A systematic review 1 including 16 studies with a total of 803 subjects was abstracted in DARE.
Large, RCTs with definitive conclusions have not been performed. Two small, rigorous, randomised trials refuted the use of antihistamines in relieving pruritus. One randomised trial supported the efficacy of antihistamines in relieving pruritus. All remaining trials lacked placebo controls or randomisation, or contained fewer than 20 participants in each treatment group. Of these trials, four supported the use of antihistamines and nine studies refuted the use of antihistamines for the relief of pruritus.
The authors state that although antihistamines are often used in the treatment of atopic dermatitis, little objective evidence exists to demonstrate relief of pruritus. The majority of trials are flawed in terms of the sample size or study design. Anecdotally, sedating antihistamines have sometimes been useful by virtue of their soporific effect and bedtime use may be warranted. There is no evidence to support the effectiveness of expensive non-sedating agents.
Comment: The quality of evidence is downgraded by study limitations and the possibility of publication bias (a large number of very small studies).
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