Tolerance

Tolerance to antihistamines is a common concern of patients taking these agents chronically. This phenomenon has been speculated to occur because of autoinduction of hepatic metabolism, resulting in an accelerated clearance rate of the antihistamine ( 103). However, studies have failed to confirm this hypothesis, and most reports of tolerance to antihistamines are now believed to be secondary to patient noncompliance because of intolerable drug side effects or breakthrough symptoms due to severity of disease (104,105,106 and 107). Short-term studies evaluating tolerance to second-generation agents have found no change in their therapeutic efficacy after 6 to 8 weeks of regular use (108,109). Studies up to 12 weeks found no evidence that second-generation agents cause autoinduction of hepatic metabolism leading to rapid excretion rates and drug tolerance (42). The clinical efficacy of these agents in the skin and treatment of allergic rhinitis does not decrease with chronic use.

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