Prescription Analysis of Antihistamines' Use in Patients With Moderate to Severe Burns

Postburn pruritus (PBP) significantly affects patients, causing discomfort and hindering recovery. Antihistamines, which block H1 receptors, are commonly prescribed for PBP, yet large-scale studies on their usage patterns are limited. This study evaluates antihistamine prescription trends and provider practices for PBP across varying burn severities from moderate to severe burns (≥20% TBSA). A treatment-pathways analysis was performed using TriNetX, a global, federated, deidentified database. Patients with burns ≥ 20% TBSA from the past 20 years (2004-2024) who developed pruritus were identified and stratified into 4 cohorts: 20%-40%, 40%-60%, 60%-80%, and ≥ 80% TBSA. The analysis evaluated trends in antihistamine prescriptions, including the number of patients treated with antihistamines, types prescribed, and median times to treatment initiation, duration, and therapy switching. The total sample included 2754 patients (20%-40% TBSA, n = 1712; 40%-60%, n = 613; 60%-80%, n = 253; ≥80%, n = 176). Over 70% received antihistamines, with hydroxyzine as the most common first-line therapy, followed by diphenhydramine. Across all cohorts, the average of the median times for initiation, therapy duration, and time before switching was 16.75 days, 90.25 days, and 27.75 days, respectively. Significant variations in the timing of therapy initiation suggest a gap in consistent symptom management during critical recovery periods, potentially affecting patient comfort and overall outcomes. These findings underscore the importance of vigilant postburn assessment, stepwise escalation based on response, and complementary strategies to optimize PBP management. Frequent switching and prolonged durations suggest a need for more effective and tailored therapeutic approaches to improve recovery outcomes for patients with burn injuries.