Cochrane for Clinicians

Putting Evidence into Practice

Second-Generation H1-Antihistamines for Chronic Spontaneous Urticaria


Am Fam Physician. 2016 Sep 1;94(5):352-353.

Author disclosure: No relevant financial affiliations.

Clinical Question

Are second-generation H1-antihistamines effective for the suppression of chronic spontaneous urticaria?

Evidence-Based Answer

There is good evidence that second-generation H1-antihistamines are helpful in the short- and intermediate-term suppression of urticaria. Cetirizine (Zyrtec) in a dosage of 10 mg daily is effective at completely suppressing symptoms of chronic spontaneous urticaria (number needed to treat [NNT] = 4).1 (Strength of Recommendation: A, based on consistent, good-quality patient-oriented evidence.)

Practice Pointers

Chronic spontaneous urticaria affects up to 1% of the general population.2 The economic burden of chronic spontaneous urticaria in the United States is estimated to be $2.5 billion to $5 billion annually.3 Second-generation H1-antihistamines are recommended as the mainstay of treatment for chronic spontaneous urticaria.4 The authors of this study sought to determine if second-generation H1-antihistamines are effective for the relief of chronic spontaneous urticaria and whether one agent is superior to others. Further, they sought to determine optimal dosing regimens, whether duration of benefits can be predicted, and the risks associated with use of these medications.

This Cochrane review included 73 studies with 9,759 participants.1 Methodologic quality of the included studies varied; only 12 were judged to be adequately randomized, and 55 of the studies were thought to be subject to potential bias from baseline group imbalances or industry sponsorship. Cetirizine in a dosage of 10 mg once daily led to complete suppression of urticaria in more participants in the short and intermediate term compared with placebo (absolute risk reduction [ARR] = 23%; 95% confidence interval [CI], 7% to 52%; NNT = 4 [95% CI, 2 to 14]). A pooled analysis of loratadine (Claritin; 10 mg) vs. placebo found no difference in relief between the two groups, and another comparison found no significant difference between loratadine, 10 mg, and cetirizine,

Author disclosure: No relevant financial affiliations.


show all references

1. Sharma M, Bennett C, Cohen SN, Carter B. H1-antihistamines for chronic spontaneous urticaria. Cochrane Database Syst Rev. 2014;(11):CD006137....

2. Maurer M, Weller K, Bindslev-Jensen C, et al. Unmet clinical needs in chronic spontaneous urticaria. A GA2LEN task force report. Allergy. 2011;66(3):317–330.

3. Delong LK, Culler SD, Saini SS, Beck LA, Chen SC. Annual direct and indirect health care costs of chronic idiopathic urticaria: a cost analysis of 50 nonimmunosuppressed patients. Arch Dermatol. 2008;144(1):35–39.

4. Bernstein JA, Lang DM, Khan DA, et al. The diagnosis and management of acute and chronic urticaria: 2014 update. J Allergy Clin Immunol. 2014;133(5):1270–1277.

5. Zuberbier T, Aberer W, Asero R, et al. The EAACI/GA(2) LEN/EDF/WAO Guideline for the definition, classification, diagnosis, and management of urticaria: the 2013 revision and update. Allergy. 2014;69(7):868–887.

These are summaries of reviews from the Cochrane Library.

This series is coordinated by Corey D. Fogleman, MD, Assistant Medical Editor.

A collection of Cochrane for Clinicians published in AFP is available at



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