Antihistamines probably not effective for eczema
This systematic review and network meta-analysis evaluated the benefits and harms of add‑on oral antihistamines for atopic dermatitis (eczema).1 Forty‑seven randomised trials (6230 participants) assessed H1 antihistamines, H2 blockers, mast cell stabilisers, or combinations. With moderate certainty, first‑ and second‑generation H1 antihistamines produced small reductions in eczema severity (mean difference −1.87) and itch (mean difference−0.89), far below the minimal important differences. With low certainty, these agents may not improve sleep disturbance or reduce exacerbations.
First‑generation antihistamines probably increase cognitive impairment and may lead to treatment discontinuation due to adverse events.
Second‑generation agents show variable cognitive effects.
Overall, add‑on antihistamines provide clinically unimportant symptom improvement and may cause harm, supporting recommendations against routine antihistamine use in atopic dermatitis management and informing updated clinical guidelines. Starship guidelines do not recommend antihistamines.2
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