Is diphenhydramine best for an acute allergic reaction?
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1. Counselling Conundrum: a real question from a patient
2. Concise Conclusion: a straight-forward patient-friendly answer
3. Quick Wrap-up
Clearly, there are nuances that may not be captured in this format. The goal here is to provide you with helpful counselling tips which often draw from multiple sources or those which are not commonly accessed by busy healthcare providers serving the community.

Counselling Conundrum: "I am 77 years old, and think I am having an allergic reaction to something. I have a rash on my back, and it's itchy. Is Benadryl the best thing for it?"
Concise Conclusion: Great question! Benadryl is certainly more of a household name, but it only works for a few hours, and can cause things like drowsiness and even increased risk of falls, especially in older adults. In this case, I think cetirizine would be a better option; it lasts all day, it causes much less drowsiness than Benadryl, and has less side effects overall.
Quick Wrap-up: Though diphenhydramine is more commonly recommended for most allergic reactions, cetirizine is even used IV in anaphylaxis, so there is no reason other than desire for sedation (in severe urticaria) to reach for diphenhydramine. We already know to avoid diphenhydramine for allergic rhinitis, but it's important we carry the same logic for other allergic reactions, like urticaria. Keep in mind around 10% of patients may still feel some drowsiness with cetirizine, despite its "non-drowsy" designation.
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