In October 2019, the Canadian Society of Allergy and Clinical Immunology (CSASI) published a position statement on oral allergy medications, stating that newer antihistamines were safer than first-generation ones and should be recommended over older ones. commodities such as Benadryl due to a higher rate of potential side effects.  The position statement specifically referred to drugs that treat non-life-threatening allergic reactions such as allergic fever and urticaria.
If it’s new to you that Benadryl is no longer recommended as a first-line treatment for common allergies, you are not alone.  In 2022, it’s not just adult patients and parents who are still affected by brand familiarity and have not made the change – and some doctors, experts say.
“I think there are quite a few pediatricians who still recommend Benadryl for allergies,” Daniel Flanders, owner and CEO of Kindercare Pediatrics in Toronto, Ontario, told CTVNews.ca in a telephone interview.
“And if you talk to an allergist, he would just say that this is outdated advice.”
Benadryl is one of the most well-known brands of allergy medicines, with many over-the-counter products available, including baby-friendly versions.  Benadryl has been approved by Health Canada, which found it safe to use without a prescription, concluding a recent safety review of first-generation antihistamines that there was no change in risk that prompted her to change her medication to a prescription only. .
While both first- and second-generation antihistamines bind to receptors in the brain and spinal cord to block the release of histamines – the chemicals that cause allergy symptoms – the first generation crosses the blood-brain barrier and causes more depression. corrected to second generation antihistamines.
Because of this difference, first-generation antihistamines such as Benadryl are associated with more side effects such as increased drowsiness, problems with motor function and working memory, and the risk of hallucinations or even death in case of overdose.
But if many experts have believed for years that Benadryl should no longer be the first choice for oral allergy medications, why are so many Canadians and doctors unaware of this?
“Unfortunately very often, physicians and other health professionals, including pharmacists and paramedics, continue to routinely recommend Benadryl as a first-line antihistamine for the treatment of allergic symptoms, including symptoms of food allergy,” CSACI told CTVNews. .  , adding that his messages for 2019 “have not yet reached many health professionals.”
Flanders said that while he does not know that any doctor in his clinic still recommends Benadryl, there are probably many in Canada who still turn to the well-known allergy medicine for treating mild allergies.
“I would say that we have probably known for 10 years that it is better to use second and third generation antihistamines preferably than Benadryl, but […] “One of the funny things about medicine is that it takes a long time to translate information from research into practice.”
“It counts in years.  “It’s not uncommon, but it takes 10 years for the standard of care to adapt to some of the changes that science is discovering.”
Flanders said that if he had to make an assessment, 25 to 50 percent of pediatricians could recommend Benadryl as a first-line treatment, although he warned that this was just his personal assessment.
“I hope that more than half of my colleagues make this right recommendation [instead of Benadryl],” he said.
A big reason why Benadryl is still recommended by healthcare professionals is the familiarity with this brand, which has been a giant allergy medication for decades.
“Benadryl has so much recognition as an allergy medicine,” Flanders said.  “The brand name is so well known and so widely used that I imagined it would take a lot of work to unprogram and reprogram parents’ minds.  And also the minds of doctors who do not keep up with the peak [of medicine]. »
It was an emotion that resonated with CSACI.
“Familiarization of health professionals, parents and adult patients with Benadryl and other first-generation antihistamines makes it difficult to motivate changes in practice,” the organization said.


WHY DID CSACI DECIDE NOT TO RECOMMEND BENADRYL? 
More than two years ago, CSACI published a study explaining that newer antihistamines are just as effective and safer than first-generation antihistamines such as Benadryl and that they should always be recommended over older antihistamines.
The active ingredient in Benadryl sold in Canada is diphenhydramine and is one of the oldest first generation antihistamines on the market since 1946.
In the statement, CSASI explained that older antihistamines were associated with more serious side effects than second- and third-generation antihistamines that had been available in Canada since the 1980s and required high-quality testing.
“It is always preferable to use safer and more effective drugs,” CSACI told CTVNews.ca in an email.  “First-generation antihistamines are significantly more likely to cause side effects such as depression, poor sleep quality and poor cognitive performance (including poor performance at school and work).  In addition, overdoses of first-generation antihistamines can cause severe toxicity.
Johnson & Johnson, the company that sells Benadryl in Canada, did not respond to a request for comment from CTVNews.ca.
In 2019, the company told the Canadian press that “Benadryl products have been trusted by doctors and mothers for more than 60 years to provide effective relief of allergy symptoms and allergic reactions” and that the products are approved by Health Canada and “when used in accordance with the instructions, are safe and effective “.
The CSACI position statement explained that newer antihistamines have less serious side effects associated with them and that from 2019, accidental exposure to higher levels of second- and third-generation antihistamines did not result in serious side effects than first-generation antihistamines. .
In 2020, a TikTok “challenge” prompted some teens to take enough Benadryl to induce hallucinations, which resulted in several teens being rushed to hospital.
The CSACI statement said that in Canada, online research showed that Benadryl was, at the time, “the most recommended antihistamine for allergic symptoms in children in the last 7 years”.


WHY IS BENADRYL STILL AVAILABLE UP? 
It is important to note that Benadryl is not considered dangerous – when followed, serious side effects are rare.
CSACI’s position was that there are new options that are just as effective and have fewer side effects overall or milder side effects.
“I would not say so much that one should never use [Benadryl]”It just doesn’t make sense to use it right now or today, because there are alternatives that are just as good and have a better side effect profile,” Flanders explained.
“Why would you take a drug that you know has significant side effects when you can take another drug that does exactly the same thing, but without the side effects?”
After CSACI published this position statement in 2019, there was a flurry of articles questioning whether Benadryl should be available as a prescription drug.  As a result, Health Canada announced that while diphenhydramine-containing products met the requirements of the Food and Drug Administration, they would assess “to determine if further risk mitigation measures are required for diphenhydramine-containing products”, noting that child safety was a major concern of the Canadian public.
On March 1 this year, Health Canada published a summary of this safety review, which focused on whether there were increases in the frequency of known adverse reactions associated with the administration of diphenhydramine orally without a prescription to children under two years of age. or an increase in the frequency of overdose in children under 18 years of age.
“There are no new safety concerns that justify regulatory action right now,” Health Canada told the monthly Health Product InfoWatch.
Flanders believes that one of the factors behind Benadryl’s continued ubiquity in the minds of Canadians is that it is so readily available.
“I think it would make sense to remove Benadryl from the list of over-the-counter allergy medications, because there are simply better options and side effects, and these can have long-term effects,” he said.
“And that can be a good way to educate or leave the general public with no choice but to choose a more appropriate drug.”
In 2019, some pharmacists pointed out that placing Benadryl behind the counter does not solve safety problems and could cause conflict if customers continue to push for it.
Nardine Nakhla, a pharmacist who teaches at the University of Waterloo in Ontario, said at the time that there were many other diphenhydramine-containing products on the shelves, which made it unrealistic to pull them all out, and that there were other products available at the checkout that had concerns. for security, making this a complex problem.


IF I HAVE BENADRYL AT HOME, SHOULD I CONTINUE TO USE IT FOR MYSELF OR MY CHILDREN? 
For CSACI, it is …