Antihistamines in the Management of Pediatric Allergic Rhinitis: A Systematic Review
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SYSTEMATIC REVIEW
Antihistamines in the Management of Pediatric Allergic Rhinitis: A Systematic Review Lilly Velentza1 · Zinovia Maridaki1 · Evangelia Blana1 · Michael Miligkos1,2
© Springer Nature Switzerland AG 2020
Abstract 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. Key points Data regarding the relevant clinical benefit of newer antihistamines are scarce. Newer antihistamines are safe and efficacious treatment options for AR but not generally superior to intranasal corticosteroids. The observed heterogeneous nature of the included studies warrants further, more standardized research. Part of this work has been presented in the Pediatric Allergy and Asthma Meeting 2019, Florence, Italy. Electronic supplementary material The online version of this article (https://doi.org/10.1007/s40272-020-00419-x) contains supplementary material, which is available to authorized users. * Lilly Velentza [email protected] 1
Pediatrics Working Group, Society of Junior Doctors, 5 Menalou Str, Maroussi, 15123 Athens, Greece
First Department of Pediatrics, National and Kapodistrian University of Athens, Athens, Greece
2
1 Introduction Allergic rhinitis (AR) represents one of the most commonly diagnosed chronic diseases in childhood and its prevalence highly varies among countries [1–3]. Common symptoms are categorized as nasal or non-nasal, whereas major comorbidities include but are not limited to other allergic diseases such as asthma (15–38% of patients with AR) [4]. Even though AR does not represent a life-threatening disease, it severely affects patients’ quality of life (QoL), causing— among others—fatigue and sleep disorders. Children are more prone to experience difficulties in social
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