Recent research has suggested that prescribing antihistamines for eczema is “of no significant benefit and may probably increase harms”, reports The Independent.
The findings, published in The BMJ, have been welcomed by experts, who say they address longstanding uncertainty around the role of these medications in treating the common skin condition. They are now calling for updated medical guidance.
Eczema (atopic dermatitis) affects around one in five children and one in 10 adults in the UK, and despite existing recommendations, at least one in five patients will use antihistamines to treat symptoms.
The National Institute for Health and Care Excellence (NICE) already advises against the routine use of these medicines to manage the condition, but they are sometimes offered if flare-ups are linked to hives or another allergic reaction, while the short-term use of sedative antihistamines can help those whose itching is severely disturbing sleep.
Experts in Canada, led by a team from McMaster University who reviewed 47 trials, including more than 6 200 children and adults with moderate to severe eczema, found that when compared with a placebo, antihistamines led to a “clinically unimportant reduction” in the severity of eczema and itchiness.
Antihistamines may also “not reduce sleep disturbance” and eczema flare-ups, suggested the study.
First generation drugs, which often cause drowsiness, may also increase cognitive impairment and could lead to patients discontinuing treatment due to side effects.
The researchers said their findings address the “longstanding uncertainty surrounding the role of antihistamines” in treating eczema, and show they are unlikely to improve patient outcomes, “while probably increasing harms”.
Study details
Antihistamines for atopic dermatitis (eczema): systematic review and network meta-analysis of randomised trials
Alexandro W L Chu, Aaron Wen, Gordon H Guyatt et al.
Published in The BMJ on 26 July 2026
Abstract
Objective
To systematically synthesise the benefits and harms of add-on oral antihistamines for managing atopic dermatitis (eczema).
Design
Systematic review and network meta-analysis of randomised trials.
Data sources
Medline, Embase, CENTRAL, the United States Food and Drug Administration, and the European Medicines Agency databases from database inception to 5 May 2025.
Study selection
Randomised trials assessing add-on oral H1 antihistamines, H2 blockers, mast cell stabilisers (nedocromil sodium and sodium cromoglycate), or their combinations. Paired reviewers independently screened records, extracted data, and assessed risk of bias using a modified Cochrane Risk of Bias tool version 2.
Methods
Random effects bayesian meta-analyses synthesised atopic dermatitis severity (oSCORAD—objective scoring atopic dermatitis, 0-83; minimal important difference 8.2; lower better), itch severity (numerical rating scale, 0-10; minimal important difference 3; lower better), sleep disturbance, atopic dermatitis related quality of life, and harms. The network meta-analysis GRADE (Grading of Recommendations Assessment, Development and Evaluation) and Core GRADE approaches informed certainty of evidence ratings.
Results
A total of 47 trials enrolled 6230 children and adults with primarily moderate to severe atopic dermatitis. With moderate certainty, compared with placebo, adding a first generation or second generation H1 antihistamine likely resulted in a small reduction in atopic dermatitis severity (mean difference -1.87, 95% credible interval -3.47 to -0.27) and itch severity (-0.89, -1.41 to -0.37). Although statistically detectable, these effects are well below established minimal important differences (smallest change in an outcome that a patient would identify as important). With low certainty, all studied interventions may not improve sleep disturbance or reduce atopic dermatitis exacerbations. First generation agents probably increase cognitive impairment and may increase treatment discontinuation because of adverse events (risk difference 66 more per 1000, 95% credible interval 0 to 231 more; moderate certainty). Second generation agents differ in their risk of cognitive impairment (range of mean effects 0 more per 1000 for loratadine, 16 more per 1000 for levocetirizine, and 17 more per 1000 for cetirizine).
Conclusions
Among patients with atopic dermatitis, adding H1 antihistamines probably results in a clinically unimportant reduction in atopic dermatitis severity and itch severity, and may not reduce sleep disturbance or atopic dermatitis exacerbations. First generation agents increase cognitive impairment and may increase treatment discontinuation because of adverse events. Cognitive impairment risk differs among second generation agents. These findings provide evidence against routine antihistamine use in atopic dermatitis management and will inform updated clinical guidelines.
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