Common Allergy Medications Risk Outweigh The Benefits, Why Experts Say It's Time To Rethink Its Use

Sneezing? Have a cold? Wheezing because of pollen? Take a cetirizine! This is what we do and have continued to do since so long, but, it may be now the time that we stop. Diphenhydramine, a first-generation antihistamine approved in 1946, has long held a place in medicine cabinets worldwide. Commonly used to treat everything from seasonal allergies to bug bites, it also appears in nighttime cold medications and over-the-counter sleep aids. However, according to a recent review by allergy experts from Johns Hopkins University and the University of California, San Diego, it’s time to move on.The study, published earlier this year, emphasized that while diphenhydramine does offer symptom relief, it comes with a host of potentially dangerous side effects, especially when safer, second-generation antihistamines like cetirizine, loratadine, and fexofenadine are readily available.Dr. Anna Wolfson, an allergist at Massachusetts General Hospital, said she sees the medication misused in clinical settings far too often. “If someone has an allergic reaction to food, people will say, ‘Don’t worry, I have diphenhydramine in my purse,’ but really, epinephrine is the first-line treatment,” she noted. The sedative effect of the drug can actually mask worsening symptoms, putting patients in more danger. So if you thought sleeping it off helps, maybe not?The Hidden Dangers: Sedation, Cognitive Impairment and MisuseThe review also highlighted how diphenhydramine interacts with the brain, often causing drowsiness, confusion, cognitive impairment, and even cardiac complications. These effects are more pronounced in older adults, where the drug’s effects can linger for up to 18 hours, leading to falls and disorientation. In children, misuse has resulted in hospitalizations, paradoxical hyperactivity, and even fatalities, some tied to the viral and deadly “Benadryl Challenge” on TikTok.The medication was also found to have no substantial clinical advantage over newer antihistamines in randomized trials. While it may reduce sneezing and itching, it offers minimal benefit for nasal congestion and often comes with more side effects.Expert Insights on Tighter OversightDr. Siri Kamath, a consultant in internal medicine at Gleneagles BGS Hospital in Bengaluru, agrees with the growing global consensus. “Diphenhydramine is an older antihistamine, and while it works, the safety cushion is thinner now, especially when anyone can buy it over the counter,” she said.Dr. Kamath explains that while the drug can still be useful in emergencies, such as anaphylactic reactions when paired with epinephrine or in managing motion sickness and certain neurological conditions, its use in routine allergy management is unnecessary and potentially harmful.She adds that regulatory bodies in India, such as the Central Drugs Standard Control Organization (CDSCO) and the Indian Pharmacopoeia Commission (IPC), monitor drug safety through real-world data. “When a drug begins doing more damage than healing, especially with safer choices available, it sparks a fresh look from regulators,” she notes.Misuse Is a Key Part of the ProblemDiphenhydramine’s accessibility without prescription has made it susceptible to misuse. Dr. Kamath says it’s not just the drug’s inherent properties, but also the lack of awareness among the public and the way it’s marketed. “Clearer labels, more thoughtful dispensing by pharmacists, and public awareness can go a long way in preventing misuse,” she said. “We can’t overlook troubling trends online. This medicine does its job when used right, but without proper checks, its easy access can turn into a silent danger.”This sentiment is echoed by American pharmacists and pediatricians who report that the medication is often misused in children for sleep and cold symptoms, despite its limited efficacy and serious risks. Saline drops, suctioning, or second-generation antihistamines like cetirizine are now preferred options for children above six months.The Case for Moving Diphenhydramine Behind the CounterGlobally, experts are now calling for diphenhydramine to be either removed from the over-the-counter market or moved behind the counter to ensure pharmacist oversight. In India, Dr. Kamath suggests tighter regulation rather than a blanket ban. “Instead of a full ban, we need better communication and tighter dispensing rules,” she said.The Consumer Healthcare Products Association, which represents manufacturers like Benadryl's maker Kenvue, maintains that the medication is safe when used as directed and already includes clear warning labels. However, with over 1.5 million prescriptions still written annually in the U.S. alone, and countless untracked OTC purchases worldwide, some experts believe more than warning labels may be needed.Balancing Familiarity with EvidenceFor many patients and families, diphenhydramine is a go-to remedy that evokes familiarity and trust. But Dr. Kamath cautions against letting that history cloud present risks. “So many patients hold on to older medicines not out of defiance, but because they’ve leaned on them for years. But familiarity should never come at the cost of safety.”

Common Allergy Medications Risk Outweigh The Benefits, Why Experts Say It's Time To Rethink Its Use

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Common Allergy Medications Risk Outweigh The Benefits, Why Experts Say It's Time To Rethink Its Use