Zyrtec vs Benadryl: An Allergy Medication Update

What is an allergic reaction?

Allergies happen when the immune system, which normally protects the body from germs, overreacts to a usually harmless substance, such as pollen, mold, bees, medicines, viral illnesses or food. When this happens, the immune system releases chemicals that cause itching, rashes, swelling, sneezing, breathing changes, coughing, and stomach problems. Sometimes, these symptoms are mild, but sometimes they can be a serious, life-threatening reaction called anaphylaxis.

My child got a rash a few minutes after eating a peanut, does it happen that quickly?

Yes! Allergic reactions usually appear within minutes to a few hours after your child is exposed to the allergen, such as eating a peanut or being stung by a bee. A reaction rarely occurs after more than 24 hours.

I was told to give my child Benadryl for allergic reactions. Is that okay?

Antihistamines are a great choice to treat mild to moderate allergic reactions. There are two different kinds of antihistamines. Diphenhydramine (Benadryl) is a first-generation antihistamine, whereas Cetirizine (Zyrtec) is a second-generation antihistamine. Both are effective, but we no longer recommend Benadryl as the first line of defense because it is an older medication that causes side effects, such as drowsiness, dry mouth, inability to learn and concentrate, constipation, and increased seizure risk.

Zyrtec, on the other hand, is a newer antihistamine that is just as effective without these side effects. Zyrtec is the preferred choice, along with Claritin (loratadine) and Allegra (fexofenadine), which belongs to the same class of antihistamines.

Is the change from Benadryl to Zyrtec just a Watchung Pediatrics recommendation?

Great question! No, this recommendation is supported by the American Academy of Pediatrics, the American Academy of Otolaryngology-Head and Neck Surgery, the American Academy of Allergy, Asthma, and Immunology, and the American Academy of Dermatology. All these organizations recommend second-generation antihistamines (Zyrtec, Claritin, Allegra) for children instead of first-generation antihistamines (Benadryl) based on large studies and expert guidelines.

My child has anaphylaxis to shellfish. Should I be using Zyrtec instead of the EpiPen?

Epinephrine (EpiPen) is always the first and best treatment for true anaphylaxis, which is a severe, life-threatening allergic reaction that involves more than one body system (hives, difficulty breathing, vomiting, facial swelling). If symptoms of anaphylaxis occur, you should give the EpiPen right away and then promptly go to the emergency department or call 911.

Zyrtec and other antihistamines can help with mild to moderate allergic reactions, but they do not stop or treat anaphylaxis and should never be used instead of an EpiPen for serious reactions.

I have never given my child Zyrtec before. How much should I give them?

My child's school allergy action plan says to give Benadryl. What should I do?

Please schedule an appointment to have your child's allergy action plan updated to reflect these new recommendations of giving Cetirizine (Zyrtec) instead of diphenhydramine (Benadryl) for allergy symptoms at school.