This article reviews the molecular biology of the interaction of histamine with
its H1-receptor and describes the concept that
H1-antihistamines are not receptor antagonists but are inverse
agonists i.e. they produce the opposite effect on the receptor to histamine. It
then discourages the use of first-generation H1-antihistamines in
clinical practice today for two main reasons. First, they are less effective
than second generation H1-antihistamines. Second, they have unwanted
side effects, particularly central nervous system and anti-cholinergic effects,
and have the potential for causing severe toxic reactions which are not shared
by second-generation H1-antihistamines. There are many efficacious
and safe second-generation H1-antihistamines on the market for the
treatment of allergic disease. Of the three drugs highlighted in this review,
levocetirizine and fexofenadine are the most efficacious in humans in
vivo. However, levocetirizine may cause somnolence in susceptible
individuals while fexofenadine has a relatively short duration of action
requiring twice daily administration for full all round daily protection. While
desloratadine is less efficacious, it has the advantages of rarely causing
somnolence and having a long duration of action. Lastly, all
H1-antihistamines have anti-inflammatory effects but it requires
regular daily dosing rather than dosing 'on-demand' for this effect to be
clinically demonstrable.