A comparison of the effect of diphenhydramine and desloratadine on vigilance and cognitive function during treatment of ragweed-induced allergic rhinitis

doi:10.1016/S1081-1206(10)61685-7

Annals of Allergy, Asthma & Immunology

Volume 91, Issue 4, October 2003, Pages 375-385

https://doi.org/10.1016/S1081-1206(10)61685-7 Get rights and content

Background

Decrements in cognitive performance are associated with the use of sedating antihistamines. Most, but not all, second-generation antihistamines have been found to be nonsedating.

Objective

To examine the central nervous system (CNS) profile of a new second-generation antihistamine, desloratadine.

Methods

Subjects with ragweed-induced allergic rhinitis (aged 18–60 years) who demonstrated a predetermined severity of symptoms after priming with ragweed pollen in the Environmental Exposure Unit were randomized to receive a single dose of desloratadine, 5 mg; diphenhydramine, 50 mg; or placebo. A comprehensive battery of repeatable, automated neuropsychological tests was administered to subjects before treatment (symptomatic baseline) and 90 minutes after taking study medication.

Results

Both desloratadine (P = .04) and diphenhydramine (P < .01) alleviated the symptoms of allergic rhinitis compared with placebo, but treatment with diphenhydramine was associated with clinically meaningful decrements on all vigilance parameters (P < .05 for desloratadine-diphenhydramine contrasts). Also, subjects treated with diphenhydramine performed significantly worse than subjects given desloratadine or placebo across all cognitive domains evaluated. Most effect sizes for the mean desloratadine and diphenhydramine differences were between 0.4 and 0.8 (moderate to high). Stanford Sleepiness Scale scores also indicated significantly more somnolence with diphenhydramine vs desloratadine or placebo (P < .001). There were no significant differences on any of the cognitive parameters between subjects treated with desloratadine and those given placebo.

Conclusions

Desloratadine improved ragweed-induced allergic rhinitis symptoms without adversely affecting performance. Diphenhydramine improved allergic rhinitis symptoms but caused significant decrements in vigilance and cognitive functioning. Thus, efficacy of antihistamine treatment must be balanced against the associated effects on CNS functioning.

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: Funding was provided by Integrated Therapeutics Group Inc (a subsidiary of Schering Plough), Kenilworth, New Jersey.

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ORIGINAL ARTICLESA comparison of the effect of diphenhydramine and desloratadine on vigilance and cognitive function during treatment of ragweed-induced allergic rhinitis

Background

Objective

Methods

Results

Conclusions

J Allergy Clin Immunol.

J Allergy Clin Immunol.

J Allergy Clin Immunol.

J Allergy Clin Immunol.

J Allergy Clin Immunol.

Ann Allergy Asthma Immunol.

J Allergy.

Ann Allergy.

Neurol Clin.

Arch Clin Neurol.

The costs of allergic rhinitis

Am J Manag Care.

The cost of productivity losses associated with allergic rhinitis

Am J Manag Care.

Treatment of allergic rhinitis: effect on occupational productivity and work force costs

Allergy Asthma Proc.

Health Characteristics of Workers by Occupation and Sex: United States 1983–85

Antihistamines.

Loss of work productivity due to illness and medical treatment

J Occup Environ Med.

Drugs detected in fatally injured drivers in the province of Ontario.

Effects of terfenadine on actual driving performance

Jpn J Pharmacol Ther.

Antihistamine effects on actual driving performance in a standard test: a summary of the Dutch experience, 1989–1994

Allergy.

Seasonal allergic rhinitis and antihistamine effects on children's learning

Ann Allergy.

The pharmacodynamics of diphenhydramine-induced drowsiness and changes in mental performance

Clin Pharmacol Ther.

Initial and steady-state effects of diphenhydramine and loratadine on sedation, cognition, mood, and psychomotor performance

Arch Intern Med.

Antihistamines, drowsiness, and psychomotor impairment: central nervous system effect of cetirizine

Ann Allergy.

Antihistamines and visual function: studies on dynamic acuity and the pupillary response to light

Br J Clin Pharmacol.

Effects of allergy season on mood and cognitive function

Ann Allergy.

Taxonomies of Human Performance: The Description of Human Tasks

Impairment of function by antihistamines

Ann Allergy.

ORIGINAL ARTICLES
A comparison of the effect of diphenhydramine and desloratadine on vigilance and cognitive function during treatment of ragweed-induced allergic rhinitis