Maulina Sharma1, Cathy Bennett2, Ben Carter3, Stuart N Cohen4. 1. Department of Dermatology, Derby Teaching Hospitals National Health Service Foundation Trust, London Road Community Hospital, Derby, United Kingdom. Electronic address: maulinasharma@yahoo.co.uk. 2. Centre for Technology Enabled Health Research, Faculty of Health and Life Sciences, Coventry University, Coventry, United Kingdom. 3. Institute of Primary Care and Public Health, Cardiff University, Cardiff, United Kingdom. 4. Nottingham University Hospitals National Health Service Trust, Queen's Medical Centre, Nottingham, United Kingdom.
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.
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.