Reuters Health Information
Diphenhydramine Poisoning Calls Are Up, Especially for Young Children
April 02, 2013
NEW YORK (Reuters Health) Apr 02 - Calls to poison centers regarding diphenhydramine (DPH) are increasing, especially calls involving children under six, according to results of a new study.
Over five years, the number of DPH calls to poison centers involving young children increased more than calls for any other age group, while the number of intentional use calls decreased, the authors wrote.
"While we had plenty information describing DPH cases and the effects of its abuse, no data were available in the literature on the demographics of DPH overdoses," said study author Dr. Annette M. Lopez, medical toxicology fellow at the Oregon Poison Center of the Department of Emergency Medicine of Oregon Health & Sciences University in Portland, in an email to Reuters Health.
"We found that children under six years old were the most likely age group to suffer from these overdoses, and the data also suggested that major outcomes, exposures that were life-threatening or that resulted in significant residual disability or disfigurement, were increasing. The patterns of use to 2010 showed a decrease in intentional ingestions," she added.
To characterize the evolving demographic patterns of DPH exposures reported to poison centers, the research team reviewed National Poison Data System (NPDS) data from 2006 to 2010 included in the American Association of Poison Control Centers Annual Reports. They looked at total calls, age, reason for exposure, treatment location and adverse effects.
They also conducted a PubMed search of "diphenhydramine" and "diphenhydramine overdose" for those years.
They presented their results in a poster March 17 at the American College of Medical Toxicology Annual Scientific Meeting in San Juan, Puerto Rico.
Over the five years studied, the number of calls each year for DPH human exposures steadily increased for adults and children, going from 31,816 in 2006 to 39,028 in 2010.
The largest change was for children younger than six, with an average increase of 1,260 calls per year. Statistically, the coefficient of determination (abbreviated as R2) was 0.9358. (An R2 near 1.0 indicates that future outcomes are likely to be predicted by the model.)
Smaller increases occurred in those aged six to19 years of age (180 calls/year increase, R2=0.9714), and in those over 19 years of age (mean 189 calls/year increase, R2=0.6641).
During that time, the proportion of calls for intentional DPH use decreased from 18.2% to 16.6% (R2=0.4579) while unintentional exposures slightly increased from 51.5% to 54.8% (R2=0.5908). Deaths remained stable (R2=0.0014) and major outcomes slightly increased (R2=0.4115).
Healthcare facilities took care of an increasing percentage of patients (R2=0.3939).
The authors noted that, over the same period, the number of PubMed articles related to DPH changed similarly, suggesting to them a change in usage pattern.
"These results indicate that the use of DPH exposures appear to be changing, with increased exposures in children under six years old and decreasing abuse amongst teenagers and children aged six to 19 years," the authors wrote, and they called for further monitoring of trends to learn why these changes are occurring.
They cautioned that the easy availability over the counter and the intoxicating effects of DPH make it commonly abused and misused.
"Most ingestions leading to overdoses occur in children less than six years old who are likely being given the medication by others. Educating the public about safely administering and storing DPH and recognizing occult DPH in various over-the-counter formulations can potentially reduce the number of exposures," Dr. Lopez said in her email.
da: https://www.medscape.com/viewarticle/781868?nlid=30110_455&src=wnl_edit_medp_peds&uac=199491SJ&spon=9