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Routine oral antihistamines provide little benefit for moderate to severe atopic dermatitis, according to a new meta-analysis published in The BMJ. Researchers evaluated 47 trials involving 6,230 children and adults with moderate to severe atopic dermatitis across more than a dozen countries to determine whether adding oral antihistamines improves eczema outcomes. Although second-generation antihistamines (eg, cetirizine, loratadine, fexofenadine) produced statistically significant reductions in eczema severity and itch, the improvements were below established thresholds for clinical importance on the Scoring Atopic Dermatitis scale—a standardized way to measure eczema based on the physical exam. First-generation antihistamines (eg, chlorpheniramine, hydroxyzine, promethazine) did not produce improvements in severity, itch, sleep disturbance, or eczema flares. In terms of safety findings, first-generation antihistamines increased cognitive impairment, with an estimated 66 additional cases per 1,000 patients.
Not your best option: Overall, the authors conclude that oral antihistamines should not be used routinely to manage atopic dermatitis in spite of the fact that they are often recommended. In this context, “the use of antihistamines is now largely superfluous,” they state. Oral H1 antihistamines are used as an add-on treatment for more than 20% of patients in the United Kingdom and 47% of patients in the United States, according to the analysis. Other available treatments for atopic dermatitis include topical anti-inflammatories, biological agents, and small molecule drugs.
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