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Antihistamines in the Management of Pediatric Allergic Rhinitis: A Systematic Review
Lilly Velentza1, Zinovia Maridaki2, Evangelia Blana2
1Pediatrics Working Group, Society of Junior Doctors, 5 Menalou Str, Maroussi, 15123, Athens, Greece. lilivele10@yahoo.gr.
Insights
Newer antihistamines (AHs) are effective for symptom control in children with allergic rhinitis but offer no significant benefit over older AHs. They are less effective than intranasal corticosteroids but more effective than montelukast.
Area of Science:
- Pediatric Allergy and Immunology
- Pharmacology
- Clinical Trials
Background:
- The clinical efficacy of newer antihistamines (AHs) compared to other treatments in pediatric allergic rhinitis is not well-established.
- Allergic rhinitis significantly impacts children's quality of life and treatment needs.
Purpose of the Study:
- To systematically review and assess the clinical benefit of newer AHs versus older AHs, corticosteroids, and montelukast in pediatric patients with allergic rhinitis.
- To evaluate the efficacy and safety of different treatment options for pediatric allergic rhinitis.
Main Methods:
- A systematic literature search was conducted across major databases (MEDLINE, SCOPUS, Cochrane) up to August 2020.
- Included randomized controlled trials (RCTs) compared newer AHs with older AHs, corticosteroids, or montelukast.
- Quality assessment was performed using the Cochrane Risk of Bias Tool.
Main Results:
- Sixteen RCTs involving 1653 pediatric patients were included.
- Newer AHs showed no significant benefit over older AHs and were less effective than intranasal corticosteroids.
- Newer AHs demonstrated greater potency in symptom control compared to montelukast, with low adverse event incidence.
Conclusions:
- Newer antihistamines are effective and well-tolerated for symptom control in pediatric allergic rhinitis.
- However, inconsistent reporting and limited comparative data hinder definitive conclusions on their relative efficacy against other treatments.
- Further high-quality, randomized comparisons are needed to fully quantify the comparative effectiveness of newer AHs.
Background:
The clinical benefit of newer antihistamines (AHs) versus other active treatments has not been assessed in pediatric patients with allergic rhinitis.
Methods:
A systematic literature search was performed in MEDLINE, SCOPUS, and the Cochrane Central Register of Controlled Trials from inception through August 2020. Randomized controlled trials (RCTs) comparing newer with older AHs, corticosteroids, or montelukast were included. The Cochrane Risk of Bias Tool was used for quality assessment.
Results:
Out of 10,656 citations, 16 RCTs (N = 1653) with a duration from 10 days to 3 months were included. When compared with older-generation AHs, the administration of newer AHs did not confer significant benefit and appeared less effective compared with intranasal corticosteroids. However, newer AHs were more potent in achieving symptom control compared with montelukast. Data regarding quality of life were generally missing. The incidence of adverse events was low in all treatment groups. The included RCTs were characterized by moderate risk of bias.
Conclusions:
Newer AHs are effective in symptom control and well tolerated in the pediatric population. However, inadequate reporting, variation in outcome measures, and a paucity of sufficient randomized comparisons precluded us from quantifying the relative efficacy of newer AHs compared with other treatment options.
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