I have two questions related to antihistamine use: 1) I'm able to reach orgasm through masturbation. However, I have only climaxed once with a man. This was with my current husband, through oral sex, and a little bit before we got married (over thirteen years ago). This has led to frustration and marital problems. I've been taking antihistamines for about thirteen years for chronic hives. How great of a role does antihistamine use (especially long-term) play in female sexual dysfunction? I'm currently using Claritin (loratadine). 2) I've been told by some health practitioners that antihistamine use is safe during pregnancy and by others that it's not (especially during the first trimester). Those who have told me it's not safe mention possible neurological problems such as spina bifida. I've been working on not taking the antihistamines at all by attempting to control my hives through diet. Most of the time, I have to take them on a daily basis. In the event that I'm unable to keep from taking the antihistamines, would it indeed pose a threat to the unborn baby?

I have this problem for ... I'm not sure...maybe about thirteen years. And I believe anxiety and use of antihistamines may contribute significantly to my problem.

Female, 36, married, USA

Answer

     As regards your questions regarding antihistamines:

     1) It appears to me that your sexual problem is not directly related to use of antihistamines. If it were, orgasm through masturbation must have been equally difficult, which was not the case with you. The second reason is that antihistamines, particularly loratadine, are not reported to interfere with orgasm. On the contrary there are reports that claim claritine as a treatment for antidepressant induced sexual dysfunction including orgasmic dysfunction.

    Therefore I have reason to suspect that your orgasmic dysfunction could be very similar to any other woman's, the only probable difference is that yours was a bit compounded by the presence of a chronic health condition. You know, all chronic illnesses affect the quality of life physically, psychologically and emotionally. It also affects the life partner in one way or the other and often leads to marital and sexual problems, arising not out of disease or drugs, but as a sequel of the illness. It calls for lot of adjustments and compromises. The disappointments often appear larger than real... Indirectly all these factors lead to some form of sexual dysfunction. The thought that you might be having a sexual dysfunction fosters anxiety which in itself is a culprit in orgasmic dysfunction. I am sure you must have understood all these things by now and I am glad that you both are taking marital therapy. The later should help you understand each other better and, with specific suggestions, your sexual life should also improve.

     I call upon you to recollect your masturbatory experience. How exactly could you reach orgasm? What mental preparations and physical acts helped you reach climax? In what way are they different from your sexual act with your partner? Try to explore these aspects and incorporate the missing elements into your partner-sex. Try different positions and techniques if you have not already done. Adopt positions that allow direct stimulation of clitoris. You may also wish to use fantasy, erotic movies, vibrators during sex which can help you reach orgasm faster. The most important thing is to get rid of anxiety and to relax. Try practising deep-and-slow breathing exercises every day for 15-20 minutes in the morning and another 15-20 mins. in the evening (empty stomach).

    Books such as 'Becoming Orgasmic' by Joseph LoPiccolo and 'For Yourself' by Lonnie Barbach should be of help to you.

    02) Regarding safety of Loratadine in pregnancy, this question does not fall under my purview. Hence I quote below what I gathered elsewhere, hoping that it will be of some use to you:

The Net Doctor (UK)'s medical team ( http://www.netdoctor.co.uk ) has this to say: 'Loratadine is one of the newer antihistamines, which seems to be less likely to cause drowsiness than older antihistamines'.

The caution on the box is one given with all antihistamine medication. This relates to the fact that there is insufficient evidence to state that these drugs are safe to be used in pregnancy.

However there is no evidence that antihistamine medication used in early pregnancy causes abnormalities in the foetus.

In later pregnancy it is thought that high doses may have toxic effects. Medication should be used in pregnancy only when the benefit to the mother is thought to be greater than the risk to the foetus, and this is especially important from week three until week 11. Later on in pregnancy medication may affect the growth of the foetus or have other toxic effects.

It is very unlikely that taking loratadine at a dose of 10mg daily would have any harmful effects upon a developing foetus, but the drug is not safe beyond all doubt.

One alternative would be for you to use antihistamine eye drops and nasal spray rather than an oral medication.

Mayo Clinic, a reputable institute, says:  "The allergy medication loratadine (Claritin, others) is a category B drug. This indicates that animal studies haven't shown any risks to the fetus. But the drug hasn't been adequately tested in human pregnancy to prove its safety. "http://www.mayoclinic.com/print/allergy-medications"

In yet another recent study it was found that Loratadine has no more adverse affects on pregancy than would occur in normal healthy females. Read it yourself!

Journal of Allergy and Clinical Immunology:2003 Mar;111(3):479-83.

Fetal safety of loratadine use in the first trimester of pregnancy: a multicenter study.

Hospital for Sick Children, Toronto, Ontario, Canada.

BACKGROUND: Women in their childbearing years often require drug therapy for allergic conditions. Loratadine, a newer nonsedating antihistamine, is often used because of its preferred side effect profile. To date no published data exist on the safety of loratadine use in pregnancy. <br>

OBJECTIVE: We sought to determine whether the use of loratadine in the first trimester of pregnancy was associated with an increased risk for major malformations. Secondary outcomes included rates of miscarriage, birth weights, and gestational age at delivery.

METHODS: All women were prospectively enrolled from 4 participating centers. Detailed maternal medical history and drug exposures were collected at intake, whereas pregnancy complications and outcomes were collected at follow-up. A group of unexposed control subjects were recruited and followed up in a similar manner.

RESULTS: This report includes follow-up on 161 loratadine exposed pregnancies and an equal number of unexposed control subjects. Maternal characteristics (age, pregnancy history, alcohol consumption, and smoking habits) were not different between the 2 groups. There were 5 malformations observed in the exposed group and 6 in the control group, which was not significantly different. Similarly, the live birth rate, gestational age at delivery, and birth weights were not different between the 2 groups.

CONCLUSION: These results suggest that loratadine use in pregnancy is not associated with a large risk for major malformations. Further studies are warranted to confirm these findings and to increase study power.

I do hope this information might assure you that you are not a great risk. However, it would be a safe to get yourself and your future baby tested regularly during pregnancy so that timely interventions could be taken in the unlikely event of fetal problems.

I would be pleased to assist you in case you need further information/help. Please feel free to contact.