Antihistamine use during breastfeeding with focus on breast milk transfer and safety in humans: A systematic literature review

Abstract

Current data on use of antihistamines during breastfeeding and risks to the breastfed infant are insufficient. The aim of this systematic review was to provide an overview of studies measuring the levels of antihistamines in human breast milk, estimating the exposure for breastfed infants and/or reporting possible adverse effects on the breastfed infant. An additional aim was to review the antihistamine product labels available in the European Union (EU) and the United States. We searched seven online databases and identified seven human lactation studies that included 25 mother–infant pairs covering cetirizine, clemastine, ebastine, epinastine, loratadine, terfenadine and triprolidine. In addition, one study investigated the impact of chlorpheniramine or promethazine on prolactin levels among 17 women, and one study investigated possible adverse drug reactions in 85 breastfed infants exposed to various antihistamines. The relative infant dose was below 5% for all antihistamines, ranging from 0.3% for terfenadine to 4.5% for clemastine. Most product labels of the 10 antihistamines with available information in both the EU and the United States reported lack of evidence and recommended to avoid use during breastfeeding. The knowledge gap on antihistamines and lactation is extensive, and further human studies are warranted to ensure optimal treatment of breastfeeding women with allergy.

Urticaria

“…However, safety in pregnancy has been shown for cetirizine and loratadine only, and these drugs are therefore preferred 192,193 . The use of sgAHs such as loratadine and cetirizine is also advised in breastfeeding women 4 , as nursing infants can develop sedation from first-generation antihistamines secreted into breast milk 194 . Omalizumab is reported safe in pregnancy 115,[195][196][197][198] and in younger children, although current licensing is for individuals aged 12 years and older 146 .…”

How Do Liquid-Junction Potentials and Medium Polarity at Electrode Surfaces Affect Electrochemical Analyses for Charge-Transfer Systems?

“…As UV absorbers, phenothiazine and many of its derivatives serve as electron donors for a range of CT systems. − Conversely, certain phenothiazine derivatives, such as promethazine, chlorpromazine, and methotrimeprazine, exhibit biological activity as H 1 blockers, i.e., antihistamines, and have a clinical significance as antiemetic and antipsychotic medications. − The antiviral properties of some of them raised quite an interest during the COVID-19 pandemic as potential agents against the SARS-CoV-2 virus. − …”

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“…This observation underlines the importance of having sufficient safety data available on the transfer of medicines to breastmilk. However, the available data on this subject are currently scarce [ 44 ], and for some medicines only consist of (single) case reports or case series with a limited number of included cases [ 45 ]. Hence, more attention for clinical lactation studies and non-clinical research methods to enhance our knowledge on this subject is also warranted [ 26 , 46 , 47 ].…”