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Antihistamines and Vomiting
Antihistamines & Vomiting
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Lewis D. Resnick, Physician Mason Pediatrics, Mason, MI
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sydney_sutherland{at}urmc.rochester.edu Lewis D. Resnick
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The article mentions that antihistamines may help with vomiting. My understanding has always been that studies of vomiting indicate that most causes are not benefited from antihistamine therapy. Unless one is talking about motion sickness, which was not mentioned in the article. Is there other info I have missed in the literature? If not, I think the article may tend to mislead. Thank you for clarifying this for me. Lewis D. Resnick, MD Mason Pediatrics Mason, MI Conflict of Interest:None declared |
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latha chandran, Editorial Board Member Pediatrics in Review, Maribeth Chitkara
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sydney_sutherland{at}urmc.rochester.edu latha chandran, et al.
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Dear Dr Resnick, Thank you for your interest in our article entitled “Vomiting in Children: Red flag, Reassurance or Referral?” in the June issue of Pediatrics in Review1. In the section that discusses “General Principles in the Management of Vomiting” we clearly state that in general, anti-emetics are not routinely recommended for pediatric vomiting, especially when the diagnosis is uncertain. We briefly discuss several classes of antiemetics such as phenothiazines, antihistamines and 5 HT3 receptor antagonists (Odansetron). We state “Antihistamines such as diphenhydramine (Benadryl), hydroxyzine (Vistaril, Atarax), and dimenhydrinate (Dramamine) may also help alleviate nausea and vomiting but have a sedative effect that makes clinical re-evaluation difficult”. We agree with you that the MOST common indication where antihistamines are effective is in the treatment of motion sickness. In fact, the American Gastroenterological Association recommends its use in motion sickness associated nausea 2. In addition to vestibular and central nervous system causes of vomiting, antihistamines may be effective in post operative emesis. A few studies have documented its efficacy in reducing such vomiting in children after strabismus surgery 3,4. A meta-analysis of randomized controlled trials looking at the efficacy of dimenhydrinate for prophylaxis of post-operative nausea and vomiting concluded that it is “a traditional and inexpensive anti- emetic with an efficacy that might be considered as clinically relevant”5. However, when the etiology of the vomiting in a pediatric patient is uncertain, the sedative effect of anti-histamines may make re-evaluation of the clinical condition difficult and thus delay the diagnosis. We hope that this clarifies the role of anti-histamines in the management of nausea and vomiting as we currently understand it. Thank you Sincerely, Latha Chandran, MD Maribeth Chitkara, MD References 1. Chandran L, Chitkara MB. Vomiting in Children: Red flag, Reassurance or Referral. Pediatrics in Review 2008;29:183-192 2. Quigley EM, Hasler WL, Parkman HP. AGA technical review on nausea and vomiting. Gastroenterology 2001;120:263-86. 3. Schlager A, Mitterschiffthaler G, Puhringer F. Rectally administered dimenhydrinate reduces post operative vomiting in children after strabismus surgery. Br J Anaesth 2000; 84(3):405-6. 4. Welters ID, Menges T, Graf M, Beikirch C, Menzebach A, Hempelmann G. Reduction of post-operative nausea and vomiting by dimenhydrinate suppositories after strabismus surgery in children. Anesth Analg 2000; 90(2):311-4. 5. Kranke P, Morin AM, Roewer N, Eberhart LH. Dimenhydrinate for prophylaxis of post-operative nausea and vomiting: a meta-analysis of randomized controlled trials. Acta Anaesthesiol Scand 2002; 46(3):238-44. Conflict of Interest:None declared |
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