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Intravenous second-generation H1-antihistamines are the preferred initial treatment for acute urticaria, with H1-antihistamines being the cornerstone of therapy.
A study by Sirinda Jamjanya et al. explored the safety and effectiveness of pharmacological interventions for acute urticaria across both emergency department (ED) and non-ED settings, providing a comprehensive assessment of current therapeutic strategies. Investigators conducted an extensive search of electronic databases and gray literature, without any kind of language restrictions. Randomized clinical trials (RCTs) assessing therapeutic agents in acute urticaria sufferers, irrespective of age, were eligible for inclusion.
The primary outcomes of interest were treatment efficacy and safety profiles, with findings presented through standardized mean differences (SMDs) and odds ratios (ORs), offering a robust evaluation of therapeutic options. In this systematic review and meta-analysis, 8 RCTs involving 680 patients were included. In the ED setting, intramuscular first-generation H1-antihistamines were more efficient in reducing pruritus symptoms (standardized mean difference [SMD], −0.38) but were associated with higher sedative effects when compared to H2-blockers.
Intravenous second-generation H1-antihistamines, on the other hand, demonstrated comparable improvements in pruritus symptoms but resulted in more favorable clinical outcomes, including a lower risk of patients returning to the ED or clinic (odds ratio [OR], 0.31) and fewer adverse events (OR, 0.24). The efficacy of adjunctive systemic glucocorticosteroids, used in combination with antihistamines, remains unclear for both ED and non-ED settings.
Importantly, no serious safety concerns were observed across any of the treatment comparisons. The findings highlight that H1-antihistamines are an essential component in the management of acute urticaria. Intravenous second-generation H1-antihistamines are recommended as the preferred initial treatment option due to their superior safety and efficacy profile.
The Journal of Allergy and Clinical Immunology
Evaluation of Pharmacological Treatments for Acute Urticaria: A Systematic Review and Meta-Analysis
Sirinda Jamjanya et al.
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