Synergistic Effect of H1-Antihistamines on Topical Corticosteroids for Pruritus in Atopic Dermatitis: A Systematic Review and Meta-Analysis

Abstract

Background: Although oral antihistamines (H1-histamine receptor antagonists) are the main treatment option for pruritus in general skin dermatosis, their effect in treating pruritus of atopic dermatitis (AD) has not yet been established. Objective: We conducted a systematic review and meta-analysis to evaluate the effectiveness of combined therapy of H1-antihistamines and topical steroids. Methods: We systematically searched MEDLINE, Embase, and CENTRAL databases for articles published from 1967 to 2015. We identified 1,206 studies and assessed their titles, abstract, and full-text. Random effects meta-analysis was used to calculate mean differences (MD) with 95% confidence intervals (CI). Results: Two studies satisfying the inclusion criteria of antihistamine therapy with mandatory topical steroid use were selected. Comparing antihistamine monotherapy with combination therapy, patients treated with the addition of antihistamine to topical corticosteroids showed a statistically significant clinical improvement (standard MD, −0.24; 95% CI, −0.42 to −0.05; p=0.01). Conclusion: H1-antihistamines may have a synergistic effect when combined with topical steroids by influencing various associative factors of chronic pruritus in AD.

How Annals of Dermatology Has Improved the Scientific Quality and Ethical Standards of its Articles in the Two-Year Period since October 2018

“…Compliance to the reporting guidelines: Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA), CAse REport (CARE), Consolidated Standards of Reporting Trials (CONSORT), and Animal Research: Reporting of In Vivo Experiments (ARRIVE) were standard guidelines for systematic reviews and meta-analyses, case reports, clinical trials, and animal studies, respectively. Two meta-analysis articles were described according to the PRISMA guideline 9 10 . Two randomized control studies did not mention the CONSORT guideline 11 12 .…”

“…One review article omitted a statement on conflicts of interest 7 . For the text description, two systemic reviews adopted the PRISMA guideline 9 10 . The randomized controlled studies, case reports, and animal experiments did not contain point-by-point descriptions of the items contained in the corresponding reporting guidelines.…”

What’s new in atopic eczema? An analysis of systematic reviews published in 2019. Part 2: treatment

“…Another SR 11 assessed the synergistic effect of H1 antihistamines with TCS on pruritus in AE. Although the qualitative analysis included seven studies, only two (one RCT and one nonrandomized trial) were included in the meta‐analysis.…”