Safety of fexofenadine and other second-generation oral antihistamines before and after the removal of the prescription requirement in Italy and other European countries: A real-world evidence study and systematic review

• Published in: The World Allergy Organization journal 2022-07, Vol.15 (7), p.100658-100658, Article 100658
• Main Authors: Carnovale, Carla, Battini, Vera, Gringeri, Michele, Volonté, Marina, Uboldi, Maria Chiara, Chiarenza, Andrea, Passalacqua, Giovanni
• Format: Article
• Language: English
• Subjects: Allergies; Drug dosages; Drug interactions; Fexofenadine; Food and drug administration adverse event reporting system (FAERS); Hay fever; Histamine; Industrial safety; Over-the-counter (OTC); Pharmacists; Pharmacovigilance; Prescription drugs; Review; Rhinitis; Second-generation oral antihistamines; Trends; Urticaria
• ISSN: 1939-4551; 1939-4551
• DOI: 10.1016/j.waojou.2022.100658

BackgroundThe change from prescription to over-the-counter (OTC) status of oral antihistamines may raise concerns about drug safety due to the possibility of misuse/abuse. In most European countries, oral antihistamines are available without prescription, whereas in Italy, only 20 tablets (Belgium, Portugal, Switzerland, Finland, Hungary) was made. The rate at which an AE related to oral antihistamines occurred was estimated by calculation of the reporting rate (number of cases/[defined daily dose/1000 inhabitants per day]) on the basis of IQVIA sales data using the Italian Institute of Statistics database. A systematic review of the literature was also performed.ResultsThere were 3760 reports of AEs with a suspected association with fexofenadine; of these, eight were reported from Italy. There was a slightly increasing trend per year, in line with a general reporting trend of other drugs. In European countries where fexofenadine is available, the impact of OTC switch on AE reporting activity was negligible: from 2016, the reporting rate increased slightly and then normalized at 3.01, an incidence value similar to that recorded before the OTC switch (3.7 in 2015). Of 22 studies included in the systematic review, 18 (82%) positively evaluated the OTC use of oral antihistamines, confirming an acceptable safety/tolerability profile.ConclusionThere was no difference in number of AEs reported for fexofenadine pre/post-OTC switch, indicating a similar safety profile. Spontaneous reporting systems are a valuable source of real-world data and support