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In a systematic review and meta-analysis of eight randomized clinical trials, encompassing 680 patients, H1-antihistamine emerges as a pivotal and effective component in treating acute urticaria, with intravenous sgAH being a preferred initial treatment option.

The following is a summary of “Evaluation of Pharmacological Treatments for Acute Urticaria: A Systematic Review and Meta-Analysis,” published in the January 2024 issue of Allergy and Immunology by Jamjanya et al.

The therapeutic landscape for acute urticaria poses uncertainties in terms of both efficacy and safety, prompting the need for a comprehensive investigation. Their objective was to conduct a systematic review and meta-analysis to shed light on the effectiveness and safety of pharmacological interventions for acute urticaria across emergency departments (ED) and non-ED settings. A meticulous search encompassing electronic databases and grey literature until July 8, 2023, was executed without language restrictions, focusing on randomized clinical trials (RCTs) involving pharmacological treatments for acute urticaria, regardless of patient age. Their primary outcomes of interest revolved around treatment efficacy and safety profiles, and the findings are presented through standardized mean differences (SMDs) or odds ratios (ORs). 

The amalgamation of data from eight identified RCTs, representing 680 patients, revealed noteworthy insights. In the ED setting (two trials, n=118), intramuscular first-generation H1-antihistamine (fgAH) demonstrated superior efficacy in reducing pruritus symptoms (SMD, -0.38; 95% CI, -0.75 to -0.02), albeit with a higher incidence of sedative effects compared to H2-blockers. For comparable pruritus symptom improvement (two trials, n=295), intravenous second-generation H1-antihistamine (sgAH) exhibited more favorable clinical outcomes in the ED setting, displaying a lower risk of return to any ED/clinic (OR, 0.31; 95% CI, 0.12 to 0.83) and a reduced risk of any adverse event (OR, 0.24; 95% CI, 0.09 to 0.63) compared to intravenous fgAH. The efficacy of adjunctive therapy involving a short course of systemic glucocorticosteroids in both ED and non-ED settings remains inconclusive. Importantly, no serious safety concerns were identified in any of the treatment comparisons. 

In conclusion, H1-antihistamine emerges as a pivotal and effective component in treating acute urticaria, with intravenous sgAH being a preferred initial treatment option based on their comprehensive evaluation.

Source: sciencedirect.com/science/article/abs/pii/S2213219824000746