It is quite clear that second-generation antihistamines (SGAs) last longer and have fewer side effects and thus are better tolerated, and they are equally effective when compared with first-generation antihistamines (FGAs). These side effects are well known, such as drowsiness, poorer school performance, paradoxical hyperactivity, indeed attention deficit/hyperactivity disorder, and yet they are still used in the emergency department and on the wards to treat allergic reactions, urticaria, anaphylaxis and itchiness. Wong KH et al (Pediatrics 2026;157:e2025072208) have reported a quality improvement (QI) based on their Connecticut Tertiary Children’s hospital. Surprisingly, prior to the study, their paediatric emergency department (PED) had …