An assessment of the use of antihistamines in the management of atopic dermatitis

Publication date: Available online 6 January 2018
Source:Journal of the American Academy of Dermatology
Author(s): Alice He, Steven R. Feldman, Alan B. Fleischer
BackgroundAntihistamines are often used to treat pruritus associated with atopic dermatitis (AD) despite lack of evidence for their efficacy. The American Academy of Dermatology does not recommend the general use of antihistamines in the management of AD, although the value of short-term sedating antihistamine use for insomnia secondary to itch is recognized.ObjectiveTo assess the use of sedating and non-sedating antihistamines for AD from 2003-2012.MethodsThe National Ambulatory Medical Care Survey (NAMCS) provided data on physician visits from 2003-2012. Sedating and non-sedating antihistamine use was identified at AD visits.ResultsThere were 990,000 annual visits for AD. Antihistamines were prescribed for AD in a significant proportion of visits across physician specialties (16-44%). Dermatologists and pediatricians primarily used sedating antihistamines (58-70%), while the majority of family/general practitioners, internists, and other specialists prescribed non-sedating antihistamines for AD (55-100%)LimitationsWe were limited by the accuracy of AD diagnosis and medication recording.ConclusionsAntihistamines are widely used for the treatment of AD. There is no high-level evidence to suggest that non-sedating antihistamines reduce itch in patients with AD, or that sedating antihistamines provide benefit in controlling AD symptoms (except perhaps sleep and AD co-morbidities, such as allergic rhinitis).