Antihistamines, both old first-generation and new, are frequently prescribed to patients with allergic skin diseases. As the expected roles of antihistamines differ in each dermatosis, we should carefully consider the characteristics of each antihistamine prior to use. This review covers recent antihistamine topics, including novel pharmacological action, and enhancement of patient quality of life (QoL).
Nonsedative, second-generation antihistamines are recommended as first-line treatment for urticaria. For atopic dermatitis, most position papers doubt their efficacy of treatment due to insufficient evidence. However, recent articles revealed novel H1 receptor-independent properties for these agents, such as modulation of cytokine and chemokine production, tissue remodeling, and indicated its favorable effects on atopic dermatitis. Furthermore, several important benefits of second-generation antihistamines on the amelioration of atopic dermatitis symptoms, patient QoL and labor efficiency including loss of productivity and absenteeism from the workplace have been reported. In contrast, prescription of first-generation antihistamines for skin allergies should be avoided due to their bad risk/benefit ratio. Whereas they are not better in controlling itch, they also fail to improve patient labor efficiency unlike second-generation antihistamines.
Although antihistamine usefulness varies greatly, understanding the characteristics of each antihistamine will allow more personalized therapy for skin allergies.
Course of Integrated Medicine, Department of Dermatology, Graduate School of Medicine, Osaka University, Osaka, Japan
Correspondence to Hiroyuki Murota, MD, PhD, 2-2 Yamadaoka, Suita, Osaka 5650871, JapanTel: +81 668793031; fax: +81 668793039; e-mail: firstname.lastname@example.org