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H1-antihistamines for chronic spontaneous urticaria: An abridged Cochrane Systematic Review - 14/09/15

Doi : 10.1016/j.jaad.2015.06.048 
Maulina Sharma, MRCP a, , Cathy Bennett, PhD b, Ben Carter, PhD c, Stuart N. Cohen, FRCP d
a Department of Dermatology, Derby Teaching Hospitals National Health Service Foundation Trust, London Road Community Hospital, Derby, United Kingdom 
b Centre for Technology Enabled Health Research, Faculty of Health and Life Sciences, Coventry University, Coventry, United Kingdom 
c Institute of Primary Care and Public Health, Cardiff University, Cardiff, United Kingdom 
d Nottingham University Hospitals National Health Service Trust, Queen's Medical Centre, Nottingham, United Kingdom 

Reprint requests: Maulina Sharma, MRCP, Department of Dermatology, Derby Teaching Hospitals National Health Service Foundation Trust, London Road Community Hospital, London Road, Derby DE1 2QY, 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.

Le texte complet de cet article est disponible en PDF.

Key words : chronic spontaneous urticaria, Cochrane, H1-antihistamines, review, treatment

Abbreviations used : CI, CSU, QoL, RR


Plan


 Supported by Queen's Medical Centre Nottingham, and National Institute for Health Research, the largest single funder of the Cochrane Skin Group.
 Disclosure: Dr Sharma has represented the Cochrane Skin Group as a stakeholder for National Institute for Health and Care Excellence Scoping Workshop for Chronic Spontaneous Urticaria: Omalizumab 2014. She has been a subinvestigator for clinical trials conducted in the Department of Dermatology, George Eliot Hospitals National Health Service Trust, Nuneaton (2005-2006), in particular, the Chronic Urticaria Treatment Evaluation CUTE Study (NCT00264303). She was not involved in writing of the results and received no payments for her involvement with the clinical trials. Professor Bennett is the proprietor of Systematic Research Ltd, a company providing research services; she is an employee of that company and received a consultancy fee for the production of this review, and travel expenses for travel to work-related meetings and conferences. She has also received consultancy fees for other Cochrane reviews and work in evidence-based medicine. Drs Carter and Cohen have no conflicts of interest to declare.
 The full version of the review is available in the Cochrane Library: Sharma M, Bennett C, Cohen SN, Carter B. H1-antihistamines for chronic spontaneous urticaria. Cochrane Database of Systematic Reviews 2014, Issue 11. Art. No.: CD006137. DOI: 14651858.CD006137.pub2. Cochrane Reviews are regularly updated as new evidence emerges and in response to feedback, and Cochrane Database of Systematic Reviews should be consulted for the most recent version of the review. See www.thecochranelibrary.com for information.
 Disclaimer: The results of a Cochrane review can be interpreted differently, depending on people's perspectives and circumstances. The conclusions presented are the opinions of review authors, and are not necessarily shared by the Cochrane Collaboration.


© 2015  American Academy of Dermatology, Inc.. Publié par Elsevier Masson SAS. Tous droits réservés.
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Vol 73 - N° 4

P. 710 - octobre 2015 Retour au numéro
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