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Kids: No Sneeze, No Sleep

Children, unlike adults, don't get drowsy on two allergy drugs

MONDAY, May 7 (HealthScout) -- It stands to reason that if you get groggy when you take antihistamines like Benadryl, so will your kids, right? Wrong.

Neither the over-the-counter Benadryl nor the prescription Claritin had any drowsy effect on kids ages 8 to 10, new research shows. The study reinforces the growing realization that drugs affect children quite differently than adults, the researchers add.

"There's actually been quite a lot of research in adults showing the effects of antihistamines on real-world situations like driving that reveal direct implications of the drugs on daily lives," says lead author Bruce Bender, head of pediatric behavioral health at the National Jewish Medical Research Center in Denver, Colo. "But there have only been a handful of studies that look at sedating and non-sedating antihistamines in children, and no study had an equivalent real-world application."

Bender and his colleagues created a simulated school to see if diphenhydramine, commonly sold under the trade name Benadryl, or loratadine, sold as Claritin (which is non-sedating), affected kids differently than adults. They enrolled 63 children ages 8 to 10 for a total of four days on three consecutive weekends. All of the students had a history of allergies and had taken antihistamines in the past.

"We placed the kids in three groups, giving them either a placebo, Benadryl or Claritin," Bender describes. "And then they spent four days in school doing what kids do in school. They had a caffeine-free breakfast. They learned; they had art; they had physical education."

He then gave the kids a computerized reaction test, a questionnaire asking them how sleepy they were, and rated them on the retention of the material they had learned. "The result, which was a surprise to us, was that there was no difference across the three drug treatments -- the placebos, those who took the sedating drug Benadryl, and those who took the non-sedating Claritin," Bender says.

Antihistamines "are one of the most commonly used medications by Americans," Bender says. "Conservatively, 50 million Americans use antihistamines every year." Antihistamines work by blocking the action of histamine -- a potent chemical that is released from certain cells when you are exposed to an allergen and causes the typical runny nose, red eyes and other symptoms of an allergy.

Bender says scientists are not quite sure why antihistamines make you sleepy. "They cross the blood-brain barrier and seem to have a direct effect on the brain." And they also don't know why kids react differently. "I'm fairly certain the drug crosses the blood-brain barrier in kids, and whether the brain doesn't respond the same, we just don't know."

The findings of the study, funded by a grant from Schering-Plough, which makes Claritin, were published in the May issue of the Journal of Pediatrics.

Bender says the study points out that "there's a difference in real-world situations than those you get in a laboratory. The big point here is that the Food and Drug Administration (FDA) is right in insisting that drug companies test drugs on kids and not just test them on adults and assume the impact is the same on children."

The results are not surprising, according to Dr. Laurie Smith, a senior clinical allergist at Walter Reed Army Medical Center's Allergy Department in Washington, D.C. "I think the study design is very creative. I think it is very likely that children have a different side effects profile from adults."

But you may not be able to get the same results with all antihistamines, warns Smith. "I am not sure that this can be extrapolated to say that all 'sedating,' i.e. classical antihistamines, will not cause perceptible fatigue, or imperceptible impairment of function in children," she says.

What To Do

For more information on antihistamines and children, visit the FDA or this site at the University of California at San Diego.

And don't forget these HealthScout stories on antihistamines.

SOURCES: Interviews with Bruce Bender, Ph.D.,pediatric behavioral health, National Jewish Medical Research Center, Denver, Colo.; and Laurie Smith, M.D., senior clinical allergist, Walter Reed Army Medical Center's Allergy Department, Washington, D.C.; May 2001, Journal of Pediatrics
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