Allergy Drug Danger: Experts Urge Diphenhydramine Ban
Outdated antihistamine linked to serious side effects, ineffective alternatives abound
A widely used over-the-counter allergy medication is facing a strong call for its removal from markets due to significant risks and the availability of safer, more effective alternatives.
Experts Raise Alarm Over Diphenhydramine Use
Dr. **Anna Wolfson**, an allergist at Massachusetts General Hospital, reports witnessing the dangerous misuse of diphenhydramine daily in her clinic. She notes that while commonly used for food allergies, it is not the first-line treatment.
“If someone has an allergic reaction to a food, people will say, ‘Don’t worry, I have diphenhydramine in my purse,’ and I would say, ‘Really, epinephrine is the first-line treatment for food allergies,’”
—Dr. Anna Wolfson, Allergist at Massachusetts General Hospital
Diphenhydramine, best known as Benadryl, can be particularly harmful after a food allergic reaction because its sedative effects may mask worsening symptoms, potentially leading individuals to miss critical signs of deterioration.
“It’s time to move on. For every single indication that people are using diphenhydramine, there are better drugs that are more effective at treating the symptoms people are trying to treat with fewer side effects,”
—Dr. Anna Wolfson
Dr. **Wolfson** adds that she has seen patients whose ability to drive and participate in daily life was impaired by the medication.
Calls for Market Removal Grow
Allergy specialists from Johns Hopkins University and the University of California, San Diego, have advocated for the complete removal of diphenhydramine from both over-the-counter and prescription drug channels in the U.S. Their review highlights the drug as outdated and hazardous, with superior alternatives readily available.
Approved in 1946, this first-generation antihistamine is frequently used for allergies, as a sleep aid, and for cold symptoms. Usage spikes in summer for bug bites, poison ivy, and seasonal allergies.
However, researchers assert that diphenhydramine carries disproportionately high risks, especially for children and older adults, compared to newer antihistamines.
Dr. **James Clark**, lead author of the review and from Johns Hopkins University School of Medicine, recommends alternatives like loratadine (Claritin), cetirizine (Zyrtec), and fexofenadine (Allegra) for allergy symptom relief.
The Consumer Healthcare Products Association acknowledges that diphenhydramine products disclose common side effects but emphasizes they are “not intended for long-term use.”
Significant Risks Associated with Diphenhydramine
Diphenhydramine functions by blocking H1 receptors, part of the body’s response to allergens. However, it also affects other brain areas, causing sedation, cognitive impairment, and potentially dangerous cardiac issues.
For older adults, the drug can persist in the body for up to 18 hours, leading to prolonged drowsiness, confusion, and an increased fall risk. The review also points to a potential link between its long-term use and dementia.
In children, risks are magnified. The review cites instances of accidental overdose, paradoxical reactions like agitation or coma, and even fatalities, particularly from pediatric formulations due to accidental ingestion. The “Benadryl Challenge” on TikTok also linked the medication to child hospitalizations and deaths.
Dr. **Manuela Murray**, Director of General Pediatrics and Urgent Care at the University of Texas Medical Branch, states diphenhydramine “should not be used lightly.”
“It should always be used under the guidance of a Medical Professional, and it is only indicated to treat allergic reactions and motion sickness,”
—Dr. Manuela Murray, Director of General Pediatrics and Urgent Care at the University of Texas Medical Branch
Dr. **Murray** further notes that it is misused for cold symptoms and is not a safe sleep aid, sometimes causing hyperactivity in children.
Dr. **Alyssa Kuban**, a pediatrician at Texas Children’s Pediatrics, agrees, finding diphenhydramine overused for conditions it doesn’t treat, with safer options available.
She advises cetirizine for children with hives, allergies, or itchy rashes, noting its longer duration and less sedating effects.
Dr. **Murray** supports loratadine and cetirizine as safer choices for children over six months, recommending saline drops and suctioning for infants.
A Call for a “Final Goodbye”
Diphenhydramine is present in over 300 OTC products, often combined with other ingredients for coughs and colds. Experts propose moving it behind the counter, similar to pseudoephedrine, to facilitate pharmacist guidance towards second-generation alternatives.
The American Pharmacists Association advises caution with combination cough and cold products containing diphenhydramine and encourages patients to consult pharmacists for appropriate, low-side-effect treatments.
Review authors emphasize a lack of strong clinical data showing diphenhydramine’s superiority. While it may alleviate sneezing and itching, its effect on nasal congestion is minimal, and it doesn’t outperform newer drugs in trials. Alternatives like oral cetirizine provide 24-hour relief with fewer adverse events.
Despite these concerns, diphenhydramine remains common in the U.S., with over 1.5 million prescriptions annually, excluding OTC purchases. According to a 2024 report by the National Institute on Drug Abuse, approximately 10% of adults aged 18-25 reported non-medical use of prescription drugs in the past year, highlighting the potential for misuse of various medications, including those commonly found over-the-counter.
“In the past, it has been a useful medication that has helped millions of patients; however, its current therapeutic ratio is matched or exceeded by second-generation antihistamines, especially due to their markedly reduced adverse reactions. It is time to say a final goodbye to diphenhydramine, a public health hazard,”
—Review Authors
