Loratadine or chlorpheniramine more effective in treatment of allergic rhinitis or uticaria?
Date First Published:
June 6, 2019
Last Updated:
October 11, 2019
Report by:
Dorothy Law, Emergency Medicine Resident (Yan Chai Hospital)
Search checked by:
Ovid Medline, Yan Chai Hospital
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))
Search Details:
Ovid Medline Search limited to English language results in humans
Outcome:
Of the 4 search results yielded, 3 were relevant to the search query and included in the report.
Relevant Paper(s):
| Study Title | Patient Group | Study type (level of evidence) | Outcomes | Key results | Study Weaknesses |
|---|---|---|---|---|---|
| Efficacy and safety of loratadine suspension in the treatment of children with allergic rhinitis. 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 | |
| Comparative efficacy of terfenadine, loratadine, and astemizole in perennial allergic rhinitis 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 | |
| First do no harm: managing antihistamine impairment in patients with allergic rhinitis. 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 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 |
Author Commentary:
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.
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:
- 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.
- Crawford, W W; Klaustermeyer, W B; Lee, P H; Placik, I M.. Comparative efficacy of terfenadine, loratadine, and astemizole in perennial allergic rhinitis
- 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.