Network meta-analysis compares antihistamines and adjuncts for chronic urticaria

A systematic review and network meta-analysis of 211 randomized trials (22,187 participants) evaluated 55 treatments for chronic urticaria, conducted to update AAAAI/ACAAI practice parameter guidelines. The analysis found that bilastine, desloratadine, fexofenadine, levocetirizine, cetirizine, and loratadine were among the most effective second-generation agents for urticaria activity and quality of life, while first-generation agents were less beneficial and more sedating; dose-escalation from single to quadruple daily doses showed diminishing additional benefit while sedation risk increased, and adding montelukast or an H2 blocker to a second-generation agent may further reduce urticaria activity.

Most relevant for: Patients with chronic urticaria lasting more than six weeks being managed with H1 antihistamines, including consideration of dose escalation or adjunct therapy.

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