Will long-term use of cetirizine affect children’s growth and development?

"Cetirizine can cause drug resistance and affect growth and development"

Some parents online are worried that giving their children cetirizine will cause their children to become drug-resistant and prevent them from growing taller.

Rumor Analysis

This statement is not rigorous.

On the one hand, cetirizine is an antihistamine and does not have the risk of causing microbial resistance like antibiotics. On the other hand, current studies have shown that no adverse events, including developmental events, have been found after long-term use of cetirizine.

Many children have to use the same medicine for a long time due to allergies. Parents will inevitably worry about the impact of the medicine on their growth and development, as well as the problem of "drug resistance".

Among the many "anti-allergic drugs", cetirizine is perhaps the most familiar one. It has been on the market for more than 30 years and has a wide range of indications, including allergic rhinitis, acute urticaria (such as wheals after vaccination, rashes caused by food allergies, and "big lumps" caused by mosquito bites), chronic spontaneous urticaria, and many allergic symptoms (such as hay fever).

Before answering questions about growth and drug resistance, let's take a look at -

Why is it "Cetirizine"

Why is it recommended to take it continuously?

Cetirizine is an antihistamine, a class of drugs that inhibit the activity of histamine receptors, thereby inhibiting allergic reactions caused by histamine.

In the 1980s, second-generation antihistamines were developed (eg, cetirizine, loratadine) that:

Second generation drugs have less sedative effects (or no sedative effects). They are less likely to penetrate the blood-brain barrier, that is, to enter the central nervous system .

The second generation has higher selectivity and affinity for H1 receptors. In other words, this drug can act more accurately on H1 receptors without having a significant impact on other receptors.

The above characteristics make cetirizine one of the most commonly used drugs for children. The drug instructions of cetirizine recommend its use for children over 1 year old , and the US FDA has approved its use for children over 6 months old .

Long-term use of cetirizine in children

Will it affect growth and development?

Currently, a clinical study on "Early Treatment of the Atopic Child" (ETAC) launched in the 20th century found that continuous use of cetirizine for more than 18 months did not cause any adverse reactions related to the nervous system or behavioral events, nor did it affect the developmental process and learning ability , including height and weight, and the development of fine and gross motor skills and language function.

Moreover, clinical studies have found that for children with dust mite allergies, the use of cetirizine for 6 months or more can significantly reduce the use of other prescription drugs compared with the control group. The use of cetirizine for 3 years or more can reduce the occurrence of new allergies.

However, long-term use of any medication, including cetirizine, should be done under the supervision of a doctor. The doctor can assess whether the child needs to take the medication for so long and monitor whether there is any impact on growth and development.

Long-term continuous use of cetirizine

Will drug resistance develop?

Drug resistance, in simple terms, means that microorganisms or cancer cells have developed resistance or weakened ability to kill/inhibit the bacteriostatic or cancer cell-killing effects of drugs. Therefore, the "drug resistance" that everyone often talks about will appear in "antimicrobial drugs", such as antibiotics, antifungal drugs, antiviral drugs, antiprotozoal drugs; and some tumor drugs.

Therefore, "drug resistance" does not apply to antihistamines , and there is no such thing as "regular use of cetirizine will cause drug resistance."

I guess some parents want to ask: "Although there is no such thing as drug resistance, will the efficacy of the drug gradually deteriorate if it is used continuously for a long time?"

At present, many people do believe that long-term use of a certain antihistamine will reduce the effectiveness of the antihistamine; alternating between different antihistamines can better control the symptoms.

However, after searching, there is currently no strong evidence that new antihistamines (such as cetirizine) will produce rapid resistance/tolerance reactions, and no relevant associations or organizations recommend the alternating use of different antihistamines.

Therefore, people may mistakenly believe that the underlying symptoms have worsened as a result of the reduced effectiveness of drug treatment.

This is the end of the popular science. Finally, I would like to remind everyone that although cetirizine is relatively safe, it is still recommended to consult a doctor before use, fully understand the benefits of treatment and the side effects of the drug, and then take it according to the correct dosage and course of treatment under the guidance of a doctor or pharmacist.

Looking in the mirror of rumors

Sometimes we are easily frightened by rumors like "all medicines are poisonous", and we are always worried about the side effects of medicines. In fact, the more widely used "classic medicines" are, the more familiar doctors are with their effects and side effects, and the more we understand their advantages and disadvantages. Taking medicines regularly under the guidance of doctors is more conducive to restoring health.

References

[1]Tolerance and Resistance - Clinical Pharmacology - MSD Manual Professional Edition (msdmanuals.com) (2024/1/8)

[2]Histamine, histamine receptors, and anti-histamines in the context of allergic responses (lymphosign.com) (2024/1/8)

[3]Giuseppe Fabio Parisi, Salvatore Leonardi, et al. Cetirizine use in childhood: an update of a friendly 30‑year drug

[4]Pengxiang Zhou, Qiong Jia, et al. Cetirizine for the treatment of allergic diseases in children: A systematic review and meta-analysis

[5]Michael Miligkos, Maria Dakoutrou, et al. Newer-generation antihistamines and the risk of adverse events in children: A systematic review

[6]Katrina L Randal, Carolyn A Hawkins. Antihistamines and allergy. Australia Prescriber, VOLUME 41: NUMBER 2: APRIL 2018

[7]Roisin Fitzsimons, Lauri-Ann van der Poel, et al. Antihistamine use in children

[8]Luo Zhang, Lei Cheng, et al. The Clinical Use of Cetirizine in the Treatment of Allergic Rhinitis

[9]Carlos E. Baena-Cagnani. Safety and Tolerability of Treatments for Allergic Rhinitis in Children

[10]Abdullah Baharudin, Amir Hamzah Abdul Latiff, et al. Using Patient Profiles To Guide The Choice Of Antihistamines In The Primary Care Setting In Malaysia: Expert Consensus And Recommendations

[11] Instructions for use of Cetirizine Hydrochloride Drops (Zyrtec), Ding Xiang Yuan (2024/1/8)

Planning and production

Author | Health Express

Review | Lu Jiaozhuo Zheng Allergy Doctor

Editor: Ding Zong

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