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Histamine‐blocking drugs for hives

Urticaria is a common skin disease characterised by itching weals or hives that can appear anywhere on the surface of the skin. Weals may be pinpoint in size or several inches in diameter. Most sufferers experience hives continuously or intermittently for less than six weeks, but they may last longer (when they are then called 'chronic'). Urticaria can also be accompanied by angioedema (swelling of a deeper layer of the skin). There are several varieties of urticaria, but the most common forms are acute urticaria and chronic urticaria. Common causes of acute urticaria are infections and adverse reactions to medications and foods, whereas in chronic urticaria the cause is often unknown. Intense itching is common, and it can lead to disturbed sleep and even depression, having a serious impact on a person's quality of life. As the face and other exposed body parts can be affected, hives and angioedema can prove embarrassing for the individual.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2015

Histamine type 2 receptor antagonists as adjuvant treatment for resected colorectal cancer

Colorectal cancer (bowel cancer) is the third most commonly diagnosed cancer in the world. Surgery is the primary curative treatment for those with early stage disease. However, a number of patients relapse after primary surgery, presumably due to cancer cells that have spread undetected to other parts of the body. In general, once colorectal cancer has spread it is no longer curable. Hence, adjuvant treatments are given around the time of surgery to eliminate any remnant cells to improve a patient's chance of cure.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2012

Proton pump inhibitor treatment initiated prior to endoscopic diagnosis in upper gastrointestinal bleeding

Bleeding from lesions in the oesophagus, stomach or duodenum is a common medical emergency. Research has suggested that reducing the amount of acid in the stomach may help to control the bleeding, but it is unknown if early initiation of such treatment (that is, before endoscopic diagnosis) is beneficial for patients.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2012

Effects of antihistamines on eczema

Eczema is a common chronic disease. Itch is the most important symptom, and eczema is often accompanied by dry skin. Skin lesions include rash, redness, swelling of the skin, crusts, oozing, and sometimes also bleeding as a consequence of persistent scratching. Although the disease can resolve during childhood, it might also recur in or persist into adult life. The cause of eczema is considered to be a combination of genetic and environmental factors. Moisturisers, topical corticosteroids, and topical immunomodulators are the mainstay during treatment of eczema, while more severe cases might need UV light therapy or systemic immunosuppressants. Itch is very difficult to treat and leads to scratching, which leads to more inflammation of the skin, and often people with eczema end up in a vicious circle of itching and scratching. The role of histamine in itching associated with eczema is not fully elucidated, but oral H1 antihistamines have been used for many years in the treatment of eczema. These might have been used largely for their sedative action, with highly sedative antihistamines, e.g. chlorpheniramine and hydroxyzine. However, oral H1 antihistamines are widely used in the treatment of allergic disorders, such as urticaria, allergic rhinitis, and allergic conjunctivitis, but their efficacy in alleviating itch and eczema remains unclear. This systematic review sought evidence for the effects and safety of the use of oral antihistamines for eczema, to guide their use in clinical practice.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2016

Decongestants, antihistamines and nasal irrigation for acute sinusitis in children

The goal of this review was to determine whether there is any evidence in the medical literature for or against the use of decongestants, antihistamines and nasal irrigation for acute sinusitis in children.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2014

Antihistamines with or without decongestants for otitis media with effusion (OME) ('glue ear') in children

Otitis media with effusion (OME), also known as glue ear or serous otitis media, is a condition in which there is fluid persisting in the middle ear. Many treatments have been suggested. This review summarizes the studies using antihistamines, decongestants or a combination of antihistamines and decongestants and finds no benefit for any of the short or long‐term outcomes including resolution of the fluid, hearing problems or the necessity of additional referral to specialists. Further, using these medications causes significant side effects, such as gastrointestinal upset, irritability, drowsiness or dizziness, in approximately 10% of patients. Therefore antihistamines, decongestants or antihistamine/decongestant combinations are not recommended treatments for OME. Watchful waiting is the best approach with consideration of referral for evaluation by an ENT consultant if symptoms persist beyond 12 weeks.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2011

Ketotifen alone or as additional medication for long‐term control of asthma and wheeze in children

Children with asthma can find using inhaled treatments medication difficult and so oral medication such as ketotifen, which is an antihistamine, can be used to help control symptoms. The review found that mild asthma symptoms were well‐controlled in the studies of 4 to 32 week duration with reduction in use of rescue bronchodilator, rescue oral steroids and in exacerbations as well as clear perception of effectiveness from physicians, parents and children.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2010

Additional bedtime medication for the control of night‐time acid reflux from the stomach.

The inhibition of gastric acid secretion is an accepted treatment for diseases related to reflux of acid from the stomach. Some types of antacids, known as proton pump inhibitors (PPI), are considered to be the most effective medical treatment for people patients with acid‐related diseases such as peptic ulcer, gastro‐oesophageal reflux disease (GERD) and Zollinger‐Ellison syndrome, but they may not reduce gastric acid secretion sufficiently to prevent night‐time acid reflux symptoms. H2‐receptor antagonists (H2RAs) have also been used for the treatment of acid‐related diseases for more than a decade and might help to control night‐time acid reflux, if taken at bedtime along with a high dose of PPI. The results show that additional bedtime H2RAs can decrease the night‐time gastric acid breakthrough, but we believe that additional bedtime H2RAs to PPI should only be used as treatment an intervention in clinical trials until further evidence has been found.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2011

Interventions for pityriasis rosea, skin rash of unknown cause

Pityriasis rosea is a scaly rash that mostly affects young adults. It is relatively common and affects about 170 out of every 100,000 people in the community each year. The first sign is a patch of scales, usually on the trunk. A generalised eruption then follows and all lesions disappear within 2 to 12 weeks. This review is important because about 50% of people with pityriasis rosea experience moderate to severe itch. It is not known whether the current treatments, which include tablets, creams, and ultra‐violet radiation, are useful and whether the benefits outweigh the risk of adverse effects.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2015

Interventions at caesarean section for reducing the risk of lung damage from inhaling stomach contents during anaesthesia

Thirty‐two studies were included in this review. However, only 22 studies, involving 2658 women, provided data for analysis, looking at interventions given prior to caesarean section for reducing the risk of aspiration. There were several different drugs and drug combinations being considered and the studies were generally of poor or questionable quality. Antacids (like sodium citrate), H2 receptor antagonists (like ranitidine), proton pump antagonists (like omeprazole), all reduced the acidity of the stomach contents. An antacid plus an H2 receptor antagonist also reduced acidity. In theory, a combination like this, where the antacid acts quickly and the H2 receptor antagonists takes a little longer, should protect at periods of greatest risk, i.e. the beginning and end of the procedure (i.e. intubation and extubation). More research is needed to identify the best combination of drugs and to check for possible adverse effects.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2014

Interventions to treat acute otitis externa, a specific form of ear canal inflammation also known as swimmer's ear

Acute otitis externa causes inflammation of the ear canal. It is a common clinical problem encountered in general practice. This review assesses the various forms of medication used to treat the condition. Nineteen randomised controlled trials were included (3382 participants). Most were of low quality. The findings of the review may not be wholly relevant to primary care as most of the trials were conducted in a hospital setting and over half involved ear cleaning as part of the treatment (this is generally not available in primary care). However, the review does demonstrate that topical treatments alone are effective at treating acute otitis externa. There was little to choose between them in terms of effectiveness. However, when treatment needs to be extended beyond one week acetic acid drops appear to be less effective than antibiotic/steroid drops. In addition, symptoms persist for two days longer in those treated with acetic acid. More research is needed to determine the effectiveness of steroid‐only drops. Patients treated with antibiotic/steroid drops can expect their symptoms to last for approximately six days after treatment has begun.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2010

Oral antihistamine‐decongestant‐analgesic combinations for the common cold

The common cold is probably the most common illness known and usually presents with a range of symptoms such as sore throat, nasal stuffiness and discharge, sneezing and cough. On average, young children have six to eight colds per year and adults have two to four. It is caused by viruses (more than 200 viruses have been implicated) and is generally not a serious condition which usually resolves by itself within one to two weeks. However, the common cold has a large impact on time lost from work or school and causes substantial discomfort.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2012

Non‐opioid drugs for managing pain in labour

Women's experience of pain during labour varies greatly. Some women feel little pain whilst others find the pain extremely distressing.  A woman’s position in labour, mobility, and levels of fear and anxiety or, conversely, confidence may influence her experience of pain. Several drug and non‐drug interventions are available for managing pain during labour. In this review we have assessed the evidence on the effectiveness and safety of non‐opioid drugs in the management of pain in labour. Non‐opioid drugs are used to control mild to moderate pain and include non‐steroidal anti‐inflammatory drugs, paracetamol, antispasmodics, sedatives and antihistamines. In the past, these drugs were used to help reduce women's anxiety and thus aid pain relief. Currently, they are not commonly used for pain relief in labour. However, they may still however be offered during the early stages of labour in some countries.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2012

Gastro‐oesophageal reflux treatment for asthma in adults and children

People with asthma also often have gastro‐oesophageal reflux (where acid from the stomach comes back up the gullet (esophagus)). Reflux is very common in people with asthma. It may be a trigger for asthma, or alternatively, asthma may trigger reflux. Treatments that can help reflux include antacids and drugs to suppress stomach acids or empty the stomach. This review of trials found that using reflux treatments does not generally help ease asthma symptoms. While asthma may be improved in some people, it was not possible to predict who might benefit.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2008

Anti‐histamines for prolonged non‐specific cough in children

Children with non‐specific cough are commonly treated with a variety of medications to treat the symptom of cough. The objective of this review was to evaluate the effectiveness of anti‐histamines in children with prolonged cough that is not related to an underlying respiratory disease, that is, non‐specific chronic cough. We included three therapeutic studies with 182 randomised participants. Two studies found that chronic cough significantly improved in both treatment and placebo groups with no difference between the two groups. One small study however described that children who had chronic cough associated with seasonal allergic rhinitis treated with cetirizine improved significantly more than children on placebo and this difference was evident by two weeks. Four studies that evaluated safety profiles included 3166 randomised participants and described a non significant increase in cough in participants who received the active medication. Despite the limitations of this review, our findings are similar to the review on anti‐histamines for acute cough which showed no good evidence for or against the use of anti‐histamines. In contrast to recommendations in adults with chronic cough, anti‐histamines cannot be recommended as empirical therapy for children with chronic cough. Further research examining the effects of this treatment using child appropriate cough outcome measures is needed.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2010

H1‐antihistamines for the emergency treatment of anaphylaxis

Anaphylaxis is a rare, but potentially life‐threatening emergency. Evidence from the United Kingdom suggests that incidence may be increasing rapidly. Common triggers of anaphylaxis include a variety of foods, drugs and insect venoms.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2016

Interventions for preventing reactions to snake antivenom

People die or can be seriously disabled after being bitten by a venomous snake. Different venomous snake species have different effects on the body, but initial treatment is similar ‐ to try and prevent venom entering the general circulation. If it becomes apparent that the venom has reached the bloodstream, the patients start becoming extremely unwell and in these circumstances health staff may give a specific antivenom (made from horse serum). However, antivenom frequently causes adverse effects which can, in themselves, be severe and result in death.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2009

Antihistamines as an addition to topical nasal steroids for allergic rhinitis in children

Allergic rhinitis is a very common chronic illness affecting 10% to 40% of children worldwide. Seasonal allergic rhinitis (hay fever) is most common around springtime. The symptoms are mostly sneezing, a runny nose and watery eyes. We looked for trials that compared antihistamines (either oral or topical) in addition to a topical nasal steroid with a topical nasal steroid alone in children who had allergic rhinitis. We wanted to know whether adding antihistamines (oral or topical) in the therapy of children with allergic rhinitis who already use topical nasal steroids would have additional benefits for them. We found one trial that had been carried out in children comparing oral antihistamines in addition to topical nasal steroids with topical nasal steroids alone but it did not provide sufficient data to draw any conclusions. Most of the trials focused only on adults or included a small number of children. Unfortunately, the trials which included children along with adults did not report whether there were any differences in the effect of treatment or adverse effects in children in comparison with adults. We are therefore unable to draw a conclusion as to whether or not this combination therapy has beneficial effect in children with allergic rhinitis or whether the benefits are acceptable in terms of the adverse effects.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2010

Scopolamine for preventing and treating motion sickness

This Cochrane Review summarises evidence from 14 randomised controlled studies evaluating the effectiveness and safety of scopolamine for motion sickness. The results show that scopolamine is more effective than placebo and scopolamine‐like derivatives in the prevention of nausea and vomiting associated with motion sickness. However, scopolamine was not shown to be superior to antihistamines and combinations of scopolamine and ephedrine. Scopolamine was less likely to cause drowsiness, blurred vision or dizziness when compared to these other agents.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2011

Medications to prevent NSAID‐induced gastroduodenal ulcers

The results of this meta‐analysis demonstrate that misoprostol, proton pump inhibitors, and double doses of H2‐receptor antagonists are effective at reducing the risk of both gastric and duodenal non steroidal anti‐inflammatory (NSAID) medications induced ulcers. In high risk patients, the use of a traditional NSAID + PPI appears equivalent to a COX‐2 inhibitor alone. The most effective strategy in high risk GI patients appears to be the combination of a COX‐2 inhibitor + PPI.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2011

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