H1-antihistamines for chronic spontaneous urticaria: an abridged Cochrane Systematic Review
Abstract
BACKGROUND: Chronic spontaneous urticaria is characterized by recurrent itchy wheals. First-line management is with H1-antihistamines.
OBJECTIVE: We sought to conduct a Cochrane Review of H1-antihistamines in the treatment of chronic spontaneous urticaria.
METHODS: A systematic search of major databases for randomized controlled trials was conducted.
RESULTS: We included 73 studies with 9759 participants; 34 studies provided outcome data for 23 comparisons. Compared with placebo, cetirizine 10 mg daily in the short and intermediate term (RR 2.72; 95% confidence interval [CI] 1.51-4.91) led to complete suppression of urticaria. Levocetirizine 20 mg daily was effective for short-term use (RR 20.87; 95% CI 1.37-317.60) as was 5 mg for intermediate-term use (RR 52.88; 95% CI 3.31-843.81). Desloratadine 20 mg was effective for the short term (RR 15.97; 95% CI 1.04-245.04) as was 5 mg in the intermediate term (RR 37.00; 95% CI 2.31-593.70). There was no evidence to suggest difference in adverse event rates between treatments.
LIMITATIONS: Some methodological limitations were observed. Few studies for each comparison reported outcome data that could be incorporated in meta-analyses.
CONCLUSIONS: At standard doses, several antihistamines are effective and safe in complete suppression of chronic spontaneous urticaria. Research on long-term treatment using standardized outcome measures and quality of life scores is needed.
How strong is the evidence?
Evidence Hub reads this as a systematic review, done in people. Its evidence level is 1 of 5 (Highest · pooled evidence). Pooled evidence from several studies sits at the top of the evidence pyramid. Reported size: 9,759 participants or records.
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