Efficacy and tolerability of second- and third-generation antihistamines in the treatment of acquired cold urticaria: a meta-analysis.

Abstract

BACKGROUND:

Acquired cold urticaria (ACU) is a form of physical urticaria that has been treated with first-generation antihistamines; there is a paucity of data regarding second- and third-generation antihistamines for the treatment of ACU.

OBJECTIVE:

To perform a systematic review of the literature to determine the efficacy of second- and third-generation antihistamines in the treatment of ACU.

METHODS:

Data were extracted via a MEDLINE search of the literature between 1950 and May 2009. We included double-blind, randomized, placebo-controlled studies comparing the treatment of patients with ACU with second- and third-generation antihistamine medications vs placebo.

RESULTS:

Overall, 98 patients were identified from 4 included studies. Two trials indicated that second- and third-generation antihistamines significantly eliminated the presence of wheals after treatment vs placebo (odds ratio [OR], 8.88; 95% confidence interval [CI], 4.35 to 18.13). Two trials demonstrated a reduction in wheal area after treatment with a second- or third-generation antihistamine compared with placebo (mean difference, -347.99 mm2; 95% CI, -489.43 to -206.54 mm2). Two trials demonstrated significant elimination of pruritus with second- or third-generation antihistamine treatment vs placebo (OR, 10.44; 95% CI, 4.39 to 24.84). All 4 studies assessed the tolerability of a second- or third-generation antihistamine vs placebo and found an increased rate of adverse events (OR, 3.04; 95% CI, 1.53 to 6.06), although the complaints were mild.

CONCLUSIONS:

The newer, less-sedating antihistamines seem to be effective in the treatment of ACU in terms of their ability to significantly reduce the presence of wheals and pruritus after cold exposure. These medications are usually well tolerated, with only mild adverse effects.

• Authors: Mark E Weinstein, Alan H Wolff, Leonard Bielory
• Journal: Annals of allergy, asthma & immunology : official publication of the American College of Allergy, Asthma, & Immunology (Ann Allergy Asthma Immunol) Vol. 104 Issue 6 Pg. 518-22 (Jun 2010) ISSN: 1081-1206 [Print] United States
• PMID: 20568385 (Publication Type: Journal Article, Meta-Analysis, Systematic Review)

Chemical References

• Histamine Antagonists

Topics

• Chronic Disease
• Cold Temperature
• Histamine Antagonists (adverse effects, therapeutic use)
• Humans
• Randomized Controlled Trials as Topic
• Urticaria (drug therapy)