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Antihistamines in Drivers, Aircrew and Occupations of Risk


I Jáuregui1, M Ferrer2, J Montoro3, I Dávila4, J Bartra5, A del Cuvillo6, J Mullol7, J Sastre8, A Valero5

1Allergy Department, Basurto University Hospital, Bilbao, Spain
2Allergology Department, University Clinic of Navarra, Pamplona, Spain
3Allergy Unit, Arnau de Vilanova University Hospital, Faculty of Medicine, Catholic University of Valencia "San Vicente Mártir", Valencia, Spain
4Immunoallergy Department, Salamanca University Welfare Complex, IBSAL, Salamanca, Spain
5Allergy Unit, Pneumology and Respiratory Allergy Department, Hospital Clínic (ICT), Barcelona, Spain
6Dr. Lobatón Clinic, Cadiz, Spain
7Rhinology and Olfactory Clinical Unit, Otorhinolaryngology Department, Hospital Clínic (ICT), Barcelona, Spain
8Allergy Department, Jiménez Díaz Foundation, Madrid, Spain

J Investig Allergol Clin Immunol 2013; Vol. 23, Suppl. 1: 27-34



The most commonly occurring allergic diseases can involve a daytime drowsiness associated with the condition itself. The antihistamines used in their treatment can also have central effects and affect certain occupations concerned with risk, road safety and maritime and air navigation. Cognitive tests, experimental studies and epidemiological data recommend avoiding 1st generation antihistamines for people who must drive regularly and/or professions concerned with safety. Although there are no comparative studies on real driving between 1st and 2nd generation antihistamines, in this type of patients there should be a preference for prescribing those with least possible central effect, especially those which are a good substrate for transmembrane transporter pumps such as P-glycoprotein and therefore have a low capacity for crossing the hematoencephalic barrier, thus allowing a broader window for therapy. In this sense, bilastine is a good P-glycoprotein substrate and shows good tolerance at CNS level, in both psychometric trials and real driving test protocols, even at double the dose recommended in the technical file.

Key words: Antihistamine. Bilastine. Real driving studies. P-glycoprotein. Cognitive tests. Road safety. Central nervous system.