inducedasthmaorsevereallergicreactionsdon’trespondwelltoantihistaminesaloneandshouldbetreatedwithother,morepotentmedicines.Inparticular,youshouldseeaphysicianimmediatelyifyouhaveseriousbreathingproblemsassociatedwithanallergicreaction.


Table1.DoYouHaveAllergiesorSomethingElse?

Location ProbablyAllergies ProbablyNOTAllergies

NoseandEyes ■■ Sneezing

■■ Tearyeyes

■■ Itchynoseandthroat

■■ Congestion,runnynose

■■ Clearnasaldischarge

■■ Cough(sometimes)

■■ Headache(sometimes)

■■ Facialpain(sometimes)

■■ Sorethroat

■■ Runnynosewithcolored,sometimesthick,mucusdischarge

■■ Fever(slightifacold;higheriftheflu)

■■ Cough,chestcongestion

■■ Muscleaches,feelingachyallover

Skin ■■ Itchy,red,scalingpatches,oftenontheface,elbowsorknees(eczema)

■■ Itchy,red,largemap-likepatchesonthebody(hives)

■■ Painful,redblistersbutnotitchyrashesappearingsoonaftercontactwithoffendingsubstance(e.g.poisonoakorivy,orcausticsubstance)andonlywherecontactoccurred

■■ Itchy,redrashingroin,underarms,onfeetorunderbreastinwomen(likelyfungal)

■■ Silveryscalypatchesthatsometimesitch(maybepsoriasis)

■■ Itchyskinwithoutrash(simpledryskin)

Source:Adaptedfrom“IsitJustanAllergy?”Consumer Reports on Healthnewsletter,May2005(Vol.15,No.5),page4.



Table2.IsitanAllergyorAsthma?

HayFeverorAllergies Asthma

Whatisit? ■■ Abodilyreactiontousuallyharmlesssubstancesintheenvironment—mostoftenpollen,mold,andanimaldander.

■■ Aconditioninwhichtheairwaysinthelungsbecomeswollenandnarrow,makingitdifficulttobreatheandgetenoughoxygeninandoutofyourlungs.Canbetriggeredbypollen,mold,dander,smokeandairpollution,exercise,otherillness,stress,andsomedrugs.

Whydosomepeoplegetit?

■■ Geneticpredisposition

■■ Canstrikepeopleofallages,butoftenshowsupinchildhoodandteenyears

■■ Geneticpredisposition

■■ Infectioncantriggerasthma

■■ Usuallyshowsupinchildhood;lesscommonlystrikesoverage25

MainSymptoms

■■ Sneezing

■■ Tearyeyes

■■ Itchynoseandthroat

■■ Congestion,runnynose

■■ Clearnasaldischarge

■■ Cough(sometimes)

■■ Difficultybreathing(sometimes)

■■ Headache(sometimes)

■■ Itchyredpatchesonskin(hives)

Mildattacks:

■■ Feelingoutofbreath

■■ Tightnessinchest

■■ Wheezing

■■ Coughing

Severeattacks:

■■ Verydifficulttobreath

■■ Difficultytalking

■■ Skinfeelsasifit’spulledtightlyaroundribsandneck

■■ Rapidheartbeat

■■ Mustsitdown,can’twalkeasily

MainTreatmentOptions

■■ Nasalsprays

■■ Antihistamines

■■ Decongestants

■■ Allergyshots

■■ Inhalersandnebulizerscontainingshort-actingbronchodilators

■■ Inhalerscontainingsteroids

■■ Leukotriene-blockerpills

■■ Steroidpillsorshots

■■ Immune-systemmodifiers

Source:Adaptedfrom“IsitJustanAllergy?”Consumer Reports on Healthnewsletter,May2005(Vol.15,No.5),page4.


Antihistaminesareeffectiveandgenerallysafe.Theylessenthesymptomsofhayfever,hives,andotherallergiesinamajorityofpeople,thoughtheydon’tusuallyrelievesymptomsentirely.Andsomepeoplegetmorereliefthanothers.Antihistaminescanalsobecomelesseffectivewithlong-termuse.

Ouranalysisindicatesthatthetabletandliquidformsofsecond-generationantihistamines—cetirizine,desloratadine,fexofenadine,levocetirizine,andloratadine—don’tdifferinanyconsistentwayintermsofeffectiveness,safety,orthesideeffectstheycause.

Theyallgenerallybringsomereliefinonetothreehours.Andalthoughresponsesvary,thedrugscontinuetoworkfor12to24hoursinmostpeople.Butthenasalsprays—azelastineandolopatadine—havebeenlinkedtochangesintastesensations,includingbitternessandnasaldiscomfort.Olopatadinenasalsprayhasbeenlinkedtonosebleeding,soresinthenose,andholesinthenasalseptum.Thoughhumanstudieshavenotbeenperformedinpregnantwomen,animalstudieshavefoundthatbothnasalsprayscancausebirthdefects,sotheyshouldnotbeusedbywomenwhoarepregnantorbreast-feeding.

ChoosinganAntihistamine—OurBestBuyPicks

Table3.SummaryofEvidenceonAntihistamines

GenericName(Brandnames)

UsualAdultDose

ProvenEffectiveAgainstHayFeverandSeasonalAllergies?

ProvenEffectiveAgainstChronicorPerennialAllergies?

ProvenEffectiveAgainstHives?(Urticaria)

Azelastinenasalspray/pump(Astelin,Astepro)

Oneortwosprayspernostriltwicedaily

Yes Yes NA2

Cetirizine(Zyrtec) 10mgoncedaily Yes Yes Yes

Desloratadine(Clarinex) 5mgoncedaily Yes Yes Yes

Fexofenadine(Allegra) 60mgonceortwicedaily,or180mgoncedaily

Yes No1 Yes

Levocetirizine(Xyzal) 5mgoncedaily Yes Yes Yes

Loratadine(Alavert,Claritin)

10mgoncedaily Yes Yes Yes

Olopatadinenasalspray(Patanase)

Twosprayspernostriltwicedaily

Yes No NA2

1.Sufficientevidencewasnotavailableforfexofenadine,althoughitislikelyeffectiveintreatingperennialallergysymptoms.

2.NA=Notapplicable;thenasalspraysarenotusedfortreatinghives.


Thereisonlylimitedresearchthathaslookedattheuseoftheseantihistaminesfortreatinghives.Loratadineappearsbetteratreducingsymptomsthancertirizineintwostudies.Cetirizinewasmoreeffectivethanfexofenadineinonestudy.Andlevocetirizineprovidedbettersymptomreliefthandesloratadine,buttherewasnodifferenceinimprovementsinquality-of-life.

Allofthenewerantihistaminescauselesssedationanddrowsinessthanolderantihistamines.Studiesindicatethatcetirizineandlevocetirizinearemoresedatingthanloratadineanddesloratadine,andthatcetirizinemightbemoresedatingthanfexofenadine.Cetirizinewasassociatedwithanincreasedriskofabnormalheartrhythminonestudy,butotheranalyses,includingalargesafetyanalysisbytheFDA,foundnoincreasedrisk.

Instudiescomparingthenewermedications,15to25percentofpeoplereportedatleastonesideeffect,includingdrowsiness.(SeeTable4totheright.)Butthreepercentorfewerstoppedtreatmentbecauseofsideeffects.Thus,aspresentedinTable3onpage9,thenewerantihistaminesarequitecomparable,withnoneofferingadistinctadvantageovertheothers.Buttheircostdifferssignificantly.AsTable5startingonpage12shows,theyrangefrom$8permonthtomorethan$200permonth.

Takingeffectiveness,safety,cost,anddosingconvenienceintoaccount,wehaveselectedthefollowingantihistaminesasConsumerReports Best Buy Drugs:

■■ Cetirizine10mgtablets

■■ Loratadine10mgtablets

■■ Loratadinedissolving10mgtablets

■■ Loratadineliquid10mg

■■ Alavertdissolving10mgtablets

Allarelow-costgenericdrugsavailablewithoutaprescriptionindrugandfoodstores,andmanysmallconveniencestores.Andallareaseffectiveandsafeastheothersecond-generationantihistamines.

Loratadineandcetirizinearemadebyseveralcompanies,andsomepharmacychainshavetheirownversionofit.Alavertisa“brandedgeneric”formofloratadine.Abrandedgenericisacopyofanoriginaldrug(inthiscaseClaritin)givenaspecialnamebyitsmanufacturerformarketingpurposes.

Cetirizineisalsoavailableover-the-counterinsoftgelcapsuleandliquidformulationsforpeoplewhoneedthose.


Table4.AntihistamineSideEffects

RelativelyMinor(usuallygoawayintime)

■■ Drowsiness

■■ Drymouth,nose,orthroat

■■ Hoarseness

■■ Headache

■■ Dizziness

■■ Nausea

Moreserious(canbeannoyingordangerousandshouldbereportedtoahealth-careprofessional)

■■ Rapidorpoundingheartbeat

■■ Unusualweakness

■■ Nervousness

■■ Stomachpain

■■ Yellowingoftheskin

■■ Difficultyurinating

■■ Visionproblems


Youshouldalsobeawarethatsomepeoplemayrespondwelltooneantihistaminewhilegettingnobenefitfromanother.Soifloratadineorcetirizinedoesnotworkforyou,thentryoneoftheotherantihistamines.

AsyoucanseefromTable5startingonpage12,themonthlycostsforourBest Buysvaryconsiderably.That’scommonfornonprescriptiondrugs,soweurgeyoutoshoparoundforthebestprice,especiallyifyouneedtotakeanantihistamineonaregularbasis.YoumightwanttocheckonlineaswelltoseewhichpharmacychainsofferthebestpricesonourBest Buys.

Thereislittleresearchofgoodquality

ontheuseofsecond-generation

antihistaminesbychildren.Because

ofthis,thereisinsufficientevidence

todetermineifanyofthesecond-

generationantihistaminesaremore

effectiveatrelievingsymptomsor

posegreatersafetyconcernsthanthe

others.Butoverall,themedicationsare

well-toleratedbythem,withlowrates

ofwithdrawalduetoadverseevents.

Ifyourchildneedsanantihistaminetotreathayfeverorotherrespiratorysymptomsduetoallergiesorhives,weadvisetryingoneofourBest Buyloratadinepicksfirst.Theavailableevidenceindicatesloratadineisjustaseffectiveastheotherover-the-counteroption,cetirizine,butitislesslikelytocausesedation.Onestudyinchildrenfoundcetirizineandloratadinetobejustaseffectiveasfirst-generationantihistaminesforrelievingallergicrhinitissymptoms,andloratadinehasbeenfoundtoprovidesymptomreliefat5mgto10mgdaily.

OurBest Buynonprescriptionmedicinesareavailablein10mgdoses.Shouldyouneedtotakealargerdosetogetsymptomrelief,trytaking20mgofourBest Buys(twopillsorportions).(Notethatthisincreasesyourchancesofhavingsideeffects,includingfeelingdrowsy.)Ifthatdoesnotwork,consultyourdoctor.Youmightneedtotryanotherclassofmedicine.

Ifyouhaveinsurancecoverageformedicine,youshouldcheckyourplan’spolicyonantihistaminestofindoutwhetherantihistaminesarecoveredandhowmuchyouwillhavetopayout-of-pocket.




Table5.AntihistamineCostComparison

Note:Ifthepriceboxcontainsa ,thatindicatesthedoseofthatdrugmaybeavailableforalowmonthlycostthroughprogramsofferedbylargechainstores.Forexample,Kroger,Sam’sClub,Target,andWalmartofferamonth’ssupplyofselectedgenericdrugsfor$4orathree-monthsupplyfor$10.Otherchainstores,suchasCostco,CVS,Kmart,andWalgreens,offersimilarprograms.Someprogramshaverestrictionsormembershipfees,socheckthedetailscarefullyforrestrictionsandtomakesureyourdrugiscovered.

GenericNameandDose BrandName1

DrugisaGeneric?2

DrugisOTC?3

UsualAdultDose4 AverageMonthlyCost5

Azelastinenasalspray/pump137mcg

Azelastine Yes NoTwosprayspernostril,twicedaily

$100

Azelastinenasalspray/pump137mcg

Astelin No NoTwosprayspernostril,twicedaily

$203

Azelastinenasalspray/pump205.5mcg

Astepro No NoTwosprayspernostril,twicedaily

$180

Cetirizinetablet10mg Zyrtec No Yes One $19

Cetirizinetablet10mg Generic Yes Yes One $11

Cetirizineliqui-gelcapsule10mg Zyrtec No Yes One $23

Desloratadinedissolvingtablet2.5mg

ClarinexReditabs

No No One $237

Desloratadinedissolvingtablet5mg

ClarinexReditabs

No No One $239

Desloratadinetablet5mg Clarinex No No One $201

Desloratadinetablet5mg Generic Yes No One $97

Desloratadineliquid2.5mg/5mL Clarinex No No 2.5mgperday $117

Fexofenadinetablet60mg Allegra No Yes Two $56

Fexofenadinetablet180mg Allegra No Yes One $24

Fexofenadinetablet60mg Generic Yes Yes Two $36

Fexofenadinetablet180mg Generic Yes Yes One $18

Fexofenadinedissolvingtablet30mg

AllegraODT No No Two $128

Fexofenadineliquid30mg/5mL Allegra No Yes 30mgtwiceperday $14

Levocetirizinetablet5mg Xyzal No No One $119

Levocetirizineliquid2.5mg/5mL Xyzal No No 5mgperday $116



Table5.AntihistamineCostComparison(continued)

GenericNameandDose BrandName1

DrugisaGeneric?2

DrugisOTC?3

UsualAdultDose4 AverageMonthlyCost5

Levocetirizinetablet5mg Generic Yes No One $59

Levocetirizineliquid2.5mg/5mL Generic Yes No 5mgperday $87

Loratadinedissolvingtablet10mg

Alavert BG Yes One $12


ClaritinReditabs

No Yes One $25


Generic Yes Yes One $13

Loratadinetablet10mg Claritin No Yes One $22

Loratadinetablet10mg Generic Yes Yes One $8

Loratadineliqui-gelcapsules10mg

Claritin No Yes One $26

Loratadineliquid1mg/5mL Claritin No Yes 5mgperday $15

Loratadineliquid1mg/5mL Generic Yes Yes 5mgperday $8

Olopatadinenasalspray Patanase No NoTwosprayspernostril,twicedaily

$153

1. “Generic”indicatesthatthedrugissoldasageneric.

2. “Yes”meansitisageneric,soldunderthechemicalorscientificname.“BG”meansitisabrandedgeneric,whichisagenericcopyofanoriginaldruggivenaspecialnamebyitsmanufacturer.Inthistable,forexample,Alavertisabrandedgeneric.“No”meansitisabrand-namedrug.

3. OTCstandsforover-the-counter;“yes”meansitisanonprescriptionOTCdrug.

4. Frequencyofusereflectsrecommendationsonthepackageinsert;someproductscanbeusedmoreorlessfrequently.

5. Fordrugsavailablebyprescriptiononly,monthlycostsreflectnationwideretailaveragepricesforFebruary2013,roundedtothenearestdollar.DataisprovidedbySourceHealthcareAnalytics,Inc.,whichisnotinvolvedinouranalysisorrecommendations.FordrugsavailableOTC,priceswereobtainedbyConsumerReportssecretshoppersfromfivemajorchainpharmacies(CVS,RiteAid,Target,Walgreens,andWalmart)andlocalsupermarketsacrosstheU.S.inJanuary2013,andinsomecases,priceswereobtainedbyConsumerReportsinJune2013attheonlinesitesofthosechainpharmacies.Thepricesfromthevariousstoreswereaveragedtoyieldperpillprices,whichwerethenconvertedintoamonthlypricebasedonthemaximumrecommendednumberofpillsperday.


Thissectionpresentsmoreinformationontheeffectivenessandsafetyofantihistamines.

Thisreportisbasedonananalysisofthescientificevidenceonsecond-generationantihistamines.Overall,3,121studiesandresearcharticleswereidentifiedandscreened.Fromthese,theanalysisfocusedon18studiesthatprovideddirectevidenceofcomparativeeffectivenessorsafety.

HowEffectiveAreAntihistamines?

Thescientificliteraturecomparingantihistamineswitheachotherisnotextensive.Mostofthestudiesareshort-term,andonlyafewincludelargenumbersofpeople.Takenasawhole,theevidenceindicatesthattheavailabledrugsdonotdiffersubstantiallyineffectiveness.Withall,reliefofsymptomsusuallybeginsinonetothreehoursandlasts12to24hoursformostpeople.

Theevidenceisparticularlyweakcomparingantihistaminesinpeoplewhohavechronicallergiesandneedtotakethedrugsfromtime-to-timeallyearlongandovermanyyears.Andthere’snoevidence—becausethestudieshavenotbeendone—thatfexofenadine(Allegraandgeneric)iseffectiveinsuchpeople,thoughtheassumptionfromotherevidenceandwideclinicaluseisthatitis.

Allthenewertabletantihistamineshavebeenfoundtobeeffectiveagainsthives,butthereisverylittleevidencecomparingonenewerantihistaminewithanother.Inonestudy,loratadineproducedaslowerbutslightlymorecompletereliefofsymptomscomparedwithcetirizine(Zyrtec)intheearlystages.Butattheendofthestudy,peopletreatedwithbothdrugsdidnotreportsignificantdifferencesintheirresponses.Inanotherstudy,levocetirizinewasbetterforrelievingsymptomsthandesloratadine,butpatientsreported

thatbothdrugsimprovedtheirqualityoflifetoasimilardegree.

HowSafeAreAntihistamines?

Thenewerantihistaminesappeartobequitesafe.Theycauselessdrowsinessthanolderfirst-generationantihistamines.But15to25percentofthepeopletakinganantihistaminewillexperienceasideeffect,includingdrowsiness.Alcoholcanexacerbatedrowsiness,soyoushouldn’tdrinkwhiletakingantihistamines.Andyoushouldusecautionifdrivingoroperatingheavyordangerousmachinerywhiletakinganantihistamine.

Inaverysmallnumberofpeople,antihistaminescancausemoreseriousreactions,suchasrapidheartbeatorheartpalpitations.Seeadoctorifyouexperiencesuchsymptoms.

Thenewerantihistaminescause

drowsiness,butstudiesindicatethey

causelessdrowsinessthantwoolder

antihistamines,diphenhydramineand

chlorpheniramine.

Otherresearchfoundthatcetirizineandlevocetirizineweremoresedatingthanloratadineanddesloratadine.Thereissomeevidencethatcetirizineisalsomoresedatingthanfexofenadine.Oneobservationalstudyfoundnodifferenceinsedationbetweenloratadineandfexofenadine.

Twosecond-generationantihistamines(terfenadineandastemizole)wereremovedfromthemarketbecausetheyledtoahigherriskofpotentiallyseriousheartproblems.Someevidencesuggeststhattheremightbeaverysmallriskofheartproblemswith

TheEvidence


currentlyavailableantihistamines.Alargestudyfoundthatcetirizinewasassociatedwithanincreasedriskofheartarrhythmias.Otherresearch,however,indicatedthatcetirizine,desloratadine,fexofenadine,andloratadinedonotposeanincreasedriskofarrhythmias.

Antihistaminescaninteractwithothermedicineordietarysupplementsinwaysthatcanbedangerous.Besuretotellyourdoctoraboutallothermedicationyoutake,evenifyouthinkitmightnotbeimportant.Themaindrugstobeconcernedaboutare:

■■ Antifungalmedications,suchasketoconazole.Theycanincreasetheeffectofsomeantihistamines.

■■ Aspirin,whichinlargedosescancauseringingintheears(tinnitus),adangersignsometimesmaskedbyantihistamines.

■■ Certaintypesoffruitjuice,suchasgrapefruitjuice,applejuice,andorangejuice.Theymightmakesomesecond-generationantihistamineslesseffective.

■■ Anydrugsknowntochangethewaytheheartbeats,suchasdroperidol.Theyshouldbeusedcautiouslyifyouaretakingantihistamines.

■■ Medicationsusedtoimprovebreathing,suchastheophylline.Theymayraisetheriskofantihistaminessideeffects.

■■ Certainantibiotics,suchaserythromycin.Theycanincreasetheeffectsofantihistamines.

■■ Antacidsthatcontainaluminumormagnesium.Whentakenwithin15minutesoffexofenadine,theseantacidssignificantlydecreasedtheeffectofthatantihistamine.

■■ Thestomachacidreducercimetidine,whichincreasestheeffectofazelastinenasalspray.

Ifyoutakeanantihistamine

combinedwithadecongestantcalled

pseudoephedrine(lookonthepackage

wheretheactiveingredientsarelisted),

beawarethatsuchproductsshould

beusedwithcautionbypeoplewith

highbloodpressure,heartconditions,

diabetes,glaucoma,orprostate

disease.

Peoplewhotakeproductsthatcombinethesedrugsaremorelikelytohavesideeffects,suchasheadachesandtroublesleeping.

Age,Race,andGenderDifferences

Peopleolderthan65andmembersofvariousethnicgroupshavebeenunder-representedinstudiesofantihistamines.Theevidenceisinsufficienttodetermineifanyofthenewerantihistaminesaresaferorbetterthantheothersatrelievingallergysymptomsamongpeopleofanyparticularracialgrouporage.There’salsoinsufficientevidencetodetermineifmenandwomenrespondtothedrugsdifferently.

Butsafetyandsideeffectsareaconcernindifferentagegroups.Desloratadine(Clarinex),levocetirizine(Xyzal),andcetirizine(Zyrtec)havebeenfoundtobesafeandeffectiveinchildrenasyoungassixmonthsold;evidenceonthesafetyandefficacyofloratadineislimitedtochildrentwoyearsorolder.Evidenceonfexofenadine,azelastinenasalspray,andolopatadinenasalsprayislimitedtochildrensixyearsorolder.

TheEvidence


Childrenmightexperiencedrowsiness

tovaryingdegreeswhentaking

antihistamines,andtheadults

responsibleforthemshouldbealert

tothis.Thisisespeciallyimportant

whenitcomestoteenagerswhodrive,

becausedrowsinesscanimpedethe

abilitytooperateanautomobilesafely.

Peopleage60andolderaremoresusceptibletothesideeffectsofantihistamines,especiallydrowsiness.Peopleolderthan70orsoareatgreaterriskoffallsingeneral,andantihistamine-induceddrowsinesscanraisethatrisk.Thedosageofsomesecond-generationantihistamines(primarilyZyrtec)shouldbereducedinolderageandforpeoplewithkidneyorliverproblems.

Pregnantornursingwomenshouldonlyusethesecond-generationantihistaminesiftheirdoctoragreesit’sabsolutelynecessary.Andeventhen,itshouldbelimitedtotheoralandliquidformulations—cetirizine,desloratadine,fexofenadine,levocetirizine,andloratadine.Animalstudiesindicatethatthosesecond-generationantihistaminesdon’tincreasetheriskofbirthdefects.Noclinicaltrialshavebeendoneinpregnantwomentoascertainthebirthdefectrisk.Azelastinenasalspraycausedbirthdefectsinmouse,rabbit,andratstudies,andolopatadinenasalsprayhasbeenassociatedwithadverseeffectsonfetusesinanimalstudies.

TheEvidence


It’simportantforyoutoknowthatthe

informationwepresenthereisnotmeantto

substituteforadoctor’sjudgment.Butwe

hopeitwillhelpyouandyourdoctorarrive

atadecisionaboutwhichantihistamineand

doseisbestforyou,ifoneiswarrantedatall,

andwhichgivesyouthemostvalueforyour

health-caredollar.

1.Mentioncosttoyourdoctor.Bearinmindthatmanypeoplearereluctantto

discussthecostofmedicineswiththeirdoctor,andthatstudieshavefoundthatdoctorsdonotroutinelytakepriceintoaccountwhenprescribingmedicines.Unlessyoubringitup,yourdoctormayassumethatcostisnotafactorforyou.

2.Askaboutoldermedications.Manypeople(includingphysicians)think

thatnewerdrugsarebetter.Whilethat’sanaturalassumptiontomake,it’snotalwaystrue.Studiesconsistentlyfindthatmanyoldermedicinesareasgoodas,andinsomecasesbetterthan,newermedicines.Thinkofthemas“triedandtrue,”particularlywhenitcomestotheirsafetyrecord.Newerdrugshavenotyetmetthetestoftime,andunexpectedproblemscananddocropuponcetheyhitthemarket.Ofcourse,somenewerprescriptiondrugsareindeedmoreeffectiveandsafer.Talkwithyourdoctoraboutnewervs.oldermedicines,includinggenericdrugs.

3.Considergenericdrugs.Prescriptionmedicinesgo“generic”whena

company’spatentsonthemhavelapsed,usuallyafterabout12to15years.Atthatpoint,othercompaniescanmakeandsellthedrugs.Genericsaremuchless

expensivethannewerbrand-namemedicines,buttheyarenotlesserqualitydrugs.Indeed,mostgenericsremainusefulmedicinesevenmanyyearsafterfirstbeingmarketed.Thatiswhymorethan75percentofallprescriptionsintheU.S.todayarewrittenforgenerics.

4.Keepup-to-daterecords.Anotherimportantissuetotalkwithyour

doctoraboutiskeepingarecordofthedrugsyoutake.Thereareseveralreasonsforthis:

■■ First,ifyouseeseveraldoctors,eachmaynotbeawareofmedicinestheothershaveprescribed.

■■ Second,sincepeopledifferintheirresponsetomedications,it’scommonfordoctorstodaytoprescribeseveralmedicinesbeforefindingonethatworkswellorbest.

■■ Third,manypeopletakeseveralprescriptionmedications,nonprescriptiondrugs,anddietarysupplementsatthesametime.Theycaninteractinwaysthatcaneitherreducethebenefityougetfromthedrugorbedangerous.

■■ Fourth,thenamesofprescriptiondrugs—bothgenericandbrand—areoftenhardtopronounceandremember.

Forallthesereasons,it’simportanttokeepawrittenlistofallthedrugsandsupplementsyoutakeandperiodicallyreviewitwithyourdoctors.

5.Knowthefacts.Finally,alwaysbesurethatyouunderstand

thedoseofthemedicinebeingprescribedandhowmanypillsyouareexpectedtotakeeachday.Yourdoctorshouldtellyouthisinformation.Whenyoufillaprescriptionatapharmacy,orifyougetitbymail,checktoseethatthedoseandthenumberofpillsperdayonthebottlematchtheamountsyourdoctortoldyou.

5 TipstoTalkingWithYourDoctor


Ourevaluationisprimarilybasedonanindependentscientificreviewoftheevidenceontheeffectiveness,safety,andadverseeffectsofsecond-generationantihistamines.PhysiciansandresearchersattheOregonHealth&ScienceUniversityEvidence-BasedPracticeCenterdidtheanalysisaspartoftheDrugEffectivenessReviewProject,orDERP.

DERPisafirst-of-its-kind,multi-stateinitiativetoevaluatethecomparativeeffectivenessandsafetyofhundredsofprescriptiondrugs.AsynopsisofDERP’sanalysisoftheantihistaminesformsthebasisforthisreport.AconsultanttoConsumer Reports Best Buy DrugsisalsoamemberoftheOregon-basedresearchteam,whichhasnofinancialinterestinanypharmaceuticalcompanyorproduct.

ThefullDERPreviewofantihistaminesisavailableathttp://derp.ohsu.edu/about/final-document-display.cfm(Thisisalongandtechnicaldocumentwrittenforphysicians.)

Additionalinformationwasextractedfromwww.ConsumerReports.org,Consumer Reports,andanarticleinConsumer Reports on Health.Consumer Reports on HealthisasubscriptionmonthlynewsletterpublishedbyConsumersUnion.

Theprescriptiondrugcostswecitewereobtainedfromahealth-careinformationcompanythattracksthesalesofprescriptiondrugsintheU.S.Pricesforadrugcanvaryquitewidely,evenwithinasinglecityortown.Thepricesforprescriptiondrugsinthisreportarenationalaveragesbasedonsalesofthedrugsinretailoutlets.Theyreflecttheretailcashpricethatwouldbepaidforamonth’ssupplyofeachdruginFebruary2013.Pricesfornonprescriptiondrugswereobtainedfromseverallargedrugstorechains.TheyreflectaveragepricesinJanuary2013.

ConsumerReportsselectedtheBest Buy Drugsusingthefollowingcriteria.Thedrug(anddose)hadto:

■■ BeapprovedbytheFDAfortreatingallergicrhinitis

■■ Beaseffectiveasanyothersecond-generationantihistamine

■■ Haveasafetyrecordequaltoorbetterthanothersecond-generationantihistamines

■■ Haveanaveragepricefora30-daysupplythatissubstantiallylowerthanthemostcostlysecond-generationantihistaminemeetingthefirsttwocriteria

TheConsumers Reports Best Buy DrugsmethodologyisdescribedinmoredetailintheMethodssectionatwww.CRBestBuyDrugs.org.

HowWePickedtheBestBuyAntihistamines

USING THE ANTIHISTAMINES TO TREAT: ALLERGIES, HAY FEVER, AND HIVESCONSUMER REPORTS BEST BUY DRUGS 19

This copyrighted report can be freely downloaded, reprinted, and disseminated for individual noncommercial use without permission from Consumers Union as long as it clearly attributed to Consumer Reports Best Buy Drugs™. We encourage its wide dissemination as well for the purpose of informing consumers. However, Consumer Reports does not authorize the use of its name or materials

for commercial, marketing, or promotional purposes. Any organization interested in broader distribution of this report should contact us at [email protected]. Consumer Reports Best Buy Drugs™ is a trademark of Consumers Reports. All quotes from the material should cite Consumer Reports Best Buy Drugs™ as the source.

©2013 Consumers Reports of United States, Inc.

Consumer Reports is an independent and nonprofit organization whose mission since 1936 has been to provide consumers with unbiased information on goods and services and to create a fair marketplace. Its website is www.consumerreports.org.

Consumer Reports Best Buy Drugs is a public-education project administered by Consumers Union. These materials were made possible by the states Attorney General Consumer and Prescriber Education Grant Program, which is funded by a multistate settlement of consumer-fraud claims regarding the marketing of the prescription drug Neurontin.

The Engelberg Foundation provided a major grant to fund the creation of the project from 2004 to 2007. Additional initial funding came from the National Library of Medicine, part of the National Institutes of Health. A more detailed explanation of the project is available at www.CRBestBuyDrugs.org.

We followed a rigorous editorial process to ensure that the information in this report and on the Consumer Reports Best Buy Drugs website is accurate and describes generally accepted clinical practices. If we find, or are alerted to, an error, we will correct it as quickly as possible. But Consumer Reports and its authors, editors, publishers, licensers, and suppliers cannot be responsible for medical errors or omissions, or any consequences from the use of the information on this site. Please refer to our user agreement at www.CRBestBuyDrugs.org for further information.

Consumer Reports Best Buy Drugs should not be viewed as a substitute for a consultation with a medical or health professional. This report and the information on www.CRBestBuyDrugs.org are provided to enhance your communication with your doctor rather than to replace it.

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1. BergerW,HampelF,Jr.,BernsteinJ,ShahS,SacksH,MeltzerEO.Impactofazelastinenasalsprayonsymptomsandqualityoflifecomparedwithcetirizineoraltabletsinpatientswithseasonalallergicrhinitis.Ann Allerg Asthma Im.2006;97(3):375-381.

2. BergerWE.Efficacyofazelastinenasalsprayinpatientswithanunsatisfactoryresponsetoloratadine.Ann Allerg Asthma Im.2003;91(2):205-211.

3. BergerWE,LumryWR,MeltzerEO,PearlmanDS.Efficacyofdesloratadine,5mg,comparedwithfexofenadine,180mg,inpatientswithsymptomaticseasonalallergicrhinitis.Allergy & Asthma Proceedings.2006;27(3):214-223.

4. CiprandiG,CirilloI,VizzaccaroA,etal.Desloratadineandlevocetirizineimprovenasalsymptoms,airflow,andallergicinflammationinpatientswithperennialallergicrhinitis:apilotstudy.International Immunopharmacology.2005;5(13-14):1800-1808.

5. CiprandiG,PronzatoC,RiccaV,PassalacquaG,DanzigM,CanonicaGW.LoratadinetreatmentofrhinitisduetopollenallergyreducesepithelialICAM-1expression.Clin Exp Allergy.1997;27(10):1175-1183.

6. CorrenJ,StormsW,BernsteinJ,BergerW,NayakA,SacksH.Effectivenessofazelastinenasalspraycomparedwithoralcetirizineinpatientswithseasonalallergicrhinitis.Clin Ther.2005;27(5):543-553.

7. GargG,ThamiGP.Comparativeefficacyofcetirizineandlevocetirizineinchronicidiopathicurticaria.J Dermatol Treat.2007;18(1):23-24.

8. GuerraL,VincenziC,MarchesiE,etal.Loratadineandcetirizineinthetreatmentofchronicurticaria.J Eur Acad Dermatol Venereol.1994;3(2):148-152.

9. HampelF,RatnerP,MansfieldL,MeevesS,LiaoY,GeorgesG.Fexofenadinehydrochloride,180mg,exhibitsequivalentefficacytocetirizine,10mg,withlessdrowsinessinpatientswithmoderate-to-severeseasonalallergicrhinitis.Ann Allerg Asthma Im.2003;91(4):354-361.

10. HandaS,DograS,KumarB.Comparativeefficacyofcetirizineandfexofenadineinthetreatmentofchronicidiopathicurticaria.J Dermatol Treat.2004;15(1):55-57.

11. HowarthPH,SternMA,RoiL,ReynoldsR,BousquetJ.Double-blind,placebo-controlledstudycomparingtheefficacyandsafetyoffexofenadinehydrochloride(120and180mgoncedaily)andcetirizineinseasonalallergicrhinitis.J Allergy Clin Immunol.1999;104(5):927-933.

12. PotterPC,KappA,MaurerM,etal.Comparisonoftheefficacyoflevocetirizine5mganddesloratadine5mginchronicidiopathicurticariapatients.Allergy.2009;64(4):596-604.

13. PrennerBM,CapanoD,HarrisAG.Efficacyandtolerabilityofloratadineversus.Fexofenadineinthetreatmentofseasonalallergicrhinitis:adouble-blindcomparisonwithcrossovertreatmentofnonresponders.Clin Ther.2000;22(6):760-769.

14. ShahSR,NayakA,RatnerP,RolandP,MichaelWallG.Effectsofolopatadinehydrochloridenasalspray0.6%inthetreatmentofseasonalallergicrhinitis:aphaseIII,multicenter,randomized,double-blind,active-andplacebo-controlledstudyinadolescentsandadults.Clin Ther.2009;31(1):99-107.

15. ThomasJ,PandhiRK,OberoiC,etal.Amulticentrictrialofloratadineandcetrizineinurticaria.Indian Journal of Dermatology, Venerology and Leprology.1998;64:12-15.

16. UCB,Inc.Astudyevaluatingtheefficacyandsafetyof5mglevocetirizineoraltablets,oncedailyvs.10mgloratadineoraltablets,oncedailyforthetreatmentofperennialallergicrhinitis[completed].NCT00524836.

17. UCB,Inc.Studyevaluatingtheefficacyandsafetyof5mglevocetirizineoraltablets,oncedailyvs.10mgloratadineoraltablets,oncedailyforthetreatmentofseasonalallergicrhinitis(SAR)[completed].NCT00525278.

18. VanCauwenbergeP,JuniperEF.Comparisonoftheefficacy,safetyandqualityoflifeprovidedbyfexofenadinehydrochloride120mg,loratadine10mgandplaceboadministeredoncedailyforthetreatmentofseasonalallergicrhinitis.Clin Exp Allergy.2000;30(6):891-899.

References

the antihistamines: treating allergies, hay fever, and hives

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