Dr. Anna Wolfson says she sees dangerous misuse of the allergic drug diphenhydramine every day at her clinic.

“If someone is having an allergic reaction to food, people will say, ‘Don’t worry, I have diphenhydramine in my wallet’, and then say, ‘Really, epinephrine is the first line treatment for food allergies’.”

Diphenhydramine can be harmful if people take it after they have an allergic reaction to food, she said.

“It’s time to move on. For all the signs that people are using diphenhydramine, there are better medications that are more effective in treating the symptoms people are trying to treat with fewer side effects,” she said. “I have had a patient who was worried that diphenhydramine might be impairing his ability to drive and fully participate in everyday life.”

Wolfson doesn’t just like alternatives. In a review published in February, San Diego, an allergy expert at Johns Hopkins University and the University of California, called for the removal of diphenhydramine from the US commercial and prescription markets.

First generation antihistamines, approved in 1946, are widely used for allergies, sleep aids and cold symptoms. According to the American Association of Pharmacists, it is a common over-the-counter drug in the United States, and it has increased in summer months to use sneezing and watery nose caused by grass and pollen allergies.

Despite its long-standing presence in American homes, the authors of the new review say it poses more disproportionate risks than new antihistamines, especially for children and older adults.

“Patients should test alternatives like loratadine, zyrtec, cetirizine, or allegra, fexofenadine,” said Dr. James Clark, who was a prime faculty at CNN, to alleviate allergic symptoms.

The Consumer Healthcare Products Association, a leading figure in the OTC medical industry, says the label reveals common side effects associated with products containing diphenhydramine. However, he states, “these products are not intended for long-term use.”

“When used according to the instructions, these medications offer established therapeutic benefits for common health diseases such as allergies, colds, exercise sickness, mild skin irritation, and occasional insomnia,” the group said in a statement on behalf of Benadril manufacturer Kemb. “As with all medicines, responsible use is essential, and consumers should always follow the instructions and warnings on the drug fact label and consult their healthcare provider if they have questions.”

If you have an allergy, you may want to avoid this type of medicine

If you have an allergy, you may want to avoid this type of medicine

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Antihistamines work by blocking receptors called H1, which are part of the body’s system, to respond to allergens that cause symptoms such as sneezing, itching, and runny nose. However, older drugs like diphenhydramine not only block allergy-related receptors, they can also affect other parts of the brain. Diphenhydramine often causes sedation, cognitive impairment and, in some cases, dangerous cardiac effects, the authors write.

In older people, the drug can remain in the body for up to 18 hours, resulting in increased risk of drowsiness, disorientation and decline. This review also highlighted possible links between long-term diphenhydramine use and dementia.

In children, the risks can be even more pronounced. The review authors quote the case studies Paradoxical responses such as accidental overdose; agitating, extreme sedation, coma. And especially in pediatric preparations, death occurs due to accidental ingestion. The drug was associated with hospitalization and deaths of several children during the Tiktok virus “Benadril Challenge.”

Dr. Manuela Murray, director of general pediatrics and emergency medicine at the University of Texas Department of Medicine, said diphenhydramine should not be used lightly.

“It should always be used under the guidance of a medical professional and is shown only to treat allergic reactions and movement intoxication,” Murray wrote in an email.

Drug therapy is often misused and “is not a safe sleeping pill medicine that does not benefit treatment for cold symptoms,” she said. In fact, it can have the opposite effect on children, leading to hyperactivity.

Dr. Alyssa Kuban, pediatrician and associate medical director for Texas Pediatric Pediatrics, said he found that Diphenhydramine was overused because of symptoms that had no direct treatment and had a safer alternative.

“Some families who use diphenhydramine when their children have colds or upper respiratory tract infections believe it helps them with crowds and sleep at night,” she said. “This is not effective against cold symptoms and is very insecure.”

She recommends over-the-counter cetirizine to treat children with hives, seasonal allergies, or itchy rashes. Cetiridine also lasts longer, and is not as sedative as diphenhydramine, she says.

Murray agrees that loratadine and cetirizine are safer for children over six months, and saline drops and aspiration are better alternatives for babies.

Diphenhydramine appears in over 300 OTC formulations and is often mixed in combination with cough, cold and influenza. The authors of this review state that, like products containing pseudoephedrine, they need to move behind the counter with minimal diphenhydramine, allowing pharmacists to guide patients to second generation alternatives.

The American Association of Pharmacists says patients should pay attention to concomitant cough and cold products that contain diphenhydramine.

Pharmacists may recommend alternative medications to older people who have a history of being cognitively affected by certain medications. The group “encourages patients and parents/caregivers to ask patients and parents/caregivers to request the pharmacist for the most appropriate treatment recommendations for the amount of the lowest side effects.”

The review authors also emphasize that there is no strong clinical data to suggest that diphenhydramine works better than other options. It can reduce symptoms such as sneezing and itching, but it has minimal impact on nasal traffic jams and does not outweigh second-generation medications in randomized trials. New options such as oral cetirizine provide 24-hour coverage with fewer adverse events.

However, in the US, medicine remains a staple diet. Reviews show that over 1.5 million prescriptions are still written each year, not counting untracked OTC purchases.

“In the past, it has been a useful drug that has helped millions of patients, but the current treatment ratio is consistent or exceeded with second-generation antihistamines, particularly due to significant reductions in side effects.

With Covid-19 transmission rising in the US, recent changes to federal vaccine guidance have led many Americans to be confused about the latest policies and are concerned about access to the shot this fall.

The US has been causing a summer surge every year due to Covid-19 incidents since the pandemic began. However, this year, experts say the seasonal waves start later than expected and are relatively restrained. Surveillance data from Wastewaterscan shows median Covid-19 concentrations were chopped in June and July and were etched at high levels in parts of the country, but overall, last year was far below this period.

“My hypothesis was that a weak winter wave would set the stage for a bigger summer because many people don’t have the immunity these days. So far, activity has been sedating more than I had expected,” epidemiologist Caitlyn Rivers wrote in her newsletter. “I remain open to what August will bring. My best guess is a continuous increase until early September, but I am uncertain.”

It’s too early to know how much the current rise will be, or how long it will be, but Dr. Jennifer Nuzzo, an epidemiologist and director of the Pandemic Center at Brown University School of Public Health, says her key concern is whether the COVID-19 vaccine “will have time to protect people, especially high-risk people.”

“My biggest worry at this point is the uncertainty about when the updated Covid vaccines will be available and who will get them,” Nuzzo said.

New research data from KFF, released Friday, shows that most adults in the US are not planning on getting the Covid-19 vaccine this fall, but most of those planning to get the shot share concerns that the vaccine is not available and insurance won’t cover the costs.

Over the past few months, U.S. Department of Health and Human Services Director Robert F. Kennedy Jr. said that Covid-19 shots are no longer recommended for healthy children or pregnant women, and that on behalf of the Federal Vaccine Advisory Board, plans to look into established federal childhood vaccine schedules.

In the latest survey, KFF voted for a nationally representative sample of nearly 1,300 adults between July 8th and 14th, at least two weeks after each of these events.

About a quarter of US adults say Kennedy has made a “big” change in US vaccine policy, but another 40% “do not have enough knowledge to say it,” a KFF poll found.

This fall, most likely seniors and Democrats, about two-thirds of those planning to get the Covid-19 vaccine this fall say they are worried that they may not be available. And more than 60% of insureds who plan to get a shot are worried that their insurance won’t cover it.

According to new KFF data, it is unclear whether about half of parents are currently recommending that the federal health agency receive the Covid-19 vaccine this fall.

Kennedy announced that the U.S. Centers for Disease Control and Prevention would not officially recommend a COVID-19 vaccine for healthy children, leaving the decision to take place between parents and their health care providers.

KFF has found that individual physicians or healthcare providers continue to be the most reliable source of information about vaccines.

Trust in the local health department and CDC has been eroded over the past two years, but most adults still say they trust these sources for vaccine information.

But far fewer people say Kennedy trusts at least “a significant amount” of money to provide information about the vaccine, according to KFF. When asked about the impact of changes to federal vaccine policies, more than a third of adults said they weren’t making people safe. Only one in five people said the change was making people safer.

Rivers says it encourages anyone hoping for the annual Covid-19 to get it sooner than later.

“The big drawback is that it hasn’t been updated yet. The new formulation will be released near the fall,” she said, but once you get the shot now you’ll be protected from unpredictable summer waves and stay ahead of any potential access concerns that may occur in the future.

The record share of U.S. kindergarten children was exempt from required vaccinations last year, with coverage of all reported vaccines, including the measles vaccine, being lower than in previous years.

Around 3.6% of kindergarten children from 2024-25 received a required vaccine exemption, leaving around 138,000 new school children without fully covering at least one nationally mandated vaccine, new data shows. The exemption jumped above the full percentage point over the past four years, CDC data shows, with the majority (all but 0.2%) being due to non-medical reasons.

Approximately 286,000 kindergarteners had not completed the 2024-25 measles-mampsulvera (MMR) vaccination series.

According to CDC data, MMR coverage has dropped to 92.5%, falling 95% below the federal government’s target for the fifth consecutive year. The majority of this year’s measles incident is with children who have not been vaccinated.

“Vaccinations are the most effective way to protect children from serious illnesses such as measles and pertussis, and can lead to hospitalization and long-term health complications,” the CDC said in a statement. “The CDC is committed to working closely with state and local partners by providing the tools, resources and data that will help communities promote vaccine access and awareness.”

However, the statement reflects the language commonly used by US Department of Health and Human Services Secretary Robert F. Kennedy Jr., who states, “the vaccine decision is personal. Parents should consult their healthcare provider about family options.”

45 states allow religious beliefs to be used as the basis for vaccine exemptions for children starting schools, and 15 states allow exemptions for other personal or philosophical reasons, according to the American Academy of Pediatrics.

“As pediatricians, we help children vaccinating children stay healthy and everyone knows it’s difficult for them to spread disease in our community,” AAP president Dr. Susan Cresley said in a statement. “In this moment when preventable diseases are on the rise, we need clear and effective communication from government leaders who recommend vaccination as the best way for children’s immune systems to combat dangerous diseases.”

This week, the organization reaffirmed its longstanding position that non-healthcare exemptions should be eliminated for school vaccination requirements.

“The science behind vaccines shows that their benefits outweigh the potential risks,” said Dr. Sean O’Leary, a pediatric infectious disease expert and chair of the AAP Infectious Diseases Committee. “There’s really no good reason to opt out.”

However, between 2024 and 25, vaccine exemptions increased in 36 states, according to new CDC data. In 17 states, more than 5% of kindergarten children received exemptions. This is not sufficient to apply to a 95% target for MMR vaccines that have been set up two MMR vaccines by HHS, in a reminder from the administrator to a document or doctor’s visit.

“We’ve seen a lot of trouble with our children,” said Dr. Josh Williams, a pediatrician with Denver Health and Associate Professor at the Colorado Anschutz Medical Campus. “So we are in a situation where we are currently in many states, and certainly many communities within certain states, where there is not enough herd immunity to protect against diseases that can be prevented by these vaccines, particularly measles outbreaks.”

In a 2019 study, Williams and fellow researchers discovered an interesting pattern of vaccine exemptions. If exemptions for both religious and personal beliefs are available in the state, religious exemptions tend to be low, but when the exemptions for personal beliefs disappear, the proportion of religious exemptions increases significantly.

“That leads to the kind of recommendations you see from organizations like AAP. Essentially, they say that these exemption policies don’t seem to actually do what they’re trying to do.

According to California, Connecticut, Maine, New York and West Virginia, they limit vaccine exemptions to medical reasons. While figures on West Virginia’s MMR coverage were not available in the latest CDC data, the other four states are one of a small group in 10 states that have reached a federal target of 95% coverage among kindergarteners.

In 2023, federal courts paved the way for religious exemptions to be added to Mississippi school vaccination policies. The exemption rate quickly jumped into the state, with MMR coverage dropping by about 1 percentage point, according to CDC data.

Overall, according to the CDC, national MMR coverage for kindergarteners has decreased from 92.7% for the 2023-24 grade to 92.5% for the 2024-25 grade.

Experts say that such changes may appear small, but they can significantly increase risk.

“It’s a small percentage point change that we’ll add up if it happened year over year, and that’s what we’ve seen,” Williams said, and the changes aren’t evenly distributed. “People who tend to reject the vaccine tend to come together. …Perhaps areas where there are low intakes are getting worse, and areas where there are more reasonable intakes continue to be reasonable.”

The majority of measles cases reported in this record-breaking year are concentrated in Texas.

MMR coverage in the state has been popular for at least the past decade with just 93.2% coverage among kindergarteners for at least the past decade. The exemptions have skyrocketed above 4%, significantly exceeding national fares. The law passed by the state legislature this year will make exemptions even easier. Starting in September, the affidavit form applying for the exemption can be printed from the state health department’s website without the need to submit a written request.

Dr. Philip Fan, director of the Dallas County Health Department, said there were many testimonies against the change.

“We were all insisting that there was a need for a consistent message of clear support for vaccinations from above,” he said. “We’re very concerned about what’s going on with HHS and what sort of message that undermines it.”

Experts say vaccines can sometimes be “a victim of their own success.” People don’t realize how much protection they provide until they see the possible pain they may have when they are not used.

This year’s measles outbreak has led to three deaths and dozens of hospitalizations, primarily among children, but experts say it could encourage the need to get vaccinated and start changing trends.

“There’s always been concern about the decline in seeing measles and other vaccines, but I think that in one context of our larger measles outbreak in recent memory, many people are in mind returning to school this fall,” Williams said. “In my clinical practice here in Denver, I have received requests from families who are worried about measles transmission at schools and daycare. Families who want to receive that protection come before the grade have come and have been able to take care of their children as much as possible before returning to school this fall.”

Williams says he likes to remind his parents that most people support vaccinations and that they work hard to gain the trust of their hesitant parents.

“It’s always good to remember that the majority of parents will vaccinate their children on time and on recommended schedules,” he said. “When that’s not true in schools or in the community, I think it’s an opportunity for supporters to talk to other parents and become partners in the process of improving vaccine trust.”