414 - Impact of the COVID-19 pandemic and TikTok™ Benadryl® Challenge on pediatric diphenhydramine ingestions in the United States

Poster Number: 414
Publication Number: 414.3263

Background: A surge in diphenhydramine misuse among children has been attributed to psychosocial stressors due the COVID-19 pandemic and the TikTok™ Benadryl® challenge However, the impact of the pandemic combined with the TikTok™ challenge on pediatric diphenhydramine ingestions is unknown.

Objective: To evaluate and compare the trends, severity and outcomes of pediatric diphenhydramine ingestions reported to United States (US) poison control centers (PCCs), between the pre-pandemic and pandemic period which included the TikTok™ challenge.

Design/Methods: We performed a retrospective review of pediatric (≤19 years old) ingestions of diphenhydramine reported to US PCCs using data from the National Poison Data System. We compared the incidence, clinical effects, disposition, and management associated with diphenhydramine ingestions during the pre-pandemic (1/1/2013-3/30/2020), early (4/1/2020-5/31/2021), late pandemic periods (6/1/2021-1/1/2023) and the TikTok™ period (8/1/2020-9/1/2021). We defined a dangerous dose as an ingestion of >300mg or 12 tablets.

Results: A total of 15,493 (pre-pandemic), 3,558 (early pandemic), and 8,440 (late pandemic) diphenhydramine ingestions were reported to the US PCCs. A progressive increase in the mean number of monthly calls was observed from the pre-pandemic to late-pandemic periods [178.08 ± 57.27 vs. 254.14 ± 36.77 vs. 422.00 ± 120.74] and during the TikTok™ challenge period compared to the previous year (224.45 vs. 250.77, p=0.031). Most of the ingestions occurred in females (69.8% vs. 74.2% vs. 72.2%) and adolescents (15.33 ± 2.99 vs. 15.08 ± 2.75 vs. 15.13 ± 2.53). A higher proportion of intentional ingestions occurred during the early and late pandemic including the TikTok™ period (93.9% vs. 95.2% vs. 96.1%; p< 0.001); the majority were of suicidal intent (70.4% vs. 75.3% vs. 76.4%; p< 0.001) and had moderate-to-severe outcomes (49.3% vs. 53.0 % vs. 54.7%; p <.001) and involved a dangerous dose (55.7% vs. 59.2% vs. 63.5%; p < 0.001). The most common clinical effect across all time periods were cardiovascular in nature. The most common therapeutic interventions included intravenous fluids, benzodiazepines, and activated charcoal.

Conclusion(s): This study revealed a significant rise in pediatric diphenhydramine ingestions, with increasing clinical severity during the COVID-19 pandemic and the TikTok™ challenge period. These findings accentuate the urgency for enhanced public health initiatives, re-evaluating over-the-counter diphenhydramine accessibility, and augmenting oversight on social media challenges to mitigate associated risks.