Dermatology Update 2016
SESSIONS & ABSTRACTS
Montréal, Le Centre Sheraton - NOVEMBER 3-6, 2016
The Antihistamine Voyage - Are we there yet?
Antihistamines are the first line treatment for patients with allergic rhinoconjunctivitis and urticaria. Differences between first and second generation antihistamines will be discussed addressing quality of life aspects of patients requiring antihistamine treatment.
First generation antihistamines such as hydroxyzine, and diphenhydramine are still widely utilized in Canada despite many international guidelines recommending against their use due to known side effects such as sedation.1 Second generation antihistamines used in Canadian clinical practice include loratadine, cetirizine, fexofenadine and desloratidine. Second generation antihistamines are generally of thought of as non-sedating, however, because of differences in drug specificity for active transporter proteins (eg, P-glycoprotein [P-gP]) across the blood–brain barrier, some second-generation agents may enter the CNS to a greater extent than others. 2
The permeation of antihistamines into the brain can alter the patient experience and reduce quality of life due to unwanted side effects.3 The use of antihistamines has been shown to alter sleep quality (first generation antihistamines) and reduce psychomotor performance on various tasks.4 This presentation will explore the potential consequences to patients of brain penetrating antihistamines.
1. Zuberbier T, Aberer W, Asero R, et al; European Academy of Allergy and Clinical Immunology; Global Allergy and Asthma European Network; European Dermatology Forum; World Allergy Organization. The EAACI/GA(2) LEN/EDF/WAO guideline for the definition, classification, diagnosis, and management of urticaria: the 2013 revision and update. Allergy. 2014; 69: 868–887.
2. Wang XY, et al; Treatment of allergic rhinitis and urticaria: a review of the newest antihistamine drug bilastine. Therapeutics and Clinical Risk Management. 2016; 12 585–597.
3. Jáuregui I, et al. Bilastine: a new antihistamine with an optimal benefit-to-risk ratio for safety during driving. Expert Opin Drug Saf. 2016;15(1):89-98
4. Ravera S, et al; A European approach to categorizing medicines for fitness to drive: outcomes of the DRUID project. Br J Clin Pharmacol. 2012; 74(6): 920-31.