Concerning PAR, the effect of cetirizine has also been compared to montelukast. Although both products appear to be effective in reducing symptoms compared to placebo, cetirizine offers better results in improving nasal itching [ 27 ].
Furthermore, clinical studies demonstrate the importance of long-term cetirizine therapy: in children with dust mite allergy, treatment for at least 6 months results in a significant reduction in the prescription of other drugs e. In the same category of children, it has been shown that treatment for at least 3 years with cetirizine is associated with a reduction of new allergic sensitizations [ 29 ]. Regarding dosage, it was confirmed that 10 mg per day in children over 6 years divided into two administrations if less than 12 years is better when compared with 5 mg in terms of symptom reduction, both concerning rhinitis and conjunctivitis.
The administration of 5 mg is only useful for the reduction of sneezing [ 30 ]. Table 2 summarizes the evidences on the efficacy of cetirizine in the treatment of allergic rhinitis and conjunctivitis.
Summary of evidence on the efficacy of cetirizine in the treatment of allergic rhinitis. Anti-H1 antihistamines are effective at reducing itchiness number, size, and duration of wheals and erythema in patients with acute or chronic urticaria. The current guidelines recommend the use of second-generation molecules for their tolerability and safety profile. In CSU, progressively increasing the dose of second-generation H1-antihistamines up to fourfold higher than the recommended dose, or using a combination of two different second-generation antihistamines, is suggested when there is treatment failure using standard doses [ 31 , 32 ].
A double-blinded, multicentre study performed on 62 children aged 2—6 years showed that cetirizine was safe and effective in the treatment of urticaria symptoms erythema, papules, edema, itching when compared with oxatomide [ 12 ].
Furthermore, cetirizine seems to be effective in 12—24 month-old children with atopic dermatitis in the prevention of acute urticaria [ 33 ]. A recently published case report showed a successful treatment of severe CSU in a year-old boy who was supposed to be unresponsive to omalizumab since its CSU was not IgE-mediated with conventional treatment cetirizine, montelukast, systemic steroids, and dietary restriction [ 34 ].
Regarding the dose to be administered, already Komeyoshi et al. These findings were confirmed later by Okubo et al.
Recent data support the safety of the drug even when the dose is up to fourfold or prolonged administered [ 37 , 38 ]. Although their use is controversial, antihistamines are commonly used in the treatment of itching associated with atopic dermatitis. The National Institute for Health and Care Excellence NICE guidelines for treating atopic eczema suggest a 1-month trial of a non-sedating antihistamine in children with severe itching; this treatment may be continued, if successful, while symptoms persist, but this treatment regimen should be reviewed every 3 months [ 39 ].
The historical double-blinded, randomized, placebo-controlled ETAC trial evaluated the efficacy of cetirizine in children with atopic dermatitis in the prevention of asthma. In the same cohort of patients, the consumption of drugs for the same conditions was studied, demonstrating that other oral H1-antihistamines were significantly more often used in the placebo group than in the cetirizine group Moreover, cetirizine reduced the amount and duration of moderate-to-strong topical corticosteroids needed to treat subjects with atopic eczema [ 41 ].
Recently, a Cochrane review evaluated the efficacy of oral H1 antihistamines as an add-on therapy to topical treatment for eczema, highlighting how, despite the scientific evidence being qualitatively limited, cetirizine was burdened by fewer side effects and less need for additional H1-antihistamines in case of eczema flare compared with other antihistamines used as an add-on therapy [ 42 ].
Antihistamines should not be considered a therapeutic option in case of asthma but may have a role in treating comorbidities such as allergic rhinitis and in that way exert an indirect positive impact on asthma control.
In fact, during allergic rhinitis and asthma, the upper and lower airways are affected by a common inflammatory process that can be sustained and amplified by interconnected mechanisms. Allergic rhinitis and non-specific vasomotor rhinitis are some of the most critical risk factors for the onset of asthmatic disease, and they are therefore important aggravating factors [ 43 ].
Thus, therapy with anti-H1 antihistamines confers an additional benefit in the control of asthmatic symptoms in subjects with concomitant allergic rhinitis and bronchial asthma [ 44 ].
Studies that evaluated the efficacy of cetirizine in patients with mild or moderate asthma were performed in adult populations in which allergic rhinitis coexisted.
These studies, many of which were randomized and placebo-controlled, showed that doses ranging from 10 to 30 mg of cetirizine determine an improvement in asthma symptoms but not always in pulmonary function tests , especially when the treatment reached 5—6 weeks [ 45 — 49 ]. Already in , Weber-Schoendorfer and Shaefer evaluated a cohort of pregnant women and showed that exposure to cetirizine in the first trimester of pregnancy was not associated with an increased risk of abortions or fetal malformations [ 50 ].
These data on safety have also been confirmed recently in observational cohort studies and meta-analyses [ 51 , 52 ]. Regarding breastfeeding, a study conducted with telephone interviews reported that breastfed babies whose mothers took antihistamines were irritable, but none of these symptoms were relevant, so no medical consultation was necessary [ 53 ]. The British Society for Allergy and Clinical Immunology recommends cetirizine as an antihistamine of choice in the case of breastfeeding at the minimum possible dose and for the shortest possible time.
In fact, elevated doses or prolonged use can cause excessive drowsiness or, on the contrary, excessive irritability in breast-fed children, especially if they are administered concomitantly with sympathomimetics such as pseudoephedrine [ 54 ]. Cetirizine is a second-generation antihistamine that retains a leading role in the effective treatment of children with allergic diseases. The evidence of year-clinical-experience support this drug above all as the first choice for good safety data during pregnancy and breastfeeding.
All authors provided substantial contributions to the conception or design of the work, or the acquisition, analysis, or interpretation of data for the paper, revised the manuscript for important intellectual content, approved the final version, and agreed to be accountable for all aspects of the work.
All authors read and approved the final manuscript. Italy through an unrestricted grant. Italy concerning the role of antihistamines in clinical practice. Publisher's Note.
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations. National Center for Biotechnology Information , U. Journal List Clin Mol Allergy v. Clin Mol Allergy. Published online Feb Diego Peroni 6 U.
Author information Article notes Copyright and License information Disclaimer. Giuseppe Fabio Parisi, Email: ti. Corresponding author. Received Nov 23; Accepted Feb The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. Ask a doctor or pharmacist before use if you are taking tranquilizers or sedatives. Stop use and ask a doctor if an allergic reaction to this product occurs.
Seek medical help right away. Keep out of reach of children. In case of overdose, get medical help or contact a Poison Control Center right away. Adults and children 6 years and over: 5 mL or 10 mL once daily depending upon severity of symptoms; do not take more than 10 mL in 24 hours.
Adults 65 years and over: 5 mL once daily; do not take more than 5 mL in 24 hours. Children 2 to under 6 years of age: 2. If needed, dose can be increased to a maximum of 5 mL once daily or 2. Do not give more than 5 mL in 24 hours.
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What is the most important information I should know about cetirizine? What is cetirizine? Cetirizine may also be used for purposes not listed in this medication guide. What should I discuss with my healthcare provider before using cetirizine? You should not use this medicine if you are allergic to cetirizine or levocetirizine. How should I use cetirizine? Cetirizine oral is taken by mouth. Use cetirizine oral exactly as directed on the label, or as prescribed by your doctor.
Older adults may need to take a lower than normal dose. Follow your doctor's instructions. You may take cetirizine with or without food. Updated October Cleveland Clinic. Cetirizine oral syrup. Your Privacy Rights. To change or withdraw your consent choices for VerywellHealth. At any time, you can update your settings through the "EU Privacy" link at the bottom of any page. These choices will be signaled globally to our partners and will not affect browsing data.
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