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Antihistamines Routinely Prescribed for Cough, Cold in Children Despite Lack of Evidence

Sara Karlovitch
Rutgers University study finds that prescriptions for antihistamines rose after prescriptions for opioid-containing medications started to fall after 2008.
An increasing number of physicians are more likely to prescribe antihistamines to treat respiratory infections in children under 12, despite having little known benefits, according to a new study conducted by Rutgers University.

Respiratory infections are extremely common in children and are often treated with cough and cold medicine. In 2008, prescriptions for cough and cold medication for children under 2 dropped after the FDA recommended against the practice, citing safety concerns. However, these prescriptions were replaced with prescriptions for antihistamines, which have little to no benefit for children. Some antihistamines will even cause sedation or agitation in children. The strongest trend for antihistamine prescription was for children younger than 12 years old.

The study, published in JAMA Pediatrics, was conducted by examining national data representing 3.1 billion pediatric visits to physician offices and emergency departments between 2002 and 2015. All visits were measured with recommendations for cough and cold medication and the presence of opioid ingredients. Single agent antihistamines were studied separately. Over the course of 14 years, physicians wrote 95.7 million prescriptions for cough and cold medication. Twelve percent of the prescriptions written during that time contained opioids.

“Generally, colds in children do not need to be treated with medications; they will get better on their own,” study author Tobias Gerhard, PhD, said in an interview with The American Journal of Managed Care® (AJMC®). “They can be managed at home with fluids, rest, medicines for fever or pain such as acetaminophen or ibuprofen, honey for cough (safe only for children over 1), and tincture of time.”

Gerhard says that children should see a doctor for a respiratory infection if they cannot keep up with fluids, if their fever persists for several days, if they appear dehydrated or lethargic, have difficulty breathing or if other concerns arise.

The 2008 warning issued by the FDA decreased nonopioid cough and cold prescriptions by 56% for children under 2. It decreased opioid cough and cold prescriptions by 68%. However, antihistamines have been increasing gradually as cough and cold medication drops.

Gerhard speculates the prescription of antihistamines has something to do with parent expectation. “Often doctors ‘want to do something’ when parents bring a sick kid to their office,” Gerhard said. “When doctors know that cough and cold medicines are not as safe for young kids, it's understandable that they might recommend something that is safer, like antihistamines, even if these drugs don’t work well.”

According to the study, more research needs to be done around cough and cold medication in the pediatric community in order to investigate related outcomes.

“A continuation of this trend would mean that a significant and increasing number of children with colds are given antihistamines which have little benefit for them” Gerhard said.

Reference

Horton DB, Gerhard T, Strom BL. Trends in cough and cold medicine recommendations for children in the United States, 2002-2015 [published online July 29, 2019]. JAMA Pediatr. doi:10.1001/jamapediatrics.2019.2252.

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