Antihistamines are seen at a pharmacy in Montreal, Monday, Nov. 11, 2019. THE CANADIAN PRESS/Ryan Remiorz

Antihistamines are seen at a pharmacy in Montreal, Monday, Nov. 11, 2019. THE CANADIAN PRESS/Ryan Remiorz

VIDEO: Canadian allergists’ group wants Benadryl behind the counter due to side effects

Some doctors say the medication is over-used because of its easy availability

Benadryl has for decades been used as a go-to drug to treat everything from bee stings to mysterious toddler hives, but a growing number of doctors now say the antihistamine is less effective and less safe than newer alternatives and call into question its ubiquitous over-the-counter status.

A position statement from the Canadian Society of Allergy and Clinical Immunology (CSACI) published in early October warns against Benadryl and other first-generation H1 antihistamines as first-line treatments for hay fever and hives in adults and children.

Health Canada is reviewing the statement, in which the group of doctors say the medication is over-used because of its easy availability and that it should be restricted to behind-the-counter access in pharmacies.

“It dumbfounds us that people still want to use it,” Dr. David Fischer a clinical allergist in Barrie, Ont., and an author of the CSACI position statement says of the group of antihistamines that include Benadryl. “There are many other safer options that work as well or better.”

Fischer says the medicinal ingredient in Benadryl, diphenhydramine hydrochloride, “makes you drowsy and irritable and if you take too high a dose or an overdose, you will end up in hospital.”

Other reported side effects from an overdose of first-generation H1 antihistamines include breathing problems, coma, and seizures,according to the CSACI statement. There is also the potential for fatal heart rhythm disturbances when combined with other medications.

In comparison, Fischer says newer generation H1 antihistamines — such as Reactine, Claritin and Aerius, which make liquids or tablets for children as well as adult products — are safer, more effective and work more quickly. One of the biggest differences is that the newer medications cause much less, or no sedation.

Even at prescribed doses, medications like Benadryl are associated with sedation, cognitive impairment, and memory problems, says Dr. Anne Ellis, an allergist and professor at Queen’s University. Children can have paradoxical reactions that make them hyper, while elderly people can get delirious, she adds.

Diphenhydramine hydrochloride is a first-generation H1 antihistamine and has been used since the 1940s. H1 refers to the type of cell receptors it works on in the brain, while first-generation means it’s an older classification of drugs that can cross into other parts of the body, leading to many other reactions apart from its intended antihistamine effects. Diphenhydramine is found in several brand-name and generic medicines for allergies or cold symptoms in North America, of which Benadryl is the best-known.

Benadryl and Children’s Benadryl are available in pharmacies and stores without a prescription and marketed in Canada for many different symptoms including sneezing, runny nose, itchy eyes, insect bites, hives and other rashes.

ALSO READ: Three cases of probable vaping-related illness in B.C.: Health Canada

Benadryl’s maker, Johnson & Johnson said in a statement that “Benadryl products have been trusted by doctors and moms for more than 60 years to provide effective symptom relief from allergies and allergic reactions.” The company said the products are approved by Health Canada and “when used as directed, are safe and effective.”

Health Canada said last week it is assessing the CSACI position paper “to determine whether further risk mitigation measures for diphenhydramine-containing products are required.”

The federal regulator said it is aware of safety concerns regarding the use of diphenhydramine-containing products in children. Since 1965, the agency has received more than 1,700 reports of “serious adverse reactions suspected to be linked to products containing diphenhydramine,” which include fatigue, fevers, headaches and drowsiness.

It adds those reports were not assessed by the agency, and that it’s “not possible to determine whether an adverse reaction reported to Health Canada is a result of using a specific health product.”

While both adults and children can experience side effects from diphenhydramine, children are particularly at risk for serious complications. This is because a small measuring error in dosing for a child can lead to an overdose and children can easily ingest the amount of medication that can be toxic.

VIDEO: Surgical objects left in patients on the rise in Canada, data shows

Health Canada pointed to a 2016 guidance document advising sleep aid products that contain diphenhydramine hydrochloride should carry a label warning against use in children under 12 years of age. However, the agency did not clarify why the same guidance document does not require this warning for diphenhydramine hydrochloride in allergy or cough medications.

For adults, the 2016 Health Canada guidance document advises against driving or engaging in “activities requiring alertness” when diphenhydramine is taken for allergies or cough.

World Health Organization data, published in 2017, reveal almost 9,000 reports of adverse drug reactions to H1 antihistamines in children, including 400 deaths. Benadryl-type medications were involved in 42 per cent of these deaths — more than four times as many than with any other antihistamine studied. Many of the deaths occurred in the United States and were due to accidental or non-accidental overdoses.

Since 2013, the World Allergy Organization has recommended newer antihistamines over first generation antihistamines for the general treatment of allergies in their White Book.

Second- and third-generation H1 antihistamines were developed to have good antihistamine effects without the other side effects, and these became available in Canada in the 1980s. These medications contain antihistamine agents such as loratadine, desloratadine, or cetirizine instead of diphenhydramine.

Dr. Kevin Chan, chair of the Canadian Paediatric Society’s acute care committee, says he has seen a general trend towards using newer antihistamines.

But, he adds, “I do not think this information has gotten out to the community hospitals at all and a lot of emergency physicians are still using first-generation antihistamines.”

Even as calls for a re-consideration of first-generation H1 antihistamines like Benadryl grow among experts in professional organizations, the medical advice has been slow to trickle down to doctors and parents who continue to give the older medications to children, and to take it themselves.

“The side effects and the problems with first-generation antihistamines have been well recognized for a very long time,” says Dr. Ellis.

“It’s very challenging to convince somebody what (they) have been doing for the past 20 years is wrong.”

ALSO READ: Canadian doctors say political activism part of their jobs on issues affecting health

Michelle Ward is a pediatrician at the Children’s Hospital of Eastern Ontario and associate professor at the University of Ottawa. She is a Fellow in Global Journalism at the University of Toronto’s Dalla Lana School of Public Health.

The Canadian Press


Like us on Facebook and follow us on Twitter.

Get local stories you won't find anywhere else right to your inbox.
Sign up here

Just Posted

Federal Conservative leader Erin O’Toole speaks during a virtual South Surrey & White Rock Chamber of Commerce town hall on Saturday, March 6, 2021.
O’Toole says South Surrey, White Rock face ‘acute’ challenges during pandemic

Federal Conservative leader speaks at local chamber town hall

A sign encouraging COVID-19 safety steps, with the Bayside rugby clubhouse – located adjacent to Semiahmoo Secondary and the South Surrey track – in background; Jan. 6, 2021. (Photo: Tracy Holmes)
Surrey sees 2,400 new COVID-19 cases in February

This is the lowest monthly increase since last fall

Liberty roses – created by acclaimed rose breeder Brad Jalbert – will be planted in White Rock later this month. (Contributed photo)
‘Liberty Rose’ to be planted along Johnston Road and at White Rock City Hall

Poppy-like rose created by acclaimed rose breeder Brad Jalbert

South Surrey’s Kirk Arsenault has started a new company, Str8laced, that sells cleat wraps that aim to keep athletes’ shoes from coming untied during games and practices. (Contributed photo)
South Surrey sports equipment entrepreneur tying up loose ends before Alberta move

Str8laced wraps keep laces from coming loose in the middle of play, says Kirk Arsenault

Volunteers from Semiahmoo Secondary joined with members of the Lower Mainland Green Team and the White Rock and South Surrey Naturalists Wednesday to remove invasive plants from White Rock’s Ruth Johnson Park. (Contributed photo)
Students, volunteers remove invasive plants from White Rock’s Ruth Johnson Park

Day-long project a collaboration between city, Lower Mainland Green Team

The James C Richardson Pipe Band marches in a Remembrance Day parade on Nov. 11, 2019 in Chilliwack. Wednesday, March 10 is International Bagpipe Day. (Jenna Hauck/ Chilliwack Progress file)
Unofficial holidays: Here’s what people are celebrating for the week of March 7 to 13

International Bagpipe Day, Wash Your Nose Day and Kidney Day are all coming up this week

Victoria man Brett Andersen is asking for people’s help to secure him one of eight free tickets to the moon. (Screenshot/@brettandersen Instagram)
Victoria man wants your help securing a free ticket to the moon

Japanese billionaire offering eight people a trip to the moon

The Conservation Officers Service is warning aquarium users after invasive and potentially destructive mussels were found in moss balls from a pet store. (BC Conservation Officers Service/Facebook)
Aquarium users in B.C. warned after invasive mussels found at pet store

Conservation officers were told the mussels were found in a moss ball from a Terrace pet store.

Cannabis bought in British Columbia (Ashley Wadhwani/Black Press Media)
Is it time to start thinking about greener ways to package cannabis?

Packaging suppliers are still figuring eco-friendly and affordable packaging options that fit the mandates of Cannabis Regulations

Hockey hall-of-fame legend Wayne Gretzky, right, watches the casket of his father, Walter Gretzky, as it is carried from the church during a funeral service in Brantford, Ont., Saturday, March 6, 2021. HE CANADIAN PRESS/Nathan Denette
Walter Gretzky remembered as a man with a ‘heart of gold’ at funeral

The famous hockey father died Thursday at age 82 after battling Parkinson’s disease

The family of injured Willoughby resident Ronald Gerald Jesso is hoping someone saw something that will help solve the mystery of how he came to be so badly hurt on the morning of Feb. 22. Jesso is still in hospital. (Jesso family/Special to Langley Advance Times)
An appeal to help solve the mystery of an injured Langley man

Family of Ronald Gerald Jesso asks witnesses to come forward

Donald Alan Sweet was once an all star CFL kicker who played for the Montreal Alouettes and Montreal Concordes over a 13-year career. Photo courtesy of Mission RCMP.
Ex-B.C. teacher who was CFL kicker charged with assault, sexual crimes against former students

Donald Sweet taught in Mission School District for 10 years, investigators seek further witnesses

During a press event on March 6, Const. Alex Berube, media relations officer for the West Shore RCMP, addressed a deadly shooting that occurred in Metchosin the night before. (Devon Bidal/News Staff)
VIDEO: One man shot dead on Vancouver Island in ‘targeted incident’

Highway 14 reopens following multi-hour closure for investigation

Most Read