• 
• 

Three Part Question

In [patients with allergic rhinitis or urticaria] is [loratadine or chlorpheniramine] more effective in [alleviating symptoms]?

1. Patients with allergic rhinitis or uticaria
2. Loratadine or chlorpheniramine
3. More effective as treatment

Clinical Scenario

Patients frequently attend the emergency department complaining of urticaria, skin itchiness or rash, allergic rhinitis, or runny nose. Is the 1st generation anti-histamine chlorpheniramine or the 2nd generation loratadine more effective in treating these symptoms?

Search Strategy

((Piriton or chlorpheniramine) AND loratadine AND (uticaria or allergy or rash))

Ovid Medline Search limited to English language results in humans

Search Outcome

Of the 4 search results yielded, 3 were relevant to the search query and included in the report.

Relevant Paper(s)

Author, date and country	Patient group	Study type (level of evidence)	Outcomes	Key results	Study Weaknesses
Boner, A L; Miglioranzi, P; Richelli, C; Marchesi, E; Andreoli, A. 1989 Aug Denmark	children with allergic rhinitis	Randomized Controlled Trial	loratadine and chlorpheniramine both effective in reducing allergic symptoms	chlorpheniramine causes drowsiness as a side effect, while loratadine does not
Crawford, W W; Klaustermeyer, W B; Lee, P H; Placik, I M. perennial allergic rhinitis USA	Patients with perennial allergic rhinitis	Randomized Controlled Trial	No difference in efficacy between loratadine and chlorpheniramine	Both drugs showed improvement for allergic rhinitis symptoms
Casale, Thomas B; Blaiss, Michael S; Gelfand, Erwin; Gilmore, Timothy; Harvey, Philip D; Hindmarch, 2003 May USA	patients with allergic rhinitis	Literature Review	Second generation anti-histamines such as loratadine cause less drowsiness than first generation anti-histamines such as chlorpheniramine	Second generation anti-histamines are recommended for treatment of allergic rhinitis

Comment(s)

4 Results were found from the Ovid Medline search, of which 3 were relevant to the query. All 3 sources concurred that loratadine and chlorpheniramine have a similar efficacy in treating allergic rhinitis. In view of this, 2 of the 3 sources recommended prescribing second generation anti-histamines such as loratadine over first generation anti-histamines due the fewer side effects (mainly drowsiness) experienced.

Clinical Bottom Line

Loratadine and chlorpheniramine have a similar efficacy, but loratadine is preferred as it causes fewer side effects. However, chlorpheniramine is availabe in oral, intravenous, and intramuscular formulations while loratadine is only available in oral formulation, so chlorpheniramine may be selected if a parenteral route is required. In our hospitals, a loratadien tablet costs $0.121HKD, which is 5 times the cost of piriton at $0.024HKD. Though both are inexpensive, it may also be a factor in the evaluation of drug choice.

References

1. Boner, A L; Miglioranzi, P; Richelli, C; Marchesi, E; Andreoli, A. Efficacy and safety of loratadine suspension in the treatment of children with allergic rhinitis. Allergy Allergy. 44(6):437-41, 1989 Aug
2. Crawford, W W; Klaustermeyer, W B; Lee, P H; Placik, I M. Comparative efficacy of terfenadine, loratadine, and astemizole in perennial allergic rhinitis Otolaryngology - Head & Neck Surgery Otolaryngology - Head & Neck Surgery. 118(5):668-73, 1998 May
3. Casale, Thomas B; Blaiss, Michael S; Gelfand, Erwin; Gilmore, Timothy; Harvey, Philip D; Hindmarch, Ian; Simons, F Estelle R; Spangler, Dennis L; Szefler, Stanley J; Terndrup, Thomas E; Waldman, Scott First do no harm: managing antihistamine impairment in patients with allergic rhinitis. Journal of Allergy & Clinical Immunology Journal of Allergy & Clinical Immunology. 111(5):S835-42, 2003 May.