Efficacy and Safety of Intensive Nonsedating Antihistamines for Chronic Spontaneous Urticaria: A Meta-Analysis of Randomized Controlled Trials

Introduction: The aim of this study was to determine the efficacy and safety of intensive versus standard nonsedating antihistamines (NSAs) for chronic spontaneous urticaria (CSU) patients. Methods: An electronic search was performed on the PubMed, Embase, and the Cochrane Library databases to identify eligible randomized controlled trials (RCTs) throughout January 2021. The weighted mean difference (WMD) and relative risk (RR) with 95% confidence interval (CI) were applied to calculate the pooled outcomes for the continuous and categorical data using the random-effects model. Results: Nine RCTs involving 1,996 CSU patients were selected. We found that intensive NSA was associated with greater reduction in the mean pruritus score than the standard dose of NSA (WMD: −0.13; p = 0.005). However, there was no significant difference between the intensive and standard dose of NSA in terms of the rate of response to antihistamines (RR: 1.00; p = 0.865). Finally, the use of intensive NSA was associated with a higher risk of somnolence than the use of standard NSA (RR: 3.28; 95% CI: 1.55–6.95; p = 0.002). Conclusion: We found that the use of intensive NSA could achieve greater reduction in the mean pruritus score, without increasing the risk of adverse events.