Is Zyrtec or Benadryl better for baby allergic reactions?

For nearly 100 years, Benadryl has been the go-to antihistamine used to treat kids’ allergy symptoms like rashes, hives, and itchy skin. But lately, doctors are taking to social media to call out the drug’s side effects, particularly for babies and young children.  

Although you can’t trust everything you see on social media, experts do say there’s truth to the claims that there are better options than Benadryl for babies. 

“In the last 30 years, longer-lasting antihistamines have been developed,” says Inderpal Randhawa, M.D., the medical director of the Children’s Pulmonary Institute at MemorialCare Miller Children’s & Women’s Hospital Long Beach. “One of those is Zyrtec, which can last four times as long as Benadryl and often has fewer side effects.”

So, does this mean it’s time to replace Benadryl with Zyrtec in our medicine cabinets, especially when introducing key allergens to babies? Here’s what pediatricians want you to know. 

What’s the difference between Benadryl and Zyrtec?

Benadryl and Zyrtec are both antihistamines, meaning they “block the release of histamine, a chemical involved in allergic reactions,” says Susan J. Schuval, M.D., the chief of the division of pediatric allergy/immunology at Stony Brook Children’s Hospital in New York

However, they use different active ingredients: Benadryl uses diphenhydramine, which was FDA-approved for allergy treatment in 1946 (you needed a prescription until the 1980s). Zyrtec’s active ingredient is cetirizine, which was introduced much later – in 1995 for prescription use and as an OTC option in 2007.

“Benadryl doesn’t break down well in humans, so its effect is short-lived, and it causes drowsiness, dryness [of the mouth and nose], and constipation,” Dr. Randhawa says. “Zyrtec is metabolized in a better way. It lasts longer and doesn’t cause extreme drowsiness.”

A child would need to take the children’s version of Benadryl every six hours. On the other hand, one dose of children’s Zyrtec would last 24 hours. 

Benadryl vs. Zyrtec: Which is safer for babies?

This time, social media got it right. Allergists and pediatricians prefer children’s Zyrtec over children’s Benadryl for babies when treating mild allergic reactions such as food allergies, says Jessica Hui, M.D.., a pediatric allergist and immunologist at National Jewish Health in Denver, really emphasizing the word, mild. You should still check with your family doctor before giving any medication, especially if your child is under the age of 3. 

However, there are occasions where  your doctor may recommend Benadryl for your baby, she adds.

“There may be times when your doctor recommends Benadryl ahead of testing or a procedure [like a mild dental procedure],” Dr. Hui says. “It can be given with other medications to help with sedation,” she adds, since it works faster and causes drowsiness. Also important to note, though, Benadryl could actually have the opposite effect in some babies, and make them hyperactive instead of drowsy.

And you may have heard that Benadryl can be used ahead of long car or plane rides to help your toddler with motion sickness. However, this is not the best choice, says Dr. Randhawa. “It does have some properties to dry up the inner ear organs responsible for motion sickness, but there are many better OTC choices such as Dramamine (which is available for kids starting at age 2).” However, you can always ask your pediatrician what might be best for your child when traveling.

If your baby is having a severe reaction, call 911 immediately. They will need a medication called epinephrine and will need to be monitored at the hospital.

– Susan J. Schuval, M.D.

When to give allergy medication to babies – and when to seek emergency care for allergies

It’s best to consult your doctor before giving your child any OTC allergy medications. Zyrtec can relieve some symptoms like rashes, hives, coughing, and sneezing, says Dr. Schuval, so you can give it if you notice any of these symptoms in your baby (after okaying it with your pediatrician).

However, OTC allergy medications cannot treat extreme allergic reactions, otherwise known as anaphylaxis (which can be fatal if not treated quickly). Signs of anaphylaxis include:

• Difficulty breathing

• Swelling of the lips, tongue, or eyelids

• Vomiting 

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• Diarrhea  

• Low blood pressure and shock (in severe cases)

If your baby is having a severe reaction, call 911 immediately. They will need a medication called epinephrine and will need to be monitored at the hospital, says Dr. Schuval. Once you learn your child has a severe allergy to a food or other trigger, your doctor will prescribe an autoinjector (EpiPen) so you can have it on you at all times. 

Although severe allergies sound scary – and they are – experts don’t recommend giving your child antihistamines like Zyrtec prior to introducing food allergies with the idea that they can prevent a severe allergic reaction (they can’t). Instead, it’s best to safely and gradually introduce common allergens like milk, eggs, peanuts, and shellfish to children. Here’s how: 

1. Introduce the allergen. While introducing foods with common allergens like peanut butter may cause you to stress, Dr. Hui says the best thing you can do for your child is to go ahead and introduce it. “We now have evidence that feeding food allergens, such as peanuts, early on, is a great way to prevent food allergies,” she says. Introduce the allergen between 6 and 12 months after speaking with your doctor about your child’s risk factor for the allergy. 
2. Go slow. Introduce one allergen at a time, Dr. Parikh suggests. You can start with just a little bit of the food, then gradually add in more as the days go on. She also recommends waiting four to five days to monitor for reactions before introducing another common allergen – that way, you know which one triggered the reaction. Also remember to introduce the food multiple times, since some babies are exposed a few times before they develop the allergy. 
3. Breathe. As you monitor your child and introduce allergens, give yourself some grace and permission to enjoy the start of solid foods, Dr. Hui says. If you’re able to have a partner with you the first time, that can help too. 

If in doubt, discuss any allergy concerns with your pediatrician. And, if you’re unclear whether a reaction to food is mild or severe, the safest bet is to seek emergency care for your child by calling 911.