Use of Nonsedating Antihistamines in the Common Cold
Date First Published:
August 26, 2010
Last Updated:
June 30, 2011
Report by:
Eric Wiest, EM Resident Physician (Grand Rapids Medical Education Partners/ Michigan State University College of Human Medicine )
Search checked by:
Jeffrey Jones, MD, Grand Rapids Medical Education Partners/ Michigan State University College of Human Medicine
Three-Part Question:
In patients [with a common cold] is [treatment with non-sedating antihistamines better than placebo] at [reducing of symptoms severity or duration]?
Clinical Scenario:
An otherwise healthy 25 year old woman presents to the ER with 3 days of runny nose, sneezing, and nonproductive cough. She reports it feels like a common cold and usually she recovers without intervention. She has never received relief from over the counter cold medications. She is seeking care because she has a job interview in two days and wants to know if there is anything she can take to recover faster. You have heard that some providers use second generation antihistamines for upper respiratory infections, and wonder if there is any evidence behind the practice.
Search Strategy:
Ovid MEDLINE(R) 1948 to March Week 4 2011. Embase via the NHS Evidence ‘Health Information Resources’ date of searching 04/04/11. The Cochrane Library April 2011.
Search Details:
[exp common-cold or exp respiratory-tract-infections/ or exp cough or exp nasal-obstruction or exp sneezing or exp rhinovirus] AND [exp cetirizine or exp loratadine or exp terfenadine or fexofenadine.mp].<br><br>Cochrane:MeSH descriptor Common Cold explode all trees AND MeSH descriptor Histamine H1 Antagonists explode all trees 34 records 0 relevant. MeSH descriptor Common Cold explode all trees AND MeSH descriptor cetirizine explode all trees or MeSH descriptor Loratadine explode all trees or MeSH descriptor Terfenadine explode all trees or fexofenadine.ti.,ab. = 4 records 3 duplicates
Outcome:
144 papers were identified on Medline and 12 on Embase, 4 were relevant to the clinical question. A Cochrane review was withdrawn in 2009 due to lack of update – but is still visible in archive online (1)
Relevant Paper(s):
| Study Title | Patient Group | Study type (level of evidence) | Outcomes | Key results | Study Weaknesses |
|---|---|---|---|---|---|
| Effect of the second-generation antihistamine, fexofenadine, on cough reflex sensitivity and pulmonary function. Dicpinigaitis PV, Gayle YE. 2003, USA | 12 subjects with URTI and 12 healthy controls underwent capsaicin cough induction test before and after fexofenadine. | Randomized controlled trial, although not for a clinical outcome. | Amount of capsiacin to induce 5 coughs | Fexofenadine demonstrated no antitussive activity | Not truly a clinical test, DOE instead of POE |
| Efficacy of terfenadine in the treatment of common cold. A double-blind comparison with placebo. Henauer SA and Glück U. 1988, Switzerland. | 91 adults with common cold symptoms randomized to terfenadine or placebo. | Randomized, double blind, placebo control. | Subjective rating of severity of nasal symptoms, mean nasal airflow, and rating on rhinoscopy. | Terfenadine demonstrated a small improvement in symptoms and airflow. | Original number of patients not enrolled, protocol broken during study, then re-designed around data. |
| Evaluation of oral terfenadine for treatment of the common cold. Berkowitz RB and Tinkelman DG. 1991, USA | 97 healthy adults with common cold symptoms randomized to terfenadine or placebo. | Randomized, double blind, placebo controlled trial | Subjective severity of symptoms and examination by physician. | No significant difference between terfenadine and placebo; drug side effects were low in both groups | Small sample size |
| Ineffectiveness of oral terfenadine in natural colds: evidence against histamine as a mediator or common cold symptoms. Gaffey MJ, Kaiser DL, Hayden FG. 1988, USA | 250 healthy adults with common cold symptoms randomized to terfenadine or placebo. | Randomized, double blind, placebo controlled trial | Subjective report of severity of symptoms; adverse effects | No significant differences between terfenadine and placebo. | 16 subjects did not comply with study protocol |
Author Commentary:
Given the prevalence of the common cold and the large number of patient encounters seeking relief, there is a relative scarcity of research. Histamine has been proposed in the pathogenesis of viral cold symptoms. Newer, non-sedating antihistamines have few adverse effects. No trials with loratadine or cetirizine were identified, although fexofenadine is thought to have an identical mechanism of action and terfenadine is a prodrug of fexofenadine. No studies confirmed the diagnosis virologically, but this is consistent with the clinical scenario where the ‘gold standard’ diagnosis in not indicated.
Bottom Line:
There was no significant evidence found to support the practice of using second generation antihistamines for the common cold, but there were few negative studies either. Further patient oriented clinical research is required.
References:
- De Sutter AIM, Lemiengre M, Campbell H. . Antihistamines for the common cold (archive)
- Dicpinigaitis PV, Gayle YE. . Effect of the second-generation antihistamine, fexofenadine, on cough reflex sensitivity and pulmonary function.
- Henauer SA and Glück U. . Efficacy of terfenadine in the treatment of common cold. A double-blind comparison with placebo.
- Berkowitz RB and Tinkelman DG. . Evaluation of oral terfenadine for treatment of the common cold.
- Gaffey MJ, Kaiser DL, Hayden FG. . Ineffectiveness of oral terfenadine in natural colds: evidence against histamine as a mediator or common cold symptoms.