TUESDAY, Aug. 4, 2026 (HealthDay News) -- Evidence shows that routine antihistamine use may not provide a benefit in the management of atopic dermatitis, according to a review published online July 29 in The BMJ.
Alexandro W.L. Chu, M.D., from McMaster University in Hamilton, Ontario, Canada, and colleagues conducted a systematic review and network meta-analysis to systematically synthesize the benefits and harms of add-on oral antihistamines for managing atopic dermatitis. Randomized trials assessing add-on oral H1 antihistamines, H2 blockers, mast cell stabilizers (nedocromil sodium and sodium cromoglycate), or their combinations were reviewed; a total of 47 trials with 6,230 enrolled children and adults with primarily moderate-to-severe atopic dermatitis were included.
The researchers found that adding a first-generation or second-generation H1 antihistamine likely results in a small reduction in atopic dermatitis severity and itch severity compared with placebo, with moderate certainty (mean differences, −1.87 and −0.89, respectively). These effects are below the established minimal important differences. All studied interventions may not improve sleep disturbance or reduce atopic dermatitis exacerbations, with low certainty. Data revealed that cognitive impairment is probably increased with first-generation agents, which may increase treatment discontinuation due to adverse events (risk difference, 66 more per 1,000). Second-generation agents differ in terms of their cognitive impairment risk (range of mean effects: 0, 16, and 17 more per 1,000 for loratadine, levocetirizine, and cetirizine, respectively).
"We have provided a foundation for an evidence-based change in practice, supporting the development of updated atopic dermatitis guidelines that prioritize efficacy, safety, and patient-centered care," the authors write.
One author disclosed ties to the biopharmaceutical industry.
