After analyzing 47 studies involving more than 6200 children and adults, scientists concluded that antihistamines should not be routinely prescribed solely to relieve itching caused by eczema.
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“The analysis of the best currently available evidence showed that antihistamines do not reduce eczema or itching enough for most people to notice a significant difference,” said the study’s senior author, allergy professor Derek Chu from McMaster University in Canada.
According to him, these drugs also clearly do not improve sleep or help prevent eczema flare-ups. Therefore, treatment should focus not on antihistamines but on controlling skin inflammation.
Why were they prescribed in the first place?
Dermatologists began prescribing antihistamines for eczema because they help with other allergic conditions that cause itching, such as hives or insect bites.
Itching is often caused by histamine – a substance related to the immune response. Therefore, it was long believed that drugs blocking it could also help people with eczema.
Moreover, first-generation antihistamines have a sedative effect, so doctors sometimes prescribed them hoping that patients would find it easier to fall asleep despite the itching worsening at night.
However, later studies showed that itching caused by eczema is mainly driven not by histamine but by inflammatory signals between the body’s cells called cytokines.
“This study confirms the direction in which atopic dermatitis treatment is moving – more attention is being paid to the true mechanisms of the disease,” said allergist Clinton Dunn.
Newer drugs helped only slightly
Researchers found that modern second-generation antihistamines only slightly reduced eczema severity and itching. However, the improvement was too small for patients or doctors to consider it significant.
Older first-generation antihistamines provided no noticeable benefit at all.
Additionally, they more often caused drowsiness, confusion, slowed thinking, and could worsen performance at school or work. According to D. Chu, some older drugs are also linked to long-term cognitive impairments and dementia risk.
The impact of second-generation drugs on cognitive functions was much smaller but varied depending on the drug. According to researchers, bilastine, desloratadine, and fexofenadine caused the least drowsiness.
The most important thing is to suppress inflammation
Eczema treatment should be aimed at reducing skin and immune system inflammation. This can include moisturizers, topical anti-inflammatory drugs, phototherapy, and in some cases, biologic drugs.
However, antihistamines should not be completely dismissed. They may be useful for people with eczema who also have other allergic diseases, such as allergic rhinitis or hives.
“Antihistamines can help with hives, hay fever, or other allergic diseases, but they should not replace proper eczema treatment aimed at controlling skin inflammation,” emphasized D. Chu.
For patients whose eczema-related itching remains severe, interferes with sleep, or complicates daily life, the study authors advise consulting a doctor or dermatologist about treatments that directly target the causes of the disease.
