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First-generation OTC antihistamines include diphenhydramine (eg, Benadryl), chlorpheniramine (eg, Chlor-Trimeton), and clemastine (eg, Tavist); second-generation products include fexofenadine (eg, Allegra), loratadine (eg, Claritin and Alavert), and cetirizine (eg, Zyrtec).

Because some second-generation antihistamines are less likely to cross the blood-brain barrier than first-generation antihistamines, they are associated with fewer nervous system effects, such as drowsiness.

Over-the-counter (OTC) antihistamines can help treat symptoms such as: First-generation OTC oral antihistamines, including diphenhydramine and chlorpheniramine, are the oldest group.

They are sedating, which means they’re likely to make you drowsy after you use them.

Loratadine and cetirizine are also contraindicated in patients with hepatic disease; however, fexofenadine is not.

CONSIDERATIONS FOR THE PHARMACIST AR is a very common condition and its symptoms can cause significant disruptions in daily activities.

However, this varies even among second-generation options.

For example, the labeling information for cetirizine indicates that “drowsiness may occur” and to “be careful when driving a motor vehicle or operating machinery.” SECOND-GENERATION OTC ANTIHISTAMINES Second-generation OTC antihistamines are available in a wide variety of dosages for adults.

Pregnant or breastfeeding women should consult a clinician prior to taking any of the 3 products, and all are contraindicated in renal dysfunction (physician consultation recommended).

Participants demonstrated similar performance with placebo and fexofenadine.

Driving performance was the worst with diphenhydramine.

Because pharmacists are often asked to make OTC recommendations for AR relief, they must be aware of the prevalence, etiologies, and manifestations of AR, and approaches to its treatment.

PERENNIAL VERSUS SEASONAL ALLERGIC RHINITIS Perennial AR occurs year-round regardless of season and is triggered by aeroallergens such as dog/cat dander, dust mite residue, cosmetics, cockroaches, and mold.

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