First- or second-generation antihistamines: which are more effective at controlling pruritus?

Abstract

For urticarial itch, first- and second-generation antihistamines have similar clinical benefit and are superior to placebo (strength of recommendation [SOR]: A, systematic review of randomized trials [RCT]). For itch related to atopic dermatitis, antihistamines are no better than placebo (SOR: B, small RCTs and other studies). Other categories of pruritus are best treated with non-antihistamine agents (SOR: C, based on expert opinion and disease-oriented research).