A retrospective review of Texas Poison Center Network experience with pediatric triprolidine exposures

INTRODUCTION Triprolidine, a first-generation antihistamine, is prescribed as monotherapy for allergic rhinitis in young children. Despite over seventy years of use, there is no standardized guidance for managing exploratory exposures or therapeutic errors. This contributes to inconsistent poison center referral recommendations and highlights a need for pediatric safety data. Our objective was to characterize the clinical outcomes of children aged six years and younger reported to a statewide poison center network following liquid triprolidine exposures.

METHODS We conducted a retrospective chart review of liquid triprolidine monotherapy exposures in children six years of age and younger reported to the Texas Poison Center Network from 2011 to 2022. After excluding polysubstance exposures and other confounders, specialists abstracted demographic, dose, and outcome data using both coded fields and narrative review. The primary outcome was the relationship between dose (mg/kg) and clinical severity. Descriptive statistics summarized case characteristics; a Kruskal-Wallis test compared median doses across outcome groups.

RESULTS After exclusions, 1,153 cases were analyzed. Most involved toddlers with exploratory exposures or therapeutic errors. Among the 369 followed to known outcome, 302 (81.8%) remained asymptomatic. Symptomatic cases typically involved transient drowsiness that resolved with observation. No major effects or fatalities were reported, and treatment, when needed, was limited to supportive care. The median reported dose did not significantly differ across outcome categories (P = 0.10).

DISCUSSION This study identified no serious clinical effects or deaths. Findings suggest that triprolidine exposures in this population are generally benign, despite occasional supratherapeutic dosing. Existing referral thresholds may be overly conservative.

CONCLUSION Unintentional triprolidine exposure carries a minimal risk of clinically significant toxicity in children less than 6 years old. Therefore, existing low-dose referral thresholds warrant re-evaluation to reduce unnecessary health care utilization without compromising patient safety.