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New research · Allergy & Immunology
BMJ (Clinical research ed.) · 21h
Meta-analysisBMJ (Clinical research ed.) · 2026

Antihistamines for atopic dermatitis (eczema): systematic review and network meta-analysis of randomised trials.

Alexandro W L Chu, Aaron Wen, Gordon H Guyatt … Derek K Chu
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Allergy & ImmunologyMeta-analysis

H1 antihistamines provide clinically unimportant reduction in atopic dermatitis severity.

Antihistamines for atopic dermatitis (eczema): systematic review and network meta-analysis of randomised trials.

Alexandro W L Chu … Derek K Chu
BMJ (Clinical research ed.) · 2026
Purpose

To systematically synthesise the benefits and harms of add-on oral antihistamines for managing atopic dermatitis (eczema).

Methods

Systematic review and network meta-analysis of randomised trials.

n = 6230 children
Results

H1 antihistamines likely resulted in a small reduction in eczema severity

mean difference -1.87 (95% CI -3.47 to -0.27)
null = 0-3.47-0.27
CI excludes the null - significant
More results

47 trials enrolled 6230 children and adults with primarily moderate to severe atopic dermatitis.

Although statistically detectable, these effects are well below established minimal important differences (smallest change in an outcome that a patient would identify as important).

More results

First generation agents probably increase cognitive impairment and may increase treatment discontinuation because of adverse events (risk difference 66 more per 1000, 95% credible interval 0 to 231 more; moderate certainty).

“
Conclusion · 1 of 2

Among patients with atopic dermatitis, adding H1 antihistamines probably results in a clinically unimportant reduction in atopic dermatitis severity and itch severity, and may not reduce sleep disturbance or atopic dermatitis exacerbations.

Conclusion · 2 of 2

First generation agents increase cognitive impairment and may increase treatment discontinuation because of adverse events. Cognitive impairment risk differs among second generation agents.

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