H(1 )Antihistamines: Current Status and Future Directions

In this review, we compare and contrast the clinical pharmacology, efficacy, and safety of first-generation H(1 )antihistamines and second-generation H(1 )antihistamines. First-generation H(1 )antihistamines cross the blood-brain barrier, and in usual doses, they potentially cause sedation and impair cognitive function and psychomotor performance. These medications, some of which have been in use for more than 6 decades, have never been optimally investigated. Second-generation H(1 )antihistamines such as cetirizine, desloratadine, fexofenadine, levocetirizine, and loratadine cross the blood-brain barrier to a significantly smaller extent than their predecessors. The clinical pharmacology, efficacy, and safety of these medications have been extensively studied. They are therefore the H(1 )antihistamines of choice in the treatment of allergic rhinitis, allergic conjunctivitis, and urticaria. In the future, clinically advantageous H(1 )antihistamines developed with the aid of molecular techniques might be available.