Time to Break up with Benadryl?
TL;DR// We simply don’t need Benadryl in the cupboard anymore. We have options that are better and safer for our kids.
Rev: 2022
When evidence and expert consensus sheds light on new, safer options for our kids; it’s time to change old habits and make better choices. Benadryl (diphenhydramine) is a reliable and well-known medication that is safe when used appropriately, but long-acting antihistamines are now preferred when managing mild allergic reactions, hives, and seasonal allergies.
Data has been mounting against the routine use of diphenhydramine for years. When taken in excess quantity, Benadryl can cause heart arrhythmias, seizures, severe respiratory depression and death. And although most individuals can recover from Benadryl toxicity with hospitalized care, there is no antidote to use as a guaranteed cure. Even at appropriate doses, diphenhydramine can cause a paradoxical reaction in kids, making them hyperactive and agitated. Plus, it’s slow to start working and doesn’t last very long.
The FDA is also asking us to take notice. They recently posted a warning to parents and clinicians about the “Benadryl Challenge.” Viral on TikTok, this challenge resulted in the death of a young person after she ingested a lethal amount of Benadryl. Many more teens have been reportedly seen in the ER after overdosing on this commonly available medication as a result of this challenge. Things like this especially concern us as kids are spending more time at home during the Pandemic.
To be clear, appropriate use of diphenhydramine in kids remains relatively safe. If you have offered Benadryl to your kids in the past, you have done nothing wrong. If your doctor or allergist has recommended the medication for management of allergies or hives, that’s okay too.
Full disclosure: In the past, I have recommended this medication to many of my families routinely. This is a collection of evidence supporting a change in my habits and practice. So, we are all working through this together.
Benadryl continues to have some unique uses, such as the treatment of extrapyramidal reactions and use in motion sickness. It is also available in IV form, which is helpful for emergency care. But for management of mild allergic itch, hives, or seasonal allergies at home; we can do better.
Benadryl? We're breaking up. It’s me. No, wait, it’s you. Definitely you.
Today, there is sufficient evidence to use long-acting oral antihistamines as both an emergency medication in case of hives or mild histamine-induced allergic reactions, as well as safe and effective management of seasonal allergy. [Food allergy? See below*] US and International allergy experts agree that long-acting antihistamines work just as quickly as diphenhydramine without sedation or cardiac side effects. And even in cases of significant overdose, long acting antihistamines have not been shown to be fatal.
Here’s what to do next:
Consider properly disposing any diphenhydramine-containing medications, if you already have a long acting antihistamine in your medicine cabinet. Remember that diphenhydramine can also be found in some cough and cold medications, various allergy meds, and some over the counter sleep aids. Check your labels to be sure.
If Benadryl is a medication used commonly in your home, please make sure you use proper dosages based on your child’s weight.
The next time you are at your child’s pediatric office, ask about what long acting histamine they prefer. Until then, you may find this post helpful.
Talk with your allergist or pediatrician about a long acting antihistamine as part of your medical emergency plans. Based on your child’s experience and history, it may be time to consider a change.
All medications (over the counter and prescription) should be stored in a locked medication cabinet. This protects toddlers from accidental ingestion and teens/young adults from intentional overdose. If you have an older child at home that you believe can responsibly self-medicate with pain or allergy medication, only keep one to two doses available in a common location in the house. Use a properly labeled pill box for this purpose. There is no reason that children should have access to large quantities of medication. Especially if you shop at warehouse clubs where you are able purchase large bottles of medication, be sure the medication is safely locked away.
Bottom line: We’re always looking for safer and better ways to care for our kids. A long acting antihistamine is now preferred over diphenhydramine for many common uses. Thanks, science!
*For children with food allergy, epinephrine (Epi-pen) is the only medication that can stop an allergic reaction. So for swift and severe allergic reactions, antihistamines should never be the first choice. Remember → antihistamines only control symptoms, not stop a life-threatening allergy cascade, so epinephrine is always the first choice in case of emergency.
