By Asuka Koda, CNN
Dr. Anna Wolfson says she sees harmful misuse of the allergy treatment diphenhydramine in her clinic on daily basis.
“If someone has an allergic reaction to a food, people will say, ‘Don’t worry, I have diphenhydramine in my purse,’ and I would say, ‘Really, epinephrine is the first-line treatment for food allergies,’” stated Wolfson, an allergist at Massachusetts Normal Hospital.
Diphenhydramine may be dangerous if folks take it after having an allergic response to meals, she stated, as a result of the drug – greatest identified by the model identify Benadryl – makes them drowsy and might trigger them to overlook indicators that their signs are getting worse.
“It’s time to move on. For every single indication that people are using diphenhydramine, there are better drugs that are more effective at treating the symptoms people are trying to treat with fewer side effects,” she stated. “I’ve had patients where I worried that diphenhydramine was impairing their ability to drive or fully participate in their daily lives.”
Wolfson isn’t alone in preferring options. In a evaluate revealed in February, allergy consultants from Johns Hopkins College and the College of California, San Diego known as for the elimination of diphenhydramine from over-the-counter and prescription markets in america, saying it’s outdated, harmful and eclipsed by safer options.
A primary-generation antihistamine authorised in 1946, diphenhydramine is broadly used for allergic reactions, sleep help and chilly signs. It’s a standard over-the-counter treatment within the US, with utilization rising in the summertime months as folks use it to deal with itching from bug bites or poison ivy, in addition to sneezing and runny nostril brought on by grass and pollen allergic reactions, in response to the American Pharmacists Affiliation.
Regardless of its longstanding presence in American houses, the authors of the brand new evaluate say it poses disproportionate dangers, particularly for kids and older adults, than newer antihistamines.
“Patients should trial alternatives agents like loratadine, which is Claritin, or cetirizine, which is Zyrtec, or fexofenadine, which is Allegra,” to alleviate allergy signs, Dr. James Clark of the Division of Otolaryngology-Head and Neck Surgical procedure on the Johns Hopkins College College of Medication, the lead creator of the paper, informed CNN.
The Client Healthcare Merchandise Affiliation, which represents the OTC drugs trade, says that widespread negative effects related to merchandise containing diphenhydramine are disclosed on the label. Nevertheless, it notes, “these products are not intended for long-term use.”
“When used as directed, these medicines provide well-established therapeutic benefits for common health ailments like allergies, the common cold, motion sickness, minor skin irritations, and occasional sleeplessness,” the group stated in an announcement on behalf of Benadryl’s maker, Kenvue. “Like all medicines, responsible use is essential, and consumers should always follow directions and warnings on the Drug Facts labels and consult healthcare providers if they have questions.”
Dangers of diphenhydramine
Antihistamines work by blocking receptors known as H1, a part of the physique’s system for responding to allergens, which set off signs like sneezing, itching and a runny nostril. However older medication like diphenhydramine don’t simply block the allergy-related receptors, they’ll additionally have an effect on different components of the mind. Diphenhydramine usually causes sedation, cognitive impairment, and in some instances, harmful cardiac results, the authors wrote.
In older adults, the drug can keep within the physique for as much as 18 hours, leading to lingering sleepiness, disorientation and rising threat of falling. The evaluate additionally highlighted a potential hyperlink between long-term diphenhydramine use and dementia.
In kids, the dangers may be much more pronounced. The evaluate’s authors cite instances of unintentional overdose; paradoxical reactions resembling agitation, excessive sedation and coma; and even demise, significantly with pediatric formulations, due to unintentional ingestions. The treatment was linked to a number of little one hospitalizations and fatalities in the course of the viral “Benadryl Challenge” on TikTok.
Dr. Manuela Murray, director of basic pediatrics and pressing care on the College of Texas Medical Department, says diphenhydramine “should not be used lightly.”
The treatment is usually misused and “doesn’t offer a benefit for treatment of cold symptoms, and it is not a safe sleep aid medication,” she stated. In reality, it will possibly have the other results in kids, resulting in hyperactivity.
Dr. Alyssa Kuban, a pediatrician and affiliate medical director at Texas Youngsters’s Pediatrics, additionally stated that she finds diphenhydramine overused for signs it doesn’t instantly deal with and that there are safer options.
“I see some families use diphenhydramine when the child has a cold or upper respiratory infection, thinking it will help with the congestion and help them to sleep better at night,” she stated. “This is not effective for cold symptoms, nor is it very safe.”
She recommends over-the-counter cetirizine to deal with kids with hives, seasonal allergic reactions or an itchy rash. Cetirizine can also be longer-lasting and never as sedating as diphenhydramine, she says.
Murray agrees that loratadine and cetirizine are safer for kids over 6 months, and saline drops and suctioning are higher options for infants.
‘Time to say a final goodbye’
Diphenhydramine seems in over 300 OTC formulations, usually blended into mixture merchandise for coughs, colds and flu. The authors of the evaluate say that, like merchandise with pseudoephedrine, diphenhydramine ought to at minimal be moved behind the counter, permitting pharmacists to information sufferers towards second-generation options.
The American Pharmacists Affiliation says sufferers ought to use warning with mixture cough and chilly merchandise that include diphenhydramine.
Pharmacists might suggest various drugs for older adults who’ve a historical past of being cognitively affected by sure drugs, the group says, and it “encourages patients and parents/caregivers to ask their pharmacist for the most appropriate treatment recommendation for their symptoms” with the least quantity of negative effects.
The evaluate authors additionally emphasize that there isn’t a sturdy scientific knowledge which will counsel that diphenhydramine works higher than different choices. Though it could cut back signs like sneezing and itching, it has minimal impact on nasal congestion and doesn’t outperform second-generation medication in randomized trials. Newer choices, resembling oral cetirizine, supply 24-hour protection with fewer opposed occasions.
Nevertheless, within the US, the treatment stays a staple. In keeping with the evaluate, greater than 1.5 million prescriptions are nonetheless written yearly, not counting untracked OTC purchases.
“In the past, it has been a useful medication that has helped millions of patients; however, its current therapeutic ratio is matched or exceeded by second-generation antihistamines, especially due to their markedly reduced adverse reactions. It is time to say a final goodbye to diphenhydramine, a public health hazard,” the authors wrote.
Initially Revealed: August 1, 2025 at 8:14 AM PDT
