Reminder: Antihistamines don’t really help in eczema

Patients with eczema (atopic dermatitis) won’t get much benefit from antihistamines, or so findings from a new large systematic review and meta-analysis suggest. This is the case for both first- and second-generation antihistamines. A new systemic review and network meta-analysis focused on effects were clinically significant. Statistical findings were weighed against a pre-established amount of change that patient groups thought was an important effect. This “minimal important difference” was the smallest change in outcome that a patient would find important or meaningful.“Eczema care increasingly focuses on controlling skin and immune inflammation with moisturizers, topical anti-inflammatory treatments, and whole-body treatments like phototherapy, biologics, and oral JAK inhibitors. That makes it important to know whether antihistamines add important benefit or mostly add treatment burden and harm,” said senior author Dr. Derek Chu, an associate professor of medicine at McMaster University andCanadian Institutes of Health Research Chair in allergy. Dr. Chu the leads Canada’s Allergy Clinical Trials Network.The systematic review and network meta-analysis examined 47 clinical trials that included 6,230 children and adults with mild to severe eczema. Researchers used objective scoring atopic dermatitis (oSCORAD) score to determine eczema severity, with scores running from zero (least severe) to 83 (most severe). Itch was measured with a numerical rating scale.Second-generation antihistamines reduced eczema severity and itch severity compared to placebo, but the decrease was not clinically meaningful or important. A change of +/- 8.2 in oSCORAD score was needed for a change to be considered important, but the difference in oSCORAD scores with a second-generation antihistamine compared to a placebo was -1.87. The researchers determined that adding an antihistamine did not meaningfully improve severity, itch, sleep disturbance or exacerbation of eczema compared to placebo.First-generation antihistamines showed no statistically significant improvement in eczema severity or itch severity compared to placebo. The researchers’ findings support that these older medications put patients at higher risk of drowsiness, confusion and slowed thinking. These cognitive effects can last for days after medication use. Neither first- nor second-generation antihistamines changed the frequency of eczema exacerbations compared to placebo. Adding an antihistamine did not increase the risk of an adverse event.“The findings support moving away from routine antihistamine use in atopic dermatitis care and toward treatments that are more effective, less likely to cause harm, and are more certain to control eczema inflammation. This may also help keep eczema control as simple and straightforward as possible, with patients focusing on high-value treatments,” said Dr. Chu in a university press release. Oral antihistamines remain important treatments for other allergic conditions, such as hay fever, hives and seasonal allergies.A 2019 Cochrane review was inconclusive about the benefit of antihistamines in eczema. This review includes more trials and separated the analysis into classes of antibiotics.The systemic analysis and network meta-analysis was commissioned as part of research required for living atopic dermatitis guidelines by the American Academy of Allergy, Asthma and Immunology and the American College of Allergy, Asthma and Immunology.The study is published in the BMJ.

Reminder: Antihistamines don’t really help in eczema

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