Antihistamines and the torsade de point in children with allergic rhinitis.

Allergic rhinitis (AR) is a very common disease, occurring in approximately 10% of children and up to 20% of adolescents. It is often underdiagnosed and its importance as a cause of morbidity is also underestimated, especially in asthmatic children. It has been estimated that 75% of asthmatic children suffer from AR, and its prevalence has increased during the last years, due to changes in environmental factors. AR may be a cause of serious discomfort for the child as well as for the family. AR may cause several complication, including serous otitis media, abnormal facial development with orthodontic problems, eustachian tube dysfunction and sinusitis. The frequent association of paranasal sinusitis in children with asthma has been observed and sinusitis has been considered a contributing factor in bronchial asthma Second-generation antihistamines are the golden therapy for AR. However, reports of potentially life-threatening dysrhythmias, specifically torsades de pointes, were described. In conclusion, we comment the in vitro inhibition of several ion channels, in particular predisposing the heart to dysrhythmias by terfenadine and astemizole. In this paper we examine recent reports on safety of both cetirizine and loratadine.