Should Antihistamines Be Used to Manage Atopic Dermatitis Itching?

Atopic dermatitis (AD) causes intense itching, and patients are often prescribed antihistamines to mitigate those effects. However, the evidence that non-sedating oral antihistamines are effective at controlling the itch is lacking. Sedating antihistamines have more studies that suggest they are useful. The American Academy of Dermatology (AAD) does not recommend the use of antihistamines for this purpose.

A recent study examined antihistamine prescriptions for AD in 2003-2012 to determine the real-life prescription patterns for these medications to control symptoms from AD. The results show that for nearly 10 million visits to caregivers, antihistamines were prescribed by non-dermatologists at 16% to 44% of visits and dermatologists prescribed antihistamines at 22% of those visits. Pediatricians and dermatologists were more likely to prescribe sedating antihistamines while general practitioners and doctors in other specialties prescribed non-sedating antihistamines more than half of the time.

The authors conclude that despite the AAD recommendation and the lack of evidence on effectiveness, antihistamine use in AD management remains prevalent. In fact, antihistamines were the second most commonly used medication for AD among non-dermatologists. The authors suggest that this trend may reflect the significant unmet demand for effective treatments for AD and as better therapies are developed the use may decline.