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Can you take more than one zyrtec: The request could not be satisfied


Cetirizine: antihistamine that relieves allergy symptoms

If you or your child have been prescribed cetirizine, follow your doctor’s instructions about how and when to take it.

If you bought cetirizine from a pharmacy or shop, follow the instructions that come with the packet.

How much to take

Cetirizine comes as tablets and capsules (10mg) and as a liquid medicine (labelled either 5mg/ml or 1mg/1ml).

The usual dose in adults is 10mg once daily.

Doses are usually lower for people with kidney problems.

For children, your doctor will use your child’s weight or age to work out the right dose.

If you have bought cetirizine for a child, follow the instructions on the packet.

Depending on their age, children may take cetirizine twice a day. In this case, try to space the doses 10 to 12 hours apart.

How to take it

You can take cetirizine with or without food.

Always take cetirizine tablets or capsules with a drink of water, milk or juice. Swallow them whole. Do not chew them.

Cetirizine liquid may be easier for children to take than tablets or capsules. The liquid medicine will come with a plastic syringe or spoon to help you measure out the right dose.

If you don’t have a syringe or spoon, ask your pharmacist for one. Do not use a kitchen teaspoon as it will not give the right amount.

When to take it

You may only need to take cetirizine on a day you have symptoms – for example, if you have been exposed to a trigger like animal hair.

Or you may need to take it regularly to prevent symptoms – for example, to stop hay fever during spring and summer.

What if I forget to take it?

Take your forgotten dose as soon as you remember, unless it’s nearly time for your next dose. Do not take a double dose to make up for a forgotten dose.

If you forget to give a dose to a child who is taking cetirizine twice a day, you can give the dose if it’s within 4 hours of when they should have had it.

If you remember more than 4 hours after, do not give the missed dose. Instead, wait until the next dose and carry on as normal.

If you forget doses often, it may help to set an alarm to remind you. You could also ask your pharmacist for advice on other ways to help you remember to take your medicine.

What if I take too much?

Cetirizine is generally very safe. Taking too much is unlikely to harm you or your child.

If you take an extra dose by mistake, you might get some of the common side effects.

If this happens or you’re concerned, contact your doctor.

Help! I Accidentally Took Two Zyrtec

Hello and thank you for your question!

I certainly understand your worry regarding accidentally taking an extra dose of Zyrtec!

The good news is that although you may experience some side effects (more on this below), Zyrtec (cetirizine) is an antihistamine that is considered relatively safe, and it would take fairly high doses to present a real medical emergency for most individuals. Accidentally taking one extra pill, in most situations, is nothing to be too concerned about.

Before moving on to the next section, I always like to put in these articles the information for Poison Control. It is a valuable resource to refer to in situations where accidental ingestion of a substance (including extra doses of medication) has occurred. It provides great direction on when you should seek emergency care and what symptoms to look out for.

You can go to their website, Poison.org, or call them at 1-800-222-1222.

Zyrtec Safety At High Doses

Zyrtec is a second-generation antihistamine that is available over the counter (it was at one time prescription only). Other second-generation antihistamines include Claritin (loratadine) and Allegra (fexofenadine).

For adults, the recommended dosage is 10mg (one Zyrtec tablet) every 24 hours. This is the FDA-approved maximum daily dose.

In the situation you described in your question, you took one extra pill, which would equate to 20mg. Even though this is higher than the daily recommend dose, it wouldn’t be considered toxic in the vast majority of situations.

In fact, several clinical studies have been published where high doses of Zyrtec have been utilized, with minimal side effects.

One such study, published in 2013 in the Journal of Dermatological Treatment, concluded that a double dose of Zyrtec (cetirizine), which is 20mg (the dose you took), was effective in helping to reduce the symptoms of itching that was previously not responding to lower doses:

Conclusion: Doubling the dose of cetirizine may be efficacious to the patients with urticaria refractory to the regular dose of cetirizine.J Dermatolog Treat
. 2013 Apr;24(2):153-60

This study only noted mild side effects to this dose.

Several other studies have come to the same conclusion…that 20mg of Zyrtec is actually helpful for a lot of individuals who haven’t had great success with conventional doses.

In terms of how much Zyrtec would be considered a dangerous overdose, the prescribing information for the drug (which is found on the FDA website) specifically discusses situations where high doses have been consumed.

It mentions two cases of overdose, one where an adult took 150mg (15 tablets) and another where a child took 180mg (18 tablets). Only mild side effects were reported at these high doses. Per the prescribing information:

In one adult patient who took 150 mg of ZYRTEC, the patient was somnolent [sleepy ]but did not display any other clinical signs or abnormal blood chemistry or hematology results. In an 18 month old pediatric patient who took an 12 overdose of ZYRTEC (approximately 180 mg), restlessness and irritability were observed initially; this was followed by drowsiness.Zyrtec Prescribing Information

So, based on the available information we have regarding Zyrtec, you shouldn’t be too worried about that extra dose you took as it is fairly well tolerated, even at higher than recommended doses.

Zyrtec Side Effects

Like most drugs, the side effects of Zyrtec are dose dependent, meaning that higher doses tend to increase the risk of side effects occurring.

The side effects of Zyrtec (and all antihistamines) include:

  • Sleepiness
  • Fatigue
  • Dry mouth
  • Dizziness
  • Headache
  • Diarrhea
  • Nausea

The most common side effect is sleepiness (often referred to as somnolence). That is what you are most at risk for with taking an extra dose, but it should wear off as the dose wears off, within 24 hours.

Past that, again, you shouldn’t have too much trouble.

Final Words

I want to add the caveat here that everyone’s medical situation is different. Even though taking an extra dose of Zyrtec won’t cause too many issues for most people, some may be more at risk for others.

One such example would be with individuals who have heart conditions.

High doses of antihistamines can cause changes in heart rhythm. Two tablets of Zyrtec probably won’t put you much more at risk of an adverse effect happening, but is still something to keep in mind. If you do experience any troubling symptoms, I highly recommend contacting Poison Control (information at the top of this answer) or going to your nearest emergency room.

I hope this answer helps you!

Thanks so much for reaching out.

Frequently Asked Questions | ZYRTEC®

Questions about:

Questions about ZYRTEC®

Do you have questions about ZYRTEC® Usage Guidelines and COVID-19 Outbreak?

Please click here for more information.

What is ZYRTEC®?

ZYRTEC® is an over-the-counter medicine that provides effective, 24-hour relief of indoor and outdoor allergy symptoms.

What allergy symptoms does ZYRTEC® relieve?

ZYRTEC® relieves your worst allergy symptoms of sneezing, runny nose, itchy, watery eyes, and itchy nose or throat.

Is ZYRTEC® an antihistamine?

Yes. ZYRTEC® contains cetirizine HCl, which is an antihistamine.

What is an antihistamine?

An antihistamine is a drug that blocks the action of histamine—an allergy-causing chemical that’s released by certain cells in the body. Antihistamines are used to treat runny nose, sneezing and other allergy symptoms.

Should I take ZYRTEC® with food?

Your choice. ZYRTEC® can be taken either with or without food.

How fast does ZYRTEC® start working?

ZYRTEC® begins to work at hour 1 on the first day you take it.

How long does ZYRTEC® last?

ZYRTEC® provides 24-hour relief, all day and all night.

Is it okay to take ZYRTEC® over a long period of time?

The ZYRTEC® package label doesn’t state a limit on how long you can take ZYRTEC®. Talk to your doctor if you have any questions, especially if you’re taking other medicines or being treated for any other conditions.

What’s the best time of day to take ZYRTEC®?

Any time of day works. And ZYRTEC® will continue to work for 24 hours.

Do I need a prescription to take ZYRTEC®?

No. Since 2008, ZYRTEC® has been available over the counter, without a prescription.

Is the over-the-counter version of ZYRTEC® the same as the prescription strength?

Yes. Today’s ZYRTEC® has the same exact strength as the version that required a prescription previously.

Can ZYRTEC® make me drowsy?

For information on side effects, please read the ZYRTEC® product label or review the product details on this site.

Can I use ZYRTEC® if it is expired?

No. If your ZYRTEC® has expired, please discard it properly and get a new package. (See next question.)

What is the proper way to dispose of unused or expired ZYRTEC® products?

Do NOT dispose of any ZYRTEC® product by emptying it into your sink, toilet or storm drain. Check to see if your pharmacy or community has a take-back program in which you can drop off your expired or unused medicine for them to dispose for you. Otherwise, place your medicine in an unmarked, sealed container and dispose of the container in your household trash. Visit the FDA website for more information.

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Questions about ZYRTEC® Dissolve Tabs

Do dissolve tabs work faster than tablets or liquid gels?

ZYRTEC® Dissolve Tabs provide the same fast relief as ZYRTEC® Tablets and ZYRTEC® Liquid Gels. All ZYRTEC® medicines start working at hour 1 on the first day you take it.

Can I chew or swallow the dissolve tabs? Or do they need to dissolve on my tongue first?

ZYRTEC® Dissolve Tabs are designed to dissolve in your mouth without chewing or drinking water, but it’s perfectly fine to chew or swallow them.

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Questions about ZYRTEC-D®

How is ZYRTEC-D® different from ZYRTEC®?

ZYRTEC-D® contains pseudoephedrine, which relieves nasal congestion. So it relieves all the same symptoms as ZYRTEC®, plus it also has a powerful decongestant. For more, see: “What symptoms does ZYRTEC® relieve?”

How does ZYRTEC-D® work on sinus pressure and congestion?

ZYRTEC-D® contains a nasal decongestant that narrows the blood vessels in the nose and sinus region, which shrinks the tissue in that area to allow air and mucus to flow normally.

Why is ZYRTEC-D® located behind the pharmacy counter?

Pseudoephedrine, an active ingredient in some cold, allergy, and sinus products, can be chemically processed into methamphetamine (commonly known as meth). The illegal use of meth had increased, prompting Congress to pass the Combat Methamphetamine Epidemic Act of 2006 (CEMA). The objective of the law is to eliminate the use of pseudoephedrine in the illegal production of meth. By law, products containing pseudoephedrine must now be sold behind the counter and through online retailers who must meet certain requirements.

Note that products containing pseudoephedrine remain available without a prescription in most states.

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Questions about Children’s ZYRTEC®

How can I be sure I’m giving my child the proper dose of Children’s ZYRTEC®?

Always follow the instructions that come with Children’s ZYRTEC®. When taking Children’s ZYRTEC® Allergy Syrup, be sure to use the dosing cup that comes in the package. Other items like kitchen teaspoons, droppers or measuring devices that come with other medicines may not be accurate. If you have any questions about treating your child’s allergies, please speak with your doctor.

Can Children’s ZYRTEC® make my child drowsy?

For information on side effects, please read the Children’s ZYRTEC® product label or review the product details on this site.

What’s the difference between Children’s ZYRTEC® Allergy Syrup and Children’s ZYRTEC® Dissolve Tabs?

Children’s ZYRTEC® Allergy Syrup can be taken by kids 2 years and older, whereas Children’s ZYRTEC® Dissolve Tabs is for ages 6 and up.

What’s the difference between ZYRTEC® Dissolve Tabs and Children’s ZYRTEC® Dissolve Tabs?

There is no difference. Both products contain 10mg of cetirizine in the same citrus flavor and can be taken by both adults and children 6 years and older.

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General Allergy Questions

How do I know if I have allergies?

If you find yourself sneezing a lot or have a consistently runny or stuffy nose, there’s a good chance you have upper respiratory allergies. Allergies affect more than 50 million people in the United States alone.

What are the common symptoms of upper respiratory allergies?

People with allergies can experience lots of symptoms, including sneezing, runny nose, stuffy nose (nasal congestion), or itchy, watery eyes.

What are outdoor allergies?

If you only develop upper respiratory symptoms at certain times of the year (often spring or fall), you probably have seasonal allergic rhinitis, or outdoor allergies. These allergies can be triggered by trees, grass and weed pollens, or outdoor mold. Learn more about outdoor allergies.

What are indoor allergies?

If you have symptoms all year round, it’s likely perennial allergic rhinitis, or indoor allergies. Common triggers include animal dander (tiny skin flakes or saliva from animals), indoor mold and dust mites. Learn more about indoor allergies.

What can I do to help relieve my outdoor allergies?

In addition to taking ZYRTEC®, you may want to:

  • Keep your windows closed and use air conditioning instead
  • Stay indoors during peak pollen hours (5 a. m. – 10 a.m.)
  • Change your clothes after you’ve been outside
  • Don’t hang your laundry outside to dry
  • Avoid mowing the lawn or raking leaves
  • Learn more outdoor allergy relief tips.

What can I do to help relieve my indoor allergies?

In addition to taking ZYRTEC®, you may want to:

  • Clean the filters in your air conditioner and heater regularly
  • Vacuum often, especially carpets and upholstered furniture
  • Keep your pets bathed and groomed
  • Run an air purifier
  • Crack open the bathroom window during showers
  • Learn more about indoor allergies.

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Printing Coupons

What is SmartSource?

SmartSource is an online network of coupons and offers that can help you save money. Just download the coupons you want and print them out to use at your favorite stores.

Why do I need Adobe Reader?

With SmartSource’s new print technology, we use Adobe PDF Security. Most people already have Adobe Reader installed, so this makes the transition seamless. And while many programs can open PDF files, SmartSource coupons rely on security technologies unique to Adobe Reader.
You can get Adobe Reader for free here.

Can I print coupons more than once?

You generally get one chance to print your coupons and offers, so make sure your printer is turned on and working when you’re ready to print. But if something goes wrong, you get one more try. Also, if the total number of available offers has been claimed, the offer can expire and may not be printed. This can be the case with popular items.

A Message says I already printed offers that I didn’t?

SmartSource coupons usually have a print limit of 2 times on any one computer. If you share a computer with other users, they could have used those prints already. Also, offers can expire if the total number that the manufacturer made available has been met. This can be the case with popular items.

The screen said my coupons were printing,but they never did

Check to verify that your printer is connected and turned on.
If you were trying to print several coupons, the file size may be exceeding the amount of memory you have available. Try printing a single coupon. If that works, you may not be able to print out all that you want in a single session.
If you share a computer with other people, make sure they did not print the coupon already. Since SmartSource coupons can only be printed up to 2 times on the same computer, you may have exceeded the number of print times.

PDF Error

If you see this message, something has occurred with the coupon file and it is no longer valid. To resolve, visit the page upon which you found the coupons, and generate a new coupon file by clicking “Print.”

“No printer connected. Please connect your printer, turn it on, and make sure paper is loaded before trying again”

If you are seeing this message, your computer is having trouble trying to find a printer. Please verify that your printer is connected to your computer (via cable or on the same network) and turned on. For more information, visit your Operating System manufacturer.
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If you are seeing the above message, it means that your computer lost connection to our print server during the print process. To resolve, verify your network connection and retry
Mac OS X

“Unsupported printer”

We do not allow printing to certain types of printers, primarily those that can capture an image of the coupon.
Ensure that you have the desired printer set to “Default” in your computer’s settings.

What are the system requirements?

Supported Operating Systems

  • Windows XP, Vista, 7,8, and 10
  • OS X 10.6 (Snow Leopard) through 11 (El Capitan)

Supported Browsers

  • Internet Explorer 10.0 and above
  • Firefox 19 and above
  • Chrome 23 and above
  • Safari 4 and above

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  1. Always use Adobe Reader
    • While many programs can open PDF files these days, SmartSource coupons rely on security technologies unique to Adobe Reader. You can get Adobe Reader for free here.
  2. Check your security settings
    • Make sure “Automatically trust documents with valid certification” is selected in the Security (Enhanced) section of the Adobe Reader Preferences.
  3. Enable JavaScript
    • For coupons to print correctly, “Enable Acrobat JavaScript” must be selected in the Adobe Acrobat Reader DC settings.

Adobe Does Not Allow Connection

For some users, Adobe Acrobat security settings will prevent you from printing. You may receive this message from Adobe:
Network Error: Printing was interrupted. Please try again.
If so, please follow these steps to allow the printing.

  1. Open Adobe Acrobat Reader DC.
  2. Select Edit > Preferences or press Ctrl-K (Cmd-, on OS X).
  3. Select Trust Manager on the Left hand side of the preferences window.
  4. Select Allow opening of non-PDF file attachments

Do you have coupons?

To access Zyrtec coupons, please visit https://www.zyrtec.com/savings

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Antihistamine (Oral Route, Parenteral Route, Rectal Route) Proper Use

Proper Use

Drug information provided by: IBM Micromedex

For patients taking this medicine by mouth:

  • Antihistamines can be taken with food or a glass of water or milk to lessen stomach irritation if necessary.

  • If you are taking the extended-release tablet form of this medicine, swallow the tablets whole. Do not break, crush, or chew before swallowing.

For patients taking dimenhydrinate or diphenhydramine for motion sickness:

  • Take this medicine at least 30 minutes or, even better, 1 to 2 hours before you begin to travel.

For patients using the suppository form of this medicine:

  • To insert suppository: First remove the foil wrapper and moisten the suppository with cold water. Lie down on your side and use your finger to push the suppository well up into the rectum. If the suppository is too soft to insert, chill the suppository in the refrigerator for 30 minutes or run cold water over it before removing the foil wrapper.

For patients using the injection form of this medicine:

  • If you will be giving yourself the injection, make sure you understand exactly how to give it. If you have any questions about this, check with your health care professional.

Antihistamines are used to relieve or prevent the symptoms of your medical problem. Take them only as directed. Do not take more of them and do not take them more often than recommended on the label, unless otherwise directed by your doctor. To do so may increase the chance of side effects.


The dose medicines in this class will be different for different patients. Follow your doctor’s orders or the directions on the label. The following information includes only the average doses of these medicines. If your dose is different, do not change it unless your doctor tells you to do so.

The amount of medicine that you take depends on the strength of the medicine. Also, the number of doses you take each day, the time allowed between doses, and the length of time you take the medicine depend on the medical problem for which you are using the medicine.

For use as an antihistamine:

For azatadine

  • For oral dosage form (tablets):

    • Adults—1 to 2 milligrams (mg) every eight to twelve hours as needed.

    • Children 12 years of age and older—0.5 mg to 1 mg two times a day as needed.

    • Children 4 to 12 years of age—Use and dose must be determined by your doctor.

    • Children and infants up to 4 years of age—Use is not recommended .
For brompheniramine

  • For regular (short-acting) oral dosage forms (capsules, tablets, or liquid):

    • Adults and teenagers—4 milligrams (mg) every four to six hours as needed.

    • Children 6 to 12 years of age—2 mg every four to six hours as needed.

    • Children 4 to 6 years of age—1 mg every four to six hours as needed.

    • Children and infants up to 4 years of age—Use is not recommended .

  • For injection dosage form:

    • Adults and teenagers—10 milligrams (mg) injected into a muscle, under the skin, or into a vein every eight to twelve hours.

    • Children 4 to 12 years of age—0.125 mg per kilogram (0.06 mg per pound) of body weight injected into a muscle, under the skin, or into a vein three or four times a day as needed.

    • Children and infants up to 4 years of age—Use is not recommended .
For cetirizine

  • For oral dosage forms (syrup and tablets):

    • Adults—5 to 10 milligrams (mg) once a day.

    • Children 6 years of age and older—5 to 10 mg once a day.

    • Children 4 to 6 years of age—2.5 mg once a day, up to a maximum of 5 mg once a day or 2.5 mg twice a day.

    • Children and infants up to 4 years of age—Use is not recommended .
For chlorpheniramine

  • For regular (short-acting) oral dosage forms (tablets or liquid):

    • Adults and teenagers—4 milligrams (mg) every four to six hours as needed.

    • Children 6 to 12 years of age—2 mg three or four times a day as needed.

    • Children 4 to 6 years of age—Use and dose must be determined by your doctor.

    • Children and infants up to 4 years of age—Use is not recommended .

  • For long-acting oral dosage forms (capsules or tablets):

    • Adults—8 or 12 milligrams (mg) every eight to twelve hours as needed.

    • Children 12 years of age and older—8 mg every twelve hours as needed.

    • Children 4 to 12 years of age—Use and dose must be determined by your doctor.

    • Children and infants up to 4 years of age—Use is not recommended .

  • For injection dosage form:

    • Adults—5 to 40 milligrams (mg) injected into a muscle, into a vein, or under the skin.

    • Children 4 years of age and older—0.0875 mg per kilogram (0.04 mg per pound) of body weight injected under the skin every six hours as needed.

    • Children and infants up to 4 years of age—Use is not recommended .
For clemastine

  • For oral dosage forms (tablets or liquid):

    • Adults and teenagers—1.34 milligrams (mg) two times a day or 2.68 mg one to three times a day as needed.

    • Children 6 to 12 years of age—0.67 to 1.34 mg two times a day.

    • Children 4 to 6 years of age—Use and dose must be determined by your doctor.

    • Children and infants up to 4 years of age—Use is not recommended .
For cyproheptadine

  • For oral dosage forms (tablets or liquid):

    • Adults and children 14 years of age and older—4 milligrams (mg) every eight hours. The doctor may increase the dose if needed.

    • Children 6 to 14 years of age—4 mg every eight to twelve hours as needed

    • Children 4 to 6 years of age—2 mg every eight to twelve hours as needed

    • Children and infants up to 4 years of age—Use is not recommended .
For desloratadine

  • For oral dosage form (tablets):

    • Adults and children 12 years of age and older—5 milligrams (mg) once a day.

    • Children 4 to 12 years of age—Use and dose must be determined by your doctor.

    • Children and infants up to 4 years of age—Use is not recommended .
For dexchlorpheniramine

  • For regular (short-acting) oral dosage form (tablets or liquid):

    • Adults and teenagers—2 milligrams (mg) every four to six hours as needed.

    • Children 5 to 12 years of age—1 mg every four to six hours as needed.

    • Children 4 to 5 years of age—0.5 mg every four to six hours as needed.

    • Children and infants up to 4 years of age—Use is not recommended .

  • For long-acting oral dosage form (tablets):

    • Adults—4 or 6 milligrams (mg) every eight to twelve hours as needed.

    • Children 4 years of age and older—Use and dose must be determined by your doctor.

    • Children and infants up to 4 years of age—Use is not recommended .
For diphenhydramine

  • For oral dosage forms (capsules, tablets, or liquid):

    • Adults and teenagers—25 to 50 milligrams (mg) every four to six hours as needed.

    • Children 6 to 12 years of age—12.5 to 25 mg every four to six hours.

    • Children 4 to 6 years of age—6.25 to 12.5 mg every four to six hours.

    • Children and infants up to 4 years of age—Use is not recommended .

  • For injection dosage form:

    • Adults—10 to 50 milligrams (mg) injected into a muscle or into a vein.

    • Children 4 years of age and older—1.25 mg per kg (0.6 mg per pound) of body weight injected into a muscle four times a day.

    • Children and infants up to 4 years of age—Use is not recommended .
For doxylamine

  • For oral dosage form (tablets):

    • Adults and teenagers—12.5 to 25 milligrams (mg) every four to six hours as needed.

    • Children 6 to 12 years of age—6.25 to 12.5 mg every four to six hours as needed.

    • Children 4 to 6 years of age—Use and dose must be determined by your doctor.

    • Children and infants up to 4 years of age—Use is not recommended .
For fexofenadine

  • For oral dosage form (capsules):

    • Adults and teenagers—60 milligrams (mg) two times a day as needed or 180 mg once a day.

    • Children 6 to 11 years of age—30 mg twice a day as needed.

    • Children 4 to 6 years of age—Use and dose must be determined by your doctor.

    • Children and infants up to 4 years of age—Use is not recommended .
For loratadine

  • For oral dosage forms (tablets or liquid):

    • Adults and children 6 years of age and older—10 milligrams (mg) once a day.

    • Children 4 to 5 years of age—5 mg once a day.

    • Children and infants up to 4 years of age—Use is not recommended .
For phenindamine

  • For oral dosage form (tablets):

    • Adults and teenagers—25 milligrams (mg) every four to six hours as needed.

    • Children 6 to 12 years of age—12.5 mg every four to six hours as needed.

    • Children 4 to 6 years of age—Use and dose must be determined by your doctor.

    • Children and infants up to 4 years of age—Use is not recommended .

For nausea, vomiting, and vertigo (only dimenhydrinate and diphenhydramine are used for vertigo):

For dimenhydrinate

  • For regular (short-acting) oral dosage forms (tablets or liquid):

    • Adults and teenagers—50 to 100 milligrams (mg) every four to six hours as needed.

    • Children 6 to 12 years of age—25 to 50 mg every six to eight hours as needed.

    • Children 4 to 6 years of age—12.5 to 25 mg every six to eight hours as needed.

    • Children and infants up to 4 years of age—Use is not recommended .

  • For long-acting oral dosage forms (capsules):

    • Adults—1 capsule (contains 25 milligrams [mg] for immediate action and 50 mg for long action) every twelve hours.

    • Children 4 years of age and older—Use and dose must be determined by your doctor.

    • Children and infants up to 4 years of age—Use is not recommended .

  • For injection dosage form:

    • Adults—50 milligrams (mg) injected into a muscle or into a vein every four hours as needed.

    • Children 2 years of age and older—1.25 mg per kg (0.6 mg per pound) of body weight injected into a muscle or into a vein every six hours as needed.

    • Children and infants up to 4 years of age—Use is not recommended .

  • For suppository dosage form:

    • Adults—50 to 100 milligrams (mg) inserted into the rectum every six to eight hours as needed.

    • Children 12 years of age and older—50 mg inserted into the rectum every eight to twelve hours as needed.

    • Children 8 to 12 years of age—25 to 50 mg inserted into the rectum every eight to twelve hours as needed.

    • Children 6 to 8 years of age—12.5 to 25 mg inserted into the rectum every eight to twelve hours as needed.

    • Children 4 to 6 years of age—Use and dose must be determined by your doctor.

    • Children and infants up to 4 years of age—Use is not recommended .
For diphenhydramine

  • For oral dosage forms (capsules, tablets, or liquid):

    • Adults—25 to 50 milligrams (mg) every four to six hours as needed.

    • Children 4 years of age and older—1 to 1.5 mg per kg (0.45 to 0.7 mg per pound) of body weight every four to six hours as needed.

    • Children and infants up to 4 years of age—Use is not recommended .

  • For injection dosage form:

    • Adults—10 milligrams (mg) injected into a muscle or into a vein. Dose may be increased to 25 to 50 mg every two to three hours.

    • Children 4 years of age and older—1 to 1.5 mg per kg (0.45 to 0.68 mg per pound) of body weight injected into a muscle every six hours.

    • Children and infants up to 4 years of age—Use is not recommended .
For hydroxyzine

  • For oral dosage forms (capsules, tablets, or liquid):

    • Adults—25 to 100 milligrams (mg) three or four times a day as needed.

    • Children 6 years of age and older—12.5 to 25 mg every six hours as needed.

    • Children 4 to 6 years of age—12.5 mg every six hours as needed.

    • Children and infants up to 4 years of age—Use is not recommended .

  • For injection dosage form:

    • Adults—25 to 100 milligrams (mg) injected into a muscle.

    • Children 4 years of age and older—1 mg per kg (0.45 mg per pound) of body weight injected into a muscle.

    • Children and infants up to 4 years of age—Use is not recommended .

For Parkinson’s disease:

For diphenhydramine

  • For oral dosage forms (capsules, tablets, or liquid):

    • Adults—25 milligrams (mg) three times a day when starting treatment. Your doctor may increase the dose gradually later if needed.

  • For injection dosage form:

    • Adults—10 to 50 milligrams (mg) injected into a muscle or into a vein.

    • Children—1.25 mg per kg (0.6 mg per pound) of body weight four times a day injected into a muscle.

For use as a sedative (to help sleep):

For diphenhydramine

  • For oral dosage forms (capsules, tablets, or liquid):

    • Adults—50 milligrams (mg) twenty to thirty minutes before bedtime if needed.
For doxylamine

  • For oral dosage form (tablets):

    • Adults—25 milligrams (mg) thirty minutes before bedtime if needed.

    • Children 4 years of age and older—Use and dose must be determined by your doctor.

    • Children and infants up to 4 years of age—Use is not recommended .
For hydroxyzine

  • For oral dosage forms (capsules, tablets, or liquid):

    • Adults—50 to 100 milligrams (mg).

    • Children 4 years of age and older—0.6 mg per kg (0.3 mg per pound) of body weight.

    • Children and infants up to 4 years of age—Use is not recommended .

  • For injection dosage form:

    • Adults—50 milligrams (mg) injected into a muscle.

For anxiety:

For hydroxyzine

  • For oral dosage forms (capsules, tablets, or liquid):

    • Adults—50 to 100 milligrams (mg).

    • Children 4 years of age and older—0.6 mg per kg (0.3 mg per pound) of body weight.

    • Children and infants up to 4 years of age—Use is not recommended .

  • For injection dosage form:

    • Adults—50 to 100 milligrams (mg) injected into a muscle every four to six hours as needed.

    • Children 4 years of age and older—1 mg per kilogram (0.45 mg per pound) of body weight injected into a muscle.

    • Children and infants up to 4 years of age—Use is not recommended .

Missed Dose

If you miss a dose of this medicine, take it as soon as possible. However, if it is almost time for your next dose, skip the missed dose and go back to your regular dosing schedule. Do not double doses.


Keep out of the reach of children.

Store the medicine in a closed container at room temperature, away from heat, moisture, and direct light. Keep from freezing.

Do not keep outdated medicine or medicine no longer needed.

Portions of this document last updated: Sept. 01, 2021

Copyright © 2021 IBM Watson Health. All rights reserved. Information is for End User’s use only and may not be sold, redistributed or otherwise used for commercial purposes.


Can You Take More Than One Piriteze A Day? Here’s How To Get The Most Out Of Hayfever Meds

Hayfever season is the worst, with many of us staying in just to avoid itchy eyes, a runny nose, sneezing, coughing. Tree pollen is rife in May and June, while grass pollen takes hold in June and July, and weed pollen runs right through to September. While there are many tips and techniques to reduce symptoms, antihistamines such as Piriteze are recommended by the NHS and other health experts. But can you take more than one Piriteze a day?

In short, with most antihistamines, it’s best to take just one per day. Piriteze contains the antihistamine cetirizine, which targets everything from watery eyes to sniffly noses caused by allergies. It is a well known non-drowsy antihistamine, and is therefore a good choice for daytime use.

The NHS advises a daily dose of 10mg a day of cetirizine, whether it’s for hayfever season or to target a specific allergy when you experience symptoms. As Piriteze tablets come in 10mg doses, it is therefore only recommended to take a single tablet a day, rather than anything more. The dose may even be slightly less depending on your age (children will probably need to take less) and if you suffer from things like kidney problems, you will also have to alter your dosage (it’s best to ask your doctor in this case), the NHS says.

The NHS also explains that, if you miss a dose, you should not make up for it by taking a double dose. Instead, just take one and carry on as normal. They do note that taking more than the recommended dose is unlikely to hurt you, but you may experience side effects.


The most common (one in 100 people) side effects of taking cetirizine are the following:

  • feeling sleepy and tired
  • headaches
  • dry mouth
  • feeling sick (nausea)
  • feeling dizzy
  • stomach pain
  • diarrhoea
  • sore throat
  • cold-like symptoms of the nose
  • itching or a rash
  • tingling in your hands and feet
  • feeling agitated

Although it’s not recommended to take more than one oral antihistamine a day, the NHS does explain you can use the tablets alongside other hayfever treatments, such as steroid nasal sprays (Beconase, Rhinacort Aqua, and Flixonase Nasules are named) or eye drops.

When asked about combining remedies, Associate Clinical Director at Bupa Health Clinics Elizabeth Rogers says, “Different medical remedies for hay fever can help you to manage different hayfever symptoms. For example, antihistamines are best for watery eyes and sneezing, whereas nasal sprays can be more effective for a blocked or runny nose.”

However, she stresses that you should always check with your doctor before mixing medicines, and always make sure you’re following medical advice.

She adds, “There are lots of over-the-counter treatments for hay fever- so if one type isn’t working for you, try another.”

Piriteze tablets are active for 24 hours a day, meaning there is really no need for more than one in a day. While popping more than one antihistamine when things get bad seems tempting, it’s always safer to go with what the packet of your medication advises, and to speak to a doctor before doubling up.

Alternatively, if you suffer from terrible hayfever (I feel you), it’s worth stopping by your doctor’s office this season, as they can prescribe stronger antihistamines that can be potentially more effective than over-the-counter options.

It’s also worth noting that there are some non-medical remedies that can help. For one, increased face mask usage has led to reduction of allergic rhinitis (nose irritation caused by allergies) during the pandemic, according to a study published in The Journal of Allergy and Clinical Immunology: In Practice.

Speaking about other options Rogers says, “Wearing wraparound sunglasses or a mask can be effective in preventing pollen from coming into contact with your eyes and nose,” adding that applying barrier balms like Vaseline around the nostrils also help to prevent pollen from entering your nose. Adopting these solutions, alongside your Piriteze, can help you ensure you have a pollen-free rest of summer.

This article was originally published on

Using Zyrtec for Treating Hives and Allergies

Zyrtec (cetirizine) is an antihistamine in the class of drugs referred to as second-generation antihistamines. Antihistamines work by blocking histamines, chemical signals released by a type of cell in the immune system (mast cells) in order to alert other cells about a potential invader.

With allergies or hives, this is a case of mistaken identity in which the immune system is asked to respond to a harmless invader, such as tree pollen or dust mites. Zyrtec is recommended for children 2 years of age and older and adults. It is available as a tablet that can be swallowed, as a chewable tablet, and as a liquid.

Lode Kuylenstierna / EyeEm / Getty Images

First-generation antihistamines include medications such as Benadryl (diphenhydramine) and Vistaril/Atarax (hydroxyzine). These medications can be very effective for the treatment of hives or allergies but usually cause significant drowsiness which limits their use.

In addition to Zyrtec, other second-generation antihistamines include Xyzal (levocetirizine), Claritin (loratadine), and Allegra (fexofenadine).


Zyrtec is approved for the treatment of:

Zyrtec can be a good antihistamine for allergies and hives though it can cause sedation and fatigue in some people. These symptoms are usually milder than with the first generation antihistamines, but more pronounced than with medications such as Claritin or Allegra.

Overall, Zyrtec appears to be more effective for controlling allergies than Claritin or Allegra, but similar to Xyzal. However, every person with allergies is different, and it’s often impossible to predict which medication will work best for any one person.

Zyrtec vs. Other Allergy Medications

Multiple studies show that Zyrtec is better at treating hay fever and hives when compared to Claritin (loratadine) or Allegra (fexofenadine). Zyrtec works faster, is more effective, and lasts longer than these other antihistamines.

When used for hives, Zyrtec may work better than Claritin or Allegra but is similar in effectiveness to Xyzal (levocetirizine) and Clarinex (desloratadine). Zyrtec, however, is more likely than Claritin or Allegra to have the side effect of fatigue.

Before Taking

If you are coping with hay fever or hives it’s important to have a good relationship with your allergist. Some people try different medications while keeping an allergy journal as a way to see which medication works best for them specifically.

With children, it’s important to weigh the benefits of treatments (including better concentration during school) against the possible risks and side effects.

Your pediatrician can help you recognize when your child may or may not benefit from medications. With older children, it can be very helpful to involve them and include them in this decision-making process.

During pregnancy, it’s ideal if you don’t take any medications, but sometimes that is not possible. The runny nose associated with pregnancy combined with allergic rhinitis can be very uncomfortable.

Zyrtec During Pregnancy

During pregnancy, those with allergic rhinitis or hives may notice a worsening of their symptoms, an improvement, or things may stay the same. The important point is that your symptoms may change and it can be helpful to be prepared.

Zyrtec has a pregnancy category “B” rating, meaning that it is generally considered to be safe for people who are pregnant. In contrast, some allergy medications should usually be avoided during pregnancy include intranasal antihistamines and first-generation antihistamines (such as Benadryl).


The dosage of Zyrtec is 2.5 milligrams (mg)—which is equivalent to 1/2 teaspoon—for children 2 to 6 years of age, and 5-10 milligrams for those aged 6 years and older. Larger doses have not been shown to be more beneficial for the treatment of hay fever, but may be more useful for the treatment of hives in some people.

Zyrtec starts to work within an hour or so after taking the medication—making it useful for the as-needed treatment of hay fever and hives. Taking it daily, however, may result in better overall control of allergy symptoms. This is in contrast to some medications, particularly nasal steroid sprays, which need to be taken for some time to be effective.

Side Effects

Zyrtec has a low incidence of side effects and is usually well-tolerated. Common side effects include:

  • Sedation: Sleepiness occurs in around 14% of people
  • Fatigue: Fatigue occurs in roughly 5% to 6% of people
  • Dizziness
  • Dry mouth

Safe Use of Antihistamines

The Full Story

Are you one of the 50 million people in the U.S. with allergies? Do you suffer with coughing, sneezing, itchy and watery eyes, a runny nose, and a scratchy throat? If so, you may take antihistamines to treat your symptoms.

Allergens are things that cause an allergic reaction. Examples include pollen, dust, pet dander, even foods or medications. When an allergen enters your body, your body releases histamine. Histamine causes the familiar symptoms of allergies. Antihistamines relieve symptoms by blocking histamine.

A lot of different antihistamines are available. They fill the counters and prescription shelves at your local drug store. New ones seem to appear all the time. Antihistamines are found in many different forms for children and adults: liquids, tablets, creams, nasal sprays, and eye drops. They are also common ingredients in over-the-counter cold and cough products, along with decongestants, pain relievers and cough suppressants.

There are two main classes of antihistamines. They work in different ways and have different side effects.

  • The older first-generation antihistamines are also called sedating antihistamines. They cause much more drowsiness and fatigue than the newer antihistamines. (In fact, these antihistamines sometimes are used as sleeping pills.) Side effects can include dizziness, poor coordination, dry mouth, nausea and vomiting, blurred vision, and trouble urinating. One antihistamine in this group is diphenhydramine (Benadryl®). Others are brompheniramine (Bromfed®, Dimetapp®), hydroxyzine (Vistaril®, Atarax®) and meclizine (Antivert®).
  • The newer second and third-generation or non-sedating antihistamines are used much more frequently. Usually, they don’t cause drowsiness. Antihistamines in this group include cetirizine (Zyrtec®), loratadine (Claritin®), and fexofenadine (Allegra®). In high doses, these antihistamines can still cause drowsiness and rapid heart rate.

Some antihistamines may work better than others for your symptoms. It can be hard to find the one that works just right. If you are desperate (and still coughing and sneezing and itching), you may be tempted to take too much. BUT – it can be dangerous to take extra antihistamines. More is not better.

  • Do NOT “double-up” on a dose.
  • Do NOT take a dose sooner than you’re supposed to.
  • Do NOT take two different antihistamines at the same time.
  • Instead, talk to your doctor or pharmacist if you have trouble finding a drug that works well for your allergy symptoms.

Antihistamines are safe when used as directed. When used improperly, serious effects can occur. Be aware:

  • Taking too much can be harmful for children and adults. Be sure to check the label for the correct dose.
  • Some people abuse the sedating antihistamines trying to get “high”. This can cause seizures and hallucinations.
  • Some antihistamines are combined with pain medicine. Taking another pain medicine at the same time could cause an overdose.
  • Some antihistamines are combined with decongestants. Taking another decongestant at the same time could cause an overdose.

Follow these guidelines when using antihistamines:

  • Read labels carefully.
    • Some antihistamines should not be used for children. Make sure you are using a children’s product when giving antihistamines to your child.
    • Some antihistamines can interact with other medicines. Check with your doctor or pharmacist or call Poison Control and speak with a Specialist if you have questions.
    • Different products may contain the same ingredients. Taking them at the same time can be dangerous.
  • Take (or give) the right dose.
  • Lock antihistamines up high, where children can’t reach them. Children can drink liquid antihistamines, swallow too many pills, or even eat antihistamine creams. Severe poisoning can occur this way.

Not sure which antihistamine is best for you? For your child? Call your doctor or pediatrician. If you took too much, or gave too much to your child, use the webPOISONCONTROL® online tool for guidance or call Poison Control right away at 1-800-222-1222. Whether you use the online tool or call, you’ll be able to determine if treatment is needed. 

Serkalem Mekonnen, RN, BSN, MPH

Certified Specialist in Poison Information





HELP ME online

Prevention Tips

Follow these guidelines when using antihistamines.

  • Read labels carefully.
    • Some antihistamines should not be used for children.
    • Some antihistamines can interact with other medicines. Check with your doctor or pharmacist if you have questions.
    • Different products may contain the same ingredients. Taking them at the same time can be dangerous.
  • Take (or give) the right dose.
  • Lock antihistamines up high, where children can’t reach them. Children can drink liquid antihistamines, swallow too many pills, or even eat antihistamine creams. Severe poisoning can occur this way.

This Really Happened

Case 1: A 13-month-old 22-lb boy was discovered by his mom playing with an empty bottle of Unisom® gelcaps (diphenhydramine 25 mg). She estimated that about 20 gelcaps (1,000 mg of diphenhydramine) were missing, an extremely toxic amount even for a large adult. The child had a seizure at home before emergency medical services (EMS) arrived. He had three more seizures en route to the hospital and was given intramuscular sedation by EMS. The child arrived at the emergency room within 45 minutes of being found with the bottle. Shortly after arrival in the emergency room he seized again and was given intravenous sedation, which ended the seizure, and he seemed to be stable.

The child was admitted to the pediatric ICU for observation. About 3.5 hours after he was found with the medication bottle, he began having frequent seizures and developed a very fast heart rate and an abnormal heart rhythm. His blood pressure dropped and he had a high fever. A tube was placed to help him breathe. Many different medications were given, but he continued to deteriorate despite medical treatment, 11 hours after he swallowed the diphenhydramine.

Because of the particular hospital’s experience treating an adult patient with a diphenhydramine overdose with hemodialysis (blood flows through a special filter that removes poisons, and the clean blood is returned to the body), a team of physicians, including a toxicologist, decided that hemodialysis was a reasonable life-saving option for this small child.

He underwent two hemodialysis treatments. After the first, his seizures and abnormal heart rhythm resolved, though his heart rate was still slightly fast. After a second hemodialysis treatment, he was stable. The breathing tube was removed, and he was able to come off sedation and the medications that had been supporting his blood pressure. The child was transferred to a regular medical floor on hospital day 3. He was discharged to home without any further problems on hospital day 4.

Reference: McKeown, N.J., West, P.L., Hendrickson, R.G., & Horowitz, B.Z. (2011). Survival after diphenhydramine ingestion with hemodialysis in a toddler. Journal of Medical Toxicology, 7(2), 147-150.

Case 2: Both the mom and dad of a toddler gave the child a teaspoon of Children’s Benadryl within twenty minutes of each other. Though the 25 mg total dose of diphenhydramine was more than he needed for his allergies, it was not enough to cause a serious problem based on his age and weight. Poison Control recommended giving him fluids to drink and observing at home. The child was fine.

Case 3: An adult male was prescribed hydroxyzine (Atarax®), an antihistamine that causes drowsiness, to help him sleep. He took twice the dose recommended by his physician due to trouble sleeping. Instead of becoming drowsy, he was quite restless. He called Poison Control in the middle of the night and was advised that antihistamines may sometimes cause restlessness instead of drowsiness, especially in higher doses. Poison Control recommended that he speak with his doctor about an alternative medication for sleep.

90,000 Articles New Pharmacy Kaliningrad

Well, who doesn’t rejoice at the arrival of the long-awaited spring? Moreover, summer is already very close. But, unfortunately, this time is the most difficult for allergy sufferers. We want to bring to your attention an article on precautions and help to get through this difficult time.

Allergy to pollen – hay fever (from pollen – “pollen”) – perhaps the most common allergic disease. It is familiar today to at least every tenth inhabitant of the Earth.And according to some sources – even one in five! In Russia, according to official statistics, up to 15% of the population (adults and children) suffer from this type of allergy.

There are many names for this disease – “hay fever”, “spring catarrh”, pollen allergy, hay fever. But in essence they are all the same. Today, hay fever is defined as an allergic disease that is caused by an inadequate response of the human immune system to pollen. Pollen from flowering plants from the surrounding air settles on the mucous membrane of the nose, eyes and mouth, enters the bronchi, contacts the skin and causes allergy symptoms in sensitive people.
This disease, on the one hand, is not new – one of the first mentions of a disease similar to pollinosis dates back to the 2nd century AD. NS. and is associated with the healer Galen. But Galen, most likely, in his entire life had a chance to treat a single patient who “sneezed” on antique trees, because then it was probably an extremely rare and strange disease. The term “hay fever” still used today was introduced in 1819 by the English scientist and physician John Bostock. In 1873, the Scottish physician Bleckle established a link between the symptoms of seasonal allergies and pollen.At the beginning of the 20th century, about 1% of the population of Europe already suffered from hay fever, and then every decade the ranks of “seasonal sufferers” began to arrive …

The main distinguishing feature of hay fever is its stubborn periodicity! That is, if a person every year at about the same time (plus or minus a week or two, if, for example, spring is early or, on the contrary, late) begins to sneeze regularly, “cry” (eyes redden, itch, tear) and to squish (it pours out of the nose, you have to carry several scarves with you), there is every reason to talk about hay fever.
Moreover, all these ailments can be present either alone or in combination, in any combination. Difficulty breathing (shortness of breath and choking), wheezing in the chest, coughing, skin rashes (urticaria or eczema) are often added to them. Everything else is already a consequence and, one might say, “trifles”: irritability and fatigue, poor sleep and appetite, unstable mood (sometimes sadness to tears, then apathy, then excitement).
Unfortunately, allergy is a disease associated with a violation of the immune system.From here we proceed … The less a person is in the fresh air, the less active lifestyle he leads, the more “irrational” he eats, the weaker his immunity, if you do not have the opportunity to walk every day, you need to help your immunity, Echination preparations (Immunal, Immunal Plus), Eleutherococcus (tablets, tincture), Karniton (tab.), Etc. Specialists of the New Pharmacy network will help you decide on the choice and price.

So, with the beginning of spring, the plants begin to bloom. More precisely – not to bloom, but to “dust”, since there are no flowers in our usual understanding on trees.Moreover, trees “harm” allergy sufferers much more even before leaves appear on the branches.
In addition, keep in mind that hay fever tends to combine with food allergies – do not be surprised if after some time and outside the flowering period of birch a painful runny nose overtakes you after you eat an apple! So, be sure to find out what foods your type of hay fever “intersects” with, and immediately start following a diet!
The concentration of pollen in the atmosphere is related to air temperature, atmospheric pressure and wind speed.In dry and warm weather, plants become more dusty and allergy symptoms worsen. On cold, rainy and calm days, much less pollen is emitted, and allergy sufferers get some respite. You should know that in the early morning hours, the intensity of plant dusting is maximum, by the evening it decreases and is minimal at night. In most European countries, “dangerous” doses of pollen in the air are reported daily on radio and television. But we haven’t come to that yet.

Any allergist will tell you that the first rule in the treatment of hay fever is to try to avoid contact with allergens.The ideal option is to take a vacation and go to another region. To the south or north. If you have nowhere to go, take action at home:
• Do not open windows and doors. Go to bed with closed windows.
• On the street, be sure to wear glasses – at least to protect your eyes from direct contact of pollen on the mucous membrane.
• Ventilate the area after rain, in the evening and when there is no wind. On open windows and vents, you can hang well-moistened sheets or gauze in several layers. If possible, try not to go outside early in the morning and on dry, hot days, when the concentration of pollen in the air is highest.It is recommended that you change your clothes on your return from the street.
• Shower at least twice a day. Shower immediately after returning from the street. Be sure to wash your hair.
• Purchase an air purifier or air conditioner.
• Daily nasal toilet, in the network New pharmacy you can buy Aquolor, Aquamaris, Marimer – isotonic solution of sea water, at affordable prices; wash your eyes and gargle with saline sodium chloride solution (1/3 teaspoon of table salt in a glass of warm boiled water), which can also be purchased at all pharmacies in our network!
• Do not dry your clothes outside (on the balcony) after washing, as pollen will settle on them.Carry out a wet cleaning in the apartment every day.

The sooner you see your doctor, the better your chances of recovering or stopping the progression of the disease.

To be treated !!!
Antihistamines are inevitable to survive the coming flare-up season. Moreover, if you want to get through this time as calmly as possible, you should have started taking medications already yesterday. Do not hope that it will “get by”.
It is best if your medication is prescribed by an allergist. Because in many cases “one tablet” is not enough and it is necessary to combine – tablets and spray or tablets and drops.
Available in tablets and syrup, nasal spray and eye drops. You can use these medicines both to prevent the development of allergy symptoms and to relieve existing symptoms.
The most famous are Suprastin, Tavegil, Diazolin, Fenkarol, Peritol and other prescription drugs of the first generation of antihistamines. The most unpleasant drawback of these drugs is their hypnotic effect, so it is not recommended to drive a car when taking such drugs.Suprastin, Tavegil enhance the effect of alcohol.

Modern antihistamines also include tablets Zyrtec, Telfast, Kestin, Claritin, drops for children and adults Fenistil, Zyrtec, gel and ointment for external use Fenistil, Gistan and much more, which are dispensed without a doctor’s prescription and are freely available in New Pharmacy.

Topical antihistamines are Allergodil (spray) and Histimet (drops and spray). These drugs are effective for allergic eye and nose infections.

Allergenic plants flowering calendar
End of March – snowdrop, alder.
April – hazel, birch (the most powerful allergen).
End of April – willow, poplar, elm, ash, maple.
May – oak, lilac, apple tree, conifers, dandelion.
End of May – foxtail, mint.
June – timothy, fescue.
July – August – wormwood, plants of the Asteraceae family, buckwheat, nettle, plantain, sorrel.

With care, your New pharmacy!

In the USA, allergists and pediatricians prefer ZIRTEK *

ZIRTEC / Zyrtec (cetirizine hydrochloride) by UCB Pharma (marketing rights in Ukraine belong to the representative office of Solway Pharmaceuticals GmbH) is the No. 1 drug for the treatment of allergic diseases in the USA.It is actively used due to its high efficiency, favorable safety profile and wide range of indications. Patients receiving a quick and long-term reduction in the severity of allergy symptoms with ZIRTEC maintain adherence to such treatment (see below). In addition, ZIRTEK is a drug for the whole family, starting with the smallest (in Ukraine it is prescribed to children from 2 years of age, in the USA, Russia, Mexico – from 6 months) to the elderly. Therefore, for many families in which the problem of allergies is urgent, the drug may be a necessary component of a home first-aid kit.

Timely initiation of treatment for allergic diseases is very important. It can prevent an increase in the severity of pathology (the so-called allergic march – from food allergies to bronchial asthma), the development of complications, and also improve the prognosis of an existing disease. Unfortunately, allergy symptoms (runny nose, sneezing, watery eyes, redness of the skin and mucous membranes, hives, etc.) are just the tip of the iceberg.Allergic diseases such as bronchial asthma, atopic dermatitis and allergic rhinitis, even during the period of clinical remission, are characterized by the presence of a chronic inflammatory process, therefore, the patient should receive anti-inflammatory therapy not only during the exacerbation period.

The fact is that in patients with allergies, the so-called minimal persistent inflammation, supported by the intake of allergens into the body, practically does not stop. It is characterized by leukocyte infiltration (eosinophils and neutrophils), expression of intercellular adhesion molecules (Lokshina E.E., Zaitseva O.V., 2006). This pathological process is also responsible for the formation and enhancement of allergen-specific tissue hyperreactivity, expressed in an increase in sensitivity not only to a specific allergen, but also to various nonspecific irritating influences – smoke, pungent odors, etc. (Gushchin I.S., 2007).

Not everyone knows that the antihistamine ZIRTEK, in addition to inhibiting the early phase of the allergic reaction (release of allergy mediators), inhibits the attraction of eosinophils, neutrophils and basophils to the allergic reaction zone, thus reducing the severity of allergic inflammation.These effects of the drug are not accompanied by a central effect, which is confirmed by psychometric tests and ECG data. In this way, ZIRTEK compares favorably with antihistamines of the first generation, which act for a short time (1.5-2 hours), become addictive after 7-12 days, are characterized by anticholinergic and antiserotonergic effects (drowsiness, fatigue or agitation, impaired coordination of movements, concentration of attention, dizziness , increased appetite).

Methods of application and dosage of ZIRTEK

Form Children 2-6 years old Children from 6 years old and adults
Oral drops 5 drops (2.5 mg) 2 times a day or 10 drops (5 mg) once 10-20 drops (5-10 mg) once a day (daily dose – 10 mg, 20 drops)
Tablets ? 1 tablet (10 mg) once a day

The advantage of ZIRTEC over other drugs in this group is that it has a selective blocking effect on histamine receptors without prior metabolism in the liver.The drug is generally slightly transformed in the liver, and, unlike other potentially cardiotoxic antihistamines metabolized by the P450 enzyme, it does not cause ECG changes and side reactions from the cardiovascular system. This is also important from the point of view that the effectiveness of the drug does not depend on the activity of the P450 enzyme, which is often impaired. ZIRTEK does not interact with other drugs such as erythromycin, ketoconazole, cimetidine, diazepam.

Summarizing the data available today on the anti-inflammatory activity of ZIRTEK, one can single out the following effects:

  • Stabilizes mast cell membranes. Suppresses the action of other mediators and inducers of histamine secretion, such as PAF and leukotrienes
  • Reduces the expression of adhesion molecules (ICAM-1, VCAM-1)
  • Prevents the accumulation of pro-inflammatory mediators in the mucous membrane of the nose, bronchi, eyes, etc.
  • Inhibits the late phase of migration of cells involved in the inflammatory response of eosinophils, neutrophils and basophils to target organs
  • Reduces adhesion of PAF-induced eosinophils on endothelial cells
  • Deactivates eosinophils
  • Reduces the superoxide potential of eosinophils
  • Reduces capillary permeability, prevents the development of tissue edema, eliminates spasms of smooth muscles
  • Reduces histamine-induced bronchoconstriction in mild bronchial asthma
  • Eliminates skin reactions to the introduction of histamine, specific allergens, as well as to cooling (with cold urticaria).

So, ZIRTEK is an antiallergic antihistamine, a selective antagonist of H 1 -receptors, which does not have a pronounced anticholinergic and serotonin effect.

ZIRTEK does not penetrate the blood-brain barrier, inhibits the early phase of the allergic reaction, and also reduces the migration of inflammatory cells, inhibits the release of mediators that are involved in the late phase of the allergic reaction.

In addition, ZIRTEC significantly reduces the hyperreactivity of the bronchial tree, which occurs in response to the release of histamine in patients with bronchial asthma.

The drug is indicated for all allergic diseases based on immediate hypersensitivity:

  • seasonal and perennial allergic rhinitis accompanied by rhinorrhea, itching, sneezing, allergic conjunctivitis;
  • dermatoses occurring with itching and rashes;
  • urticaria, including chronic idiopathic;
  • Quincke’s edema.

The protective effect of ZIRTEK against the “allergic march”, established in the studies of ETAC (Warner J.O. et al., 2001; Ciprandi G. et al., 2003), more pronounced compared to ketotifen (Belan E.B., 2006), which is consistent with the data on its greater anti-allergic and anti-asthmatic efficacy (Miyamoto T. et al., 1994).

In the aforementioned ETAS study, the efficacy and safety of ZIRTEC was studied. The results of the study after 18 months indicate that treatment with ZIRTEK, begun between the 1st and 2nd years of life of children with atopic dermatitis sensitized to grass pollen or house dust, significantly reduces the number of cases of subsequent bronchial asthma – by 50% in those sensitized to grass pollen and 40% in those sensitized to house dust.Thus, ZIRTEK prevents the development of typical atopic bronchial asthma in children at high risk of developing it.

18-month follow-up showed that sensitized children in the placebo group were very likely to develop asthma at the end of 18 months and increased during the 18-month post-treatment period.

In children who received ZIRTEK, the risk of developing bronchial asthma continued to decrease over the next 18 months.

There were no clinically significant differences in neurological or cardiovascular status between the groups of children treated with ZIRTEC and placebo.It was concluded that the use of ZIRTEK prevents or delays the development of bronchial asthma in every second child from the high-risk group – with atopic dermatitis, aggravated by heredity and sensitization to plant pollen and house dust mites. The use of ZIRTEK in children with atopic dermatitis increases the effectiveness of the therapy while reducing the need for corticosteroids.

According to the results of a double-blind, placebo-controlled, randomized study, long-term therapy with ZIRTEK in a daily dose with a single dose can reduce the risk of expanding the spectrum of sensitization in children with monovalent allergies (Giprandi G., 2003).

In a comparative study of ZIRTEK and loratadine with the determination of an effective dose in eliminating a skin reaction to histamine (Ramboer L. et al., 2000), it was noted that to reduce the area of ​​hyperemia by 50%, a dose of loratadine 7 times greater was required compared to ZIRTEK through 2 hours, 9 times more after 4 hours and 8 times more after 6 hours after ingestion.

In a comparative study of the pharmacodynamics of antihistamines, ZIRTEK 10 mg 1 time per day, fexofenadine in doses of 120 and 180 mg were used.In contrast to placebo, all three treatments clearly reduced flushing and papules over 24 hours. However, a decrease in skin surface lesions with ZIRTEK was expressed by more than 50% over 24 hours.

The results of the study showed that ZIRTEK has a more pronounced and long-term antihistamine effect than fexofenadine (120 and 180 mg), while eliminating the skin reaction to histamine within 24 hours after taking the drug (Purohit A., 2001).

Another double-blind, randomized, placebo-controlled, crossover study compared the ability of various second-generation H 1 receptor inhibitors over 24 hours to suppress histamine-induced blistering and flushing in healthy men (Allergy, January, 1999).

4 hours after taking cetirizine, terfenadine, fexofenadine, epinastine, ebastine and loratadine, the area of ​​the affected surface decreased, respectively, by 97; 89; 80; 75; 58 and 53% relative to indicators before taking drugs. ZIRTEK was superior to all other drugs in terms of effectiveness.

So, ZIRTEK is a well-studied innovative second-generation antihistamine, effective in a wide range of allergic diseases. In addition to the pronounced and rapid (within 20-60 minutes) relief of allergy symptoms, with prolonged use, the drug exhibits additional antiallergic effects.In this regard, the change in the tactics of its appointment (from situational to permanent for a long time) is considered as a possible measure for the prevention of “allergic march”, that is, the development of bronchial asthma (Ikura Y. et al., 1992; Bustos GJ et al., 1995 , Warner JO et al., 2001).

The efficacy and good tolerance of ZIRTEKA determine the high adherence of patients to treatment: according to the survey, out of 180 thousand respondents, 95% of patients who were prescribed the drug did not refuse to take it ( www.zyrtec.comrel = “nofollow” target = “_blank”> ). This, as well as a number of other advantages that favorably distinguish ZIRTEC from other antihistamines, allowed the drug to take a leading place in the arsenal of doctors and for a long time to attract the attention of researchers who are discovering new aspects of its effectiveness and safety.

The authoritative studies presented, as well as the accumulated experience of using the drug ZIRTEK (cetirizine hydrochloride), make it possible to recommend it for long-term use in patients with protracted allergic dermatitis, allergic rhinitis, conjunctivitis, and also to use the drug as a prophylaxis for the development of bronchial asthma in children at high risk.o

Elena Gutsalo,
Daria Polyakova

All the above studies were carried out using the original drug ZIRTEC (cetirizine hydrochloride) and belong to UCB Pharma.

Exclusive marketing and sales rights in Ukraine belong to the representative office of Solvay Pharmaceuticals GmbH in Ukraine.

* According to IMS Health, Zyrtec / Zyrtec is the most prescribed drug for allergy treatment by allergists and pediatricians in the United States (by the number of new appointments in 12 months to September 2006).).


Clinical studies have shown that the use of cetirizine in recommended doses leads to the development of minor undesirable effects on the central nervous system including drowsiness, fatigue, dizziness, and headache. In some cases, paradoxical stimulation of the central nervous system was recorded.

Despite the fact that cetirizine is a selective blocker of peripheral h2-receptors and has practically no anticholinergic effect, isolated cases of difficulty urinating, disturbances of accommodation and dry mouth have been reported.

Abnormal liver function has been reported, accompanied by an increase in hepatic enzyme activity and bilirubin levels. In most cases, the adverse events resolved after discontinuation of cetirizine.

List of adverse reactions

Data are available from double-blind controlled clinical trials comparing cetirizine and placebo or other antihistamines used at recommended doses (10 mg once daily for cetirizine) more than 3200 patients, from which a reliable analysis of safety data can be carried out.

According to the results of the pooled analysis, in placebo-controlled studies using cetirizine at a dose of 10 mg, the following adverse reactions were identified with a frequency of 1.0% or higher

Adverse reactions

(WHO terminology) Cetirizine 10 mg

(n = 3260) Placebo

(n = 3061)

General disorders and disorders at the injection site



9000 95%

Nervous system disorders





0.9218 8.07%

Disorders from the gastrointestinal tract

Abdominal pain

Dry mouth







Mental disorders




Thoracic and respiratory system disorders




Although the incidence of drowsiness in the cetirizine group was higher than that in the placebo group, in most cases this adverse event was mild or moderate severity.In an objective assessment carried out in the framework of other studies, it was confirmed that the use of cetirizine at the recommended daily dose in healthy young volunteers does not affect their daily activity.


In placebo-controlled studies, in children aged 6 months to 12 years, the following adverse reactions were identified with a frequency of 1% or more:

Adverse reactions

(WHO terminology ) Cetirizine

(n = 1656) Placebo

(n = 1294)

Gastrointestinal disorders



, 6%

Mental disorders




Respiratory system, chest and mediastinal disorders



General disorders and disorders at the injection site




Experience of post-registration use

In addition to the adverse events identified during clinical trials and described above, were observed in the framework of post-marketing use of the drug the following adverse reactions.

Adverse events are presented below according to the classes of the MedDRA organ system and the frequency of development, based on the data of post-registration use of the drug.

The incidence of adverse events was determined as follows: very often (? 1/10), often (? 1/100, <1/10), infrequently (? 1/1000, <1/100), rarely

(? 1/10000, <1/1000), very rare (<1/10000), frequency unknown (due to insufficient data).

Disorders of the blood and lymphatic system:

Very rare: thrombocytopenia

Disorders of the immune system:

Rare: hypersensitivity reactions


very rare

Metabolic and nutritional disorders:

Frequency unknown: increased appetite

Mental disorders:

Uncommon: agitation

Rarely: aggression, confusion 902

Very rare: tic

Frequency unknown: suicidal ideation, sleep disturbances (including nightmares)

Nervous system disorders

Uncommon: paresthesias

Rarely 19: Seizures 9000 : and taste disturbance, dyskinesia, dystonia, fainting, tremor

Frequency unknown: memory impairment, including amnesia, deafness

Visual impairment

Very rare: accommodation impairment, blurred vision, nystagmus

Frequency unknown: vasculitis

Hearing disorders and labyrinth disorders

Frequency unknown: vertigo

Heart disorders

Rarely: tachycardia 0 -intestinal tract

Uncommon: diarrhea

Disorders from the liver and bile ducts

Rare: liver failure with changes in liver function tests (increased activity of transaminases, alkaline phosphatase and gamma lrubs) 902 19

Frequency unknown: hepatitis

Disorders of the skin and subcutaneous tissues

Uncommon: rash, itching

Rare: urticaria

Frequency unknown: acute generalized exanthematous pustulosis

Renal and urinary tract disorders

Very rare: dysuria, enuresis

Frequency unknown: urinary retention

9000 -muscular system disorders and connective tissue:

Frequency unknown: arthralgia

General disorders

Uncommon: asthenia, malaise

Rarely: peripheral edema

laboratory results

Rarely: increased body weight

Description of individual adverse reactions

After discontinuation of cetirizine, there were cases of itching, including intense itching and / or urticaria.

If you have any side effects indicated in the instructions or they are aggravated, or you notice any other side effects not listed in the instructions, inform your doctor.

Frequently asked questions – GUZ TO Tula Regional Clinical Hospital

The head of the blood gravitational surgery department of the Tula Regional Clinical Hospital, doctor of the highest qualification category, Alexander Ilyich KHASBIULIN, tells about the methods of blood purification.

Usually, doctors refer patients to the gravity surgery department who are not helped by traditional methods of treatment. There is no effect from the drugs – there is still hope that after the blood has been purified, the matter will get off the ground. It has been noticed that virtually any disease is cured faster if blood purification is carried out simultaneously with therapy. If you are often ill, suffer from diseases of the respiratory system, cardiovascular system, sinusitis, boils, skin diseases, etc., blood cleansing can help you.

You ask, is it possible to clean the blood just like that, for prevention? If the tests are good and the person is not worried about anything, then the doctor will not undertake this procedure. After all, blood purification is considered an operation.

With the help of purification, all “unnecessary” and “harmful” components are removed from the blood: inflammation, allergens, toxins, etc. This improves the rheology of the blood (it becomes less dense), the blood supply to the body. The person does not experience any sensations.The only painful factor is an injection into a vein.

There are 4 ways to purify blood.


WHAT IS THE ESSENCE. The filter separates the blood into its liquid part (plasma) and cellular composition (erythrocytes, leukocytes, platelets). Reasonable amounts of plasma are removed along with the “harmful” components it contains. The rest is mixed with a special solution and pure blood is injected back into the body. The plasmapheresis procedure allows you to improve the properties of blood, increase sensitivity to drugs, and increase immunity.

The patient lies on the bed, he is punctured by two peripheral veins in his arms. From one vein, the blood is pumped into the filter by a roller, where it is purified, the blood returns to the other vein. The procedure lasts from an hour to one and a half. It happens that one time is enough for a patient to completely cleanse the blood. Some people undergo 2-3 plasmapheresis procedures.

INDICATIONS: bronchial asthma, pneumonia, hypertension, coronary heart disease, high cholesterol, rheumatoid arthritis, lupus erythematosus, multiple sclerosis, myosthenia, angioedema, drug allergies, urticaria, psoriasis, neurodermatitis, eczema and many others.


WHAT IS THE ESSENCE. This is a method of purification using blood contact through a carbon sorbent. The sorbent is able to cleanse the blood not only from poisons that come from the external environment, but also from those that are formed in the body in various diseases.

As with plasmapheresis, the patient is punctured by two veins in the arms. From one vein, blood is pumped into a vessel with special charcoal. The charcoal is round in shape, some jokingly call it “black caviar”.The coal is very dense, covered with a shell on top, and on it the pores are small, medium and large. It is through these pores that the blood is filtered. The procedure takes about 1 hour.

Now scientists are developing selective methods of blood purification by the method of hemosorption, in which only what is needed for each specific patient could be taken from the blood. For example, with high cholesterol – only cholesterol, with high bilirubin – bilirubin.

INDICATIONS: for various poisoning, acute and chronic renal and hepatic failure, bronchial asthma, pancreatitis, diabetes mellitus, pyoderma, eczema, allergic reactions, etc.


WHAT IS THE ESSENCE. This is ultraviolet blood irradiation. The rays that purify the blood are more like sun rays, which heal. Has a bactericidal effect on the blood.

This method punctures one vein. The blood passes through an ultraviolet lamp, thus being exposed to ultraviolet rays. The procedure takes 20-30 minutes.

INDICATIONS: boils, acne, tonsillitis, otitis media, sinusitis.A good method for detoxifying the body, staphylococcus dies from it. UV blood has an immunostimulating effect on the body.



PROCESS. One vein is punctured, a light guide is placed in the needle. It acts on the blood inside the vessel. Thus, intravascular laser treatment of blood takes place.

INDICATIONS. Herpes, allergic diseases, cardiovascular diseases, respiratory diseases, colds.


Over 70 years of age. However, according to emergency indications, procedures are carried out.

Low protein (hypoproteinemia).

Low hemoglobin (below 80 g per liter).

Low pressure (80×60).

If there are diseases that can cause bleeding (stomach ulcer, bleeding fibroids).

DID YOU KNOW THAT … … The Department of Gravitational Surgery has existed in the Tula Regional Clinical Hospital since 1987.However, earlier only the most severe, intensive care patients were treated here.


6 liters of blood in the body of an adult. Its main part is made up of red blood cells – erythrocytes. In women, one cubic millimeter of blood contains an average of 4.8 million red blood cells, in men – 5.4 million. In total, 25 trillion red blood cells circulate in the human body. If they could be stacked tightly to each other, they would occupy an area equal to 3800 square meters.If you put them side by side, then you get a tape with a length of 187 thousand kilometers.

Recommendations after dental implantation – Dentistry Atlant

  • Firstly, any surgical intervention SHOULD be painful in the first hours. In this regard, you will need to take painkillers “in advance”, without waiting for the pain to develop to the level of “severe”. From our practice, with a simple implantation, on average 1-2 tablets of anesthetic after surgery are enough.During reconstructive operations (bone augmentation, gums), pain can last for the first two days. Regarding which pain pills or injections are best to take, our doctors will answer consultations. We note unequivocally that you CANNOT take KETOROLAC, KETANOV and aspirin-containing drugs. They increase the bleeding in the wound, which will lead to bleeding, bruising and sleepless nights !!! Otherwise, you can take any pain pills or injections…. as much as necessary to eliminate pain, CONSIDERING the instructions for use of the drug you have chosen and its individual intolerance!
  • Secondly, as a rule, there is no edema after simple implantation, but edema of varying severity can be considered normal.This is a consequence of surgical intervention and it has its own physiological characteristics: up to 3 days, the edema increases, from the fourth day it begins to decrease on its own. To reduce the severity of edema, it is necessary to apply something cold, wrapped in several layers of towels, in the area of ​​the operation during the first 4 – 5 hours after the surgery (hold for 15-20 minutes and take a break for 30-40 minutes).
  • Minor bleeding may occur for several days after the intervention.In the presence of severe bleeding, the following is necessary: ​​measure blood pressure and immediately contact the clinic by phone 8 (4012) 34-33-24. In the vast majority of cases, bleeding from a wound is a consequence of an increase in blood pressure. It is necessary to reduce it by all means available to you. If this does not help, it is necessary to call an ambulance or get to the clinic where the operation was carried out. Also, during the period of increased bleeding, you need to bite a gauze swab in the area of ​​intervention (not paper and not cotton wool !!!).
  • Take your prescribed drugs without changing the dosage regimen. If you have any side effects from the drugs used, you must urgently contact your doctor.
  • After the operation (up to the removal of stitches from the surgical wound), food should be soft, does not require chewing, not hot, and include a sufficient amount of liquid and nutrients.
  • Physical activity should be reduced for 7-10 days after surgery.Exclude visits to: baths, saunas, swimming pools, fitness and any other events where you can provoke a rise in blood pressure.
  • For 7-10 days after surgery, you should gently rinse your mouth with warm water after each meal. Daily brushing of your teeth should be gentle so as not to damage the tissues in the area of ​​the operation. Sometimes it is recommended to use a disinfectant solution prescribed by the attending physician (according to the instructions), but not rinsing, but irrigation of the oral cavity or bath.
  • Smoking and drinking alcohol in the pre- and postoperative periods can reduce the effect of treatment and increase the likelihood of complications. In this regard, the use of alcohol is completely excluded for the period: 5 days before the operation and 14 days after the operation and to minimize the use of tobacco products for the same period as much as possible.
  • Suture removal is performed 7-14 days after the operation (provided that the suture material does not dissolve on its own).
  • Patients after a sinus lift, during the first two weeks, are prohibited from sniffing, blowing their nose sharply, flying on an airplane, diving (creating a discharged or increased air pressure in the nose).This creates a threat of rupture of the mucous membrane in the maxillary sinus and material migration through the sinus or in the soft tissues of the cheek, which will lead to the development of sinusitis and infection of the implant. In case of accumulation of mucous secretions in the nose, it is recommended to smoothly empty the nasal cavity with exhaled air.


  • In the first few hours after surgery, your gums may hurt and swell. The edema is well removed with ice, which is applied to the cheek through a layer of tissue (towel); ice also reduces pain.
  • Possible increase in edema. The swelling develops maximally on the third day. Bruises may appear. The swelling and bruising will go away on its own.
  • The pain symptom is normal after any surgical intervention, it is necessary to use pain relievers ahead of time (immediately, when the first pain sensations appear).
  • Anesthetic drug: Analgin, Pentalgin, Sedalgin, Ibuklin and others. DO NOT: Ketarolac, Ketanov, aspirin-containing and others (give bleeding).
  • Slight bleeding is normal during the first hours after surgery, and saliva may be pinkish for several days. The bleeding may last longer if you have high blood pressure or if you are taking blood thinners or aspirin the other day. If severe bleeding continues on the first day or any bleeding on the second day, see your doctor.
  • The corners of the mouth may become dry and chapped. Moisten them with ointment.Possible exacerbation of herpes.
  • For posterior oral surgery, opening the mouth wide may be difficult for three days after removal, but should improve every day. The throat may hurt slightly and the temperature may rise.


  • Severe and prolonged pain that cannot be relieved by pain medication.
  • Bleeding for more than 30 minutes or heavy bleeding with a lot of scarlet blood.
  • Numbness of the skin on the face, lasting more than 2 days after the end of the operation.
  • Severe edema making it difficult to swallow, breathe and / or open the mouth.
  • Body temperature over 38 C.

Ask an allergist a question – Questions and answers

Hello Julia!

It is always difficult to answer unfamiliar, non-native patients, because there is no common language, so I will try not to disappoint you:

1) Lactase deficiency – a condition not related to food allergies, is well compensated by a decrease in the proportion of milk sugar (lactose) in the daily diet of a person.Accordingly, unpleasant symptoms (gas, colic, “like constipation” despite the fact that the stool is liquid, frothy, green, with a sharp sour odor) disappear in babies when milk is replaced with complementary foods or when the enzyme lactase is added to each portion of milk. Many adults also have problems with lactose and lactase deficiency, finding an intuitive way out – “dislike” for unleavened milk, cream, ice cream, etc., while they can usually afford dairy products.

2) If by the age of 3 years the baby has not only symptoms from the gastrointestinal tract (see p.1), but also some manifestations of “allergy to milk and beef-veal-venison”, then we are probably talking about dermatitis or allergic rhinitis or asthma or anaphylaxis (they can be combined or replace each other) and about allergy to milk proteins (and not sugar). Here, the reaction mechanism is immune, sometimes it is associated with specific IgE (and this option is the most unpleasant, dangerous, not inclined to pass with age), sometimes it is not (due to non-IgE mechanisms, for example, cellular mechanisms of allergy).Conclusion: you need an allergy examination and discussion of the results with a doctor who knows and leads your child. The cherished “certificate that the kindergarten requires” can be the result of such a visit to the doctor.

3) The most informative and accurate answer to the question of whether the IgE mechanism of allergy is really hidden behind the symptoms is ImmunoCAP or Immulite to cow’s and goat’s milk, casein, beef and soy – f 2. f300. f78. f 27. f14 (this is the survey code). I hope that such testing is available in your city.

4) Treatment of dermatitis. rhinitis. asthma is not limited to a single recommendation to “eliminate the culprit and the cross-products.” Therefore, it makes sense to find a doctor who will tell, advise, teach and inspire you to do more for the health of your son or daughter. Let the little person have a big support group!

Modern possibilities for the treatment of pollinosis in children


Alexander Sergeevich Trukhmanov , Professor, Doctor of Medical Sciences:

– We turn to an extremely urgent problem, especially now – to allergology.I am pleased to give the floor to Professor Olga Vitalievna Zaitseva with the report “Modern possibilities for the treatment of hay fever in children.”

Olga Vitalievna Zaitseva , Professor, Doctor of Medical Sciences:

– Dear colleagues! Indeed, this was the most pressing problem of spring – hay fever. Today I would like to discuss with you the problem of modern possibilities of therapy for such a frequent and serious illness. Serious quality of life for patients, both adults and children.

Pollinosis is an allergic disease caused by pollen of plants, and not just plants, but wind-pollinated plants. This is a very common problem facing our patients and doctors – not only allergists, but also pediatricians and therapists.

The frequency of hay fever depends on the area where people live, and, of course, on the hereditary predisposition to the development of allergies. There are regions in the world where almost half of the population has allergic problems during plant pollination.In our country, the frequency of hay fever ranges from 12% to 17%. Of course, it depends on the region where people live.

Allergic reactions of the first type, the so-called atopy, are the cornerstone of hay fever. All of this is now well understood.

The first mention of hay fever was at the beginning of the 19th century, when John Bostock linked the disease to hay and called it “hay fever.” At the end of the 19th century, pollen was proven to be the cause of hay fever.

But modern ideas about the pathogenesis, etiology and course of the disease occurred in the second half of the twentieth century.The treatment of allergic diseases and allergies of the first type, atopy in particular, began actively.

It has been shown that the amount of pollen in one cubic meter of air may be negligible. One cubic meter contains 10 – 50 pollen grains. The plant may already be causing the symptoms of the disease.

Plant pollen is the male gamete of plants. It contains a huge amount of allergens. The pollen concentration depends on many qualities.

Last year we experienced a fairly calm spring.The weather was wet and the spring was long. This year, in the region of the middle zone, in Moscow and the Moscow region, there was a fantastic outbreak of hay fever, even in those patients who did not suffer from allergies before, but were predisposed to it. It was a stormy spring with little or no rain.


The number of patients who have clinical symptoms in a particular region at one time or another depends on the air temperature, atmospheric pressure, wind speed and, of course, atmospheric precipitation.Of course, these patients must already be sensitized to one or another plant pollen.

The pan-European database of aeropalinological data is very helpful. These are special traps that were first installed on the roof of the biological building of Moscow State University. At present, there are a lot of such stations, pollen traps in Europe: 600 stations in Russia, even more in Europe.

In online mode (real time), the amount of pollen is transmitted via the Internet. Patients and doctors can know when pollination started this year, how intense it is.Our preventive and curative measures largely depend on this.

Do not forget that now we can find out the amount of pollen (even the smallest) through some Internet channels.

There are three main plant peaks in the central zone of Russia, which quite often cause hay fever.

1. April-May. Trees and shrubs bloom: birch, alder, hazel, willow, oak and some others.

2. June-July. Next peak: cereals and meadow grasses.

3. August-September. Complex herbs: wormwood, quinoa, hemp. Ambrosia brings a lot of problems now. It appeared not so long ago in our country, but it brings a huge number of problems to the inhabitants of the southern regions.

There are, unfortunately, recently isolated ragweed plants in our region.

I would like to remind you that the flowering period is different from the dusting period. The dusting period is always longer. Imagine. The birch has finished blooming, the pollen has fallen to the ground.But suddenly the wind rose, the pollen rose again into the air, and the patients developed symptoms of the disease.

It is correct to talk about the period of dusting, which still lasts for quite a long time after the period of flowering. This largely depends on the weather conditions.


Pollinosis clinic can be varied. First of all, it is allergic rhinitis, which can be more severe, can be more easy.

(Slide Show).

In one of the photographs you see such a symptom.We call it allergic fireworks. Itching of the nose leads to the fact that children (sometimes adults) scratch their nose in this peculiar way. This is one of the indirect diagnostic signs of the disease.

Allergic rhinitis, allergic conjunctivitis significantly reduces the quality of life. Fortunately, people do not die from these diseases. But the quality of life is declining so much that children cannot attend kindergarten and school. Adults cannot work. Many patients sensitized to pollen are very difficult to tolerate these manifestations of hay fever.

Sometimes in patients with hay fever, changes develop not only in the upper respiratory tract, but also in the lower respiratory tract. Seasonal bronchial asthma develops. Skin manifestations may also appear. Manifestations of gastrointestinal allergies, which are not always regarded as manifestations of allergies.

I would like to draw your attention to the fact that atopic reaction of the first type is very often systemic in nature, especially in children. It begins most often with skin manifestations, with gastrointestinal manifestations.Then manifestations from the upper and lower respiratory tract join.

The course of the disease in the same patient is called an allergic march. Our task is not only to treat such a disease. Treatment of one disease leads to the prevention of the development of another disease. Therapeutic measures are of some kind and of a preventive nature.

This is very important because each subsequent illness is usually more severe and significantly reduces the quality of life.


There is one more problem in pediatrics – underdiagnosis of allergic rhinitis. With what kind of diagnoses, especially small patients are not observed. Prolonged recurrent rhinitis, and often a sick child, and adenoiditis, and sinusitis, and “nasal”, and various other diseases. The diagnosis is given to children who have manifestations of seasonal allergic rhinitis.

If a child has these recurrent rhinitis, as a rule, in spring or summer, it is necessary to exclude the presence of allergic rhinitis, allergic conjunctivitis, hay fever in this child.Please pay attention to this – timely diagnostics.

It is advisable to carry out diagnostics in autumn, when pollination is over. Scarification tests and various serological tests can be performed. Naturally, examination by an ENT doctor, pediatrician, allergist. But you must make this diagnosis on time, because not only the child’s health today depends on it, but also tomorrow, the day after tomorrow and the rest of his life.

Treatment of patients with hay fever is multidirectional.First of all, it is the elimination of allergens. If possible, then, of course, they need to be removed.

This is pharmacotherapy, which should be not only effective, but safe. The pediatrician now puts safety first.

Immunotherapy, allergen-specific immunotherapy. Patient education.

A few words about immunotherapy. Now it cannot be carried out. Now is the period of dusting. But if a child has sensitization and allergen-specific immunotherapy is indicated for him, starting from autumn and winter it is necessary to raise a question before the parents so that this long-term difficult organization …

From three to five years, the child should receive certain regimens of therapy.But this must be done, because it is the only treatment that can cure allergies.


All other methods, as a rule, preserve the quality of life. They help manage symptoms, which is of course extremely important. But if it is possible to carry out immunotherapy (not every patient can be given), then we must set them up to carry out specific immunotherapy by any method. Sublingual, parenteral or otherwise. The allergist will decide this.But the question must be raised about this.

Patient education course.

With regard to elimination. Ideally, it would be nice to change the climatic zone during flowering. But this is definitely difficult. First, plants bloom at different times. Secondly, the period of dusting is sometimes quite long. In real life, this is not easy.

If the patient at this time is in the area where it is dusty, where he has symptoms of hay fever, of course, it is necessary to refuse to walk outside the city.Especially in the morning, when the greatest amount of pollen is in the air.

If the patient comes home, it is imperative to wash, change outerwear. If the child was without a hat, then it is necessary not only to wash, but to take a shower, wash your hair. It is also very important that not only the patient has home clothes, but the whole family. Any family member on his clothes from the street can bring that insignificant amount of pollen (we said it is negligible), which causes allergic diseases in a child.

It is necessary to install high-quality air purifiers in the room. I emphasize that they must be of high quality. It is desirable that the windows in the room be hermetically closed. The patient must adhere to a strict specific allergenic diet.

What is it.

In addition to the usual hypoallergenic diet, it must be remembered that the pollen of many plants has cross-allergic reactions with many foods.

Birch pollen is cross-allergic not only with birch sap, but also with almost all stone trees (apple, plum, sweet cherry, cherry, apricot).During dusting, the use of these products is strictly prohibited. They significantly worsen the condition of patients. It is advisable to limit these foods in another season.

But if the child does not show an allergy (for example, to apples), then they can be given in small quantities. These include carrots, celery, potatoes, and peas.

There is a danger of allergies if a child receives any herbal remedies, that is, preparations based on herbs or some other plants.

We do not recommend using not only oral herbal remedies, but also all kinds of baths, rubbing, inhalations in patients with hay fever.

The second peak of flowering is cereals.

All foods that include oats, barley, wheat, rye and other grains must be strictly excluded. This also includes sorrel and honey. Honey should not be used in almost all patients with hay fever.

It’s not really easy. It’s not easy to eliminate bread and really develop a rigid diet that does not include grains.

Third period – bloom of wormwood, quinoa, ragweed.

We exclude melons, watermelon, zucchini, eggplant, honey. And this is the season. Very often our patients start using these products. We see a worsening of the manifestations of allergies.

Principles of pharmacological therapy for hay fever. The principle of stepwise therapy, an individual approach, is extremely important.

There are several groups of drugs that we use in stepwise therapy. In the first place, of course, are second-generation antihistamines.They are indicated for all patients with hay fever of any severity of the disease and for almost the entire time of dusting, when there is a risk of developing the disease.


In case of insufficient effectiveness of second generation antihistamines, intranasal glucocorticosteroids are connected to them. Sometimes topical cromones are used, which are less effective. Good enough experience now with leukotriene receptor antagonists.

We try to use decongestants as little as possible.But with severe nasal congestion, of course, we use them.

All these rules are included in the international program. It refers to the recommendations for the treatment of allergic rhinitis. But it can be applied to all manifestations of hay fever, since with hay fever manifestations of allergic rhinitis exist.

Please note that second generation antihistamines are used for any severity of allergic rhinitis and hay fever. Starting with moderate severity, intranasal glucocorticosteroids and leukotriene receptor antagonists are attached.

When prescribing certain drugs for children, it is necessary to pay attention to the age, from what time we can prescribe these drugs. So, “Mometasone furoate” (“Mometasone furoate”) and “Fluticasone furoate” (“Fluticasone furoate”) can be prescribed as early as two years. And “Fluticasone propionate” (“Fluticasone propionate”) from the age of four.

The drug “Beclometasone” from the age of six, “Budesonid” also from the age of six. These dosages must be observed.

Side effects of vasoconstrictor drugs.Of course, vasoconstrictor drugs bring great relief to patients, but for several hours – 2, 4, 6, hours, depending on which drug you use. Unfortunately, their long-term use causes severe medicamentous rhinitis, irritation, dryness, burning of the mucous membrane, hypersecretion. Sometimes nasal congestion increases – a withdrawal syndrome.

In addition, the most serious complications of decongestants, especially in young children, can be caused by the cardiovascular system and the central nervous system.

In Moscow, there is a toxicology department of the Filatov hospital, which is sometimes jokingly called the department of naphtha specialists. Children are admitted there with poisoning with “Naphthyzinum”, which was administered in the form of drops. An overdose or incorrect prescription of the concentration of the drug should be alarming, you need to be very careful.

The fewer decongestants we prescribe, the better.


Once again, I want to return to the most common drugs that are used for allergic rhinitis, with hay fever, almost all patients have the entire period of dusting.These are H1-histamine blockers. We sometimes call them antihistamines. Currently, they are divided into two generations: the first and the second.

For allergic rhinitis and hay fever, only the second generation of these drugs can be used. “Cetirizine”, “Levocetirizine”, “Desloratadine”, “Loratadine”, “Fexofenadine” and other drugs related to the second generation.

The disadvantages of the first generation antihistamines are the pronounced sedative effect and the effect on the cognitive function of our patients.Especially small patients.

The nuisance is a short-term action. It’s unpleasant that addictiveness can occur. If a patient has to receive antihistamines for two or three months, and we have to change the first generation antihistamine every 7-8 days, this is inconvenient. But, by and large, it’s not scary.

And the sedative and cognitive effects are very unpleasant and serious. Even more serious is the cardiotoxicity that some first generation antihistamines have.

Very interesting work has been done comparing first and second generation antihistamines. Impact on the learning ability of children with allergic rhinitis. The ability to learn significantly decreased in those children who received “Dimedrolum” in comparison with “Loratadin”. There practically did not decrease the ability to learn in comparison with healthy children.


First generation antihistamines are now strictly prohibited for use in children on FDA recommendations.An organization that is perhaps the most stringent in the world for the safety of treating allergic diseases and any other in patients. Control over the quality of food, medicines. It is strictly forbidden to use drugs of the first generation in children under six years of age for any disease.

(Slide Show).

This point of view is shared by our European colleagues who have done a great job. I am now demonstrating it on a slide.It is not recommended to use first-generation drugs in children with allergies, and it is strictly prohibited under six years of age.

(Slide Show).

Second generation drugs have truly long-term safety. It has been shown in a myriad of studies that have been done in children and adults around the world. You can see some of these studies on the slide. Much more, actually. These are effective and very safe drugs.

Their effectiveness is due to their action not only on the early phase of an allergic reaction, which is extremely important for allergic rhinitis, hay fever, allergic conjunctivitis.But, unlike the first generation, they also block the late phase of the allergic reaction, that is, they reduce the severity of inflammation.

On the one hand, they prevent the development of inflammation in general. On the other hand, they block the late phase of the allergic reaction.

Pathogenetic effect of drugs for patients with hay fever. Antihistamines of the latest generation in children with allergies are also prescribed from different ages. Pediatricians should pay great attention to age indicators.

The most common drug prescribed for infants is Cetirizine. From the age of six months, you can prescribe the original “Cetirizine” – “Zyrtec”. Starting from the year, it is possible to appoint “Zodac” and “Parlazin”. This is the generic Cyterezin. The most frequently used, of course, “Zodak”.

Desloratadine is also prescribed since year. From two years old – “Levocetirizine” and “Loratadin”. From the age of six, “Fexofenadine”.


“Zodak”, as I said, is quite often used nowadays.We know Zyrtec very well, which has been in the practice of our pediatricians for many years. First of all, “Zyrtec” in the form of drops, which we use in babies. When Cetirizine, a high-quality generic drug, was significantly cheaper than Zirtek, we, of course, showed a rather great interest in it.

(Slide Show).

I would like to draw your attention to the fact that the dosages of “Cetirizin” – “Zodak” are practically the same as “Zyrtec”. Here they are shown on the slide.They are written in the instructions. The dosage must be observed.

The drug can be used once or twice a day, depending on how convenient the patient is. There is a great experience of using “Zodak” not only abroad, but also in our country. There is experience in the use of syrup and drops “Zodak” in patients in St. Petersburg. Our allergists did a lot of research there.

But I would like to share my own experience. From the point of view of a practicing physician, this is an interesting study.We compared two “Cetirizines” (efficacy and safety of these drugs) in children with allergic rhinitis.

The study was carried out last year in our clinic. There were quite a large number of children. Some of the children received Zodak. The comparison group received “Zyrtec”. The kids had symptoms of hay fever. Not only allergic rhinitis, but also allergic conjunctivitis.

(Slide Show).

One of the results of our study – a score in terms of the effect of our drug – is shown on this slide.The comparison groups were initially comparable. We watched the children for two months. For two months, the children received drugs. This was justified, because the trees had been dusting for a long time. The dusting was not active, but it was long enough.

After 10 days, a clinical effect was obtained in both groups, that is, children who received “Zirtek” and “Zodak”. However, in “Zirtek” it was somewhat more pronounced, the drug acted more quickly. Moreover, both drugs have shown high efficiency in relation to allergic conjunctivitis, slightly less – in relation to allergic rhinitis.


After 30 days, that is, after a month, we saw a high, and the same effectiveness of both drugs. Both Zyrtec and Zodak were effective against allergic rhinitis and allergic conjunctivitis. Conjunctivitis disappeared in almost all patients. And allergic rhinitis, especially nasal congestion, persisted for a long time.

But a month later, the quality of life of the children was quite high. We did not observe any differences in the effectiveness of the drug.The same was true after two months of observation. Children received the drug for two months, when almost no one had manifestations of allergic conjunctivitis, allergic rhinitis (nasal congestion) persisted in approximately 1/5 of patients in one and the other groups.

Unfortunately, after a little over two months, the second peak of flowering appeared. The manifestations of allergic rhinitis reappeared in three children. It so happened that it was in the “Zirtek” group. In fact, it was simply due to the sensitization of the children.

Draws attention to the fact that the quality of life of children has improved quite rapidly. Didn’t bring practically any complications to the parents. It was convenient to prescribe this drug. The children were treated first in a hospital. Then the bulk of the outpatient.

Virtually none of these children received intranasal glucocorticosteroids. Dusting has been fairly moderate in the past year. Although we have noted this. This was one of the criteria by which we would like to discuss the need to compare this or that drug.

This year the dust was such that almost all children received antihistamines. Naturally, “Cetirizine” is one of the first drugs. As well as inhaled glucocorticosteroids. Intranasal too.

It is important to draw your attention to the fact that about a quarter of children in one and the other group developed a little sleepiness. If they were schoolchildren, then we recommended using the drug in the evening. It can be used once a day. We did not observe any other side effects in these patients.


We also analyzed pharmacoeconomic aspects. This analysis showed that the course of treatment with “Zodak” was 3.5 times cheaper than the course of treatment with “Zirtek”. This, of course, is decisive for a certain category of patients.

I would like to make the following conclusion.

“Cetirizine” in the form of drops for children “Zyrtek” and “Zodak” demonstrated a pronounced positive dynamics of clinical symptoms of hay fever in both groups. Indeed, both drugs were highly effective and convenient.There was the highest compliance with the use of these drugs.

In case of exacerbation of hay fever, the drug of choice may be Zodak, as the cheapest and highest quality generic drug of the original drug Cetirizine.

I thank you for your attention and will be happy to answer your questions. Some of them have already been received.

Question: Share your clinical experience on cross-allergy to antibiotics in case of pollinosis.

We did not have such observations during hay fever.There is a cross allergy to mushrooms. Mushrooms are different. There are moldy mushrooms that are surrounded by a child almost throughout the year. And there are those that arise in damp spring, damp summer. Then we see cross-allergy.

As for pure cross-allergy in case of pollinosis, not to mushrooms, but to wind-pollinated flowering plants, here I think it is associated with polysensitization. Unfortunately, the sensitization of children is growing.

Due to limited time, I could not show.A very interesting observation-analysis was carried out in our department. We analyzed the frequency of sensitization and its severity in children over the past 20 years according to the data of our clinic. We have a very large hospital. Naturally, all children underwent scarification tests.

It has been shown that over the past 20 years the degree of sensitization to pollen has increased significantly, on the one hand. On the other hand, this spectrum expanded. Due to allergy to mushrooms and antibiotics, this could also be.


Question: To what extent is the use of hormonal agents shown for hay fever in children under 10 years of age?

I tried to reflect this in my lecture. They are really shown. They are very effective. But they are second-stage drugs. In general, for children, it is advisable not to step down, but to step up, that is, from simple to complex.

If there are first manifestations of hay fever, or perhaps not yet, but you know the sensitization, and according to the allergy station, pollen has already appeared in the air, you prescribe antihistamines.In case of insufficient correction with antihistamines, you switch on (this is the second stage) atopic glucocorticosteroids, strictly observing the age regulation, which I already spoke about today, while maintaining the intake of antihistamines.

Question: Is smoking and alcohol more dangerous for people with allergies?

Unfortunately, this is not really a question for me. I am a pediatrician. Although children start smoking early. Sometimes we don’t even know how often our little patients smoke.I saw real smokers at the age of six. They may have allergies more often. In any case, obstructive bronchitis occurs more frequently in them.

We have done a rather interesting research. This was done by our residents. They studied the frequency of smoking in child patients: in preschoolers, schoolchildren, first-year students, graduates and doctors of our hospital.