Ann Dermatol.  2019 Aug;31(4):420-425. 10.5021/ad.2019.31.4.420.

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

• Hur MS
• Choe YB
• Ahn KJ
• Lee YW

• KMID: 2451479
• DOI: http://doi.org/10.5021/ad.2019.31.4.420

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.

Keyword

Dermatitis; atopic; Histamine H1 antagonists; Meta-analysis; Pruritus

MeSH Terms

Adrenal Cortex Hormones*
Dermatitis
Dermatitis, Atopic*
Histamine Antagonists
Histamine H1 Antagonists
Humans
Pruritus*
Skin
Skin Diseases
Steroids
Adrenal Cortex Hormones
Histamine Antagonists
Histamine H1 Antagonists
Steroids

Figure

• 

  Fig. 1 Flow diagram of the research strategy. Two studies were included in our meta-analysis which satisfied the inclusion criteria.

• 

  Fig. 2 Forest plot of the studies included in the meta-analysis. There was a significant difference in effectiveness of adjunctive therapy. SD: standard deviation, IV: inverse variance, CI: confidence interval.

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