Antihistamines have effects beyond relief of itch. Their sedative effects are often used to help children with atopic dermatitis (and their parents) sleep. And there is recent evidence for an direct and beneficial effect on the skin's permeability barrier. See: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3555427/

I agree with what you are saying. We are in fact planning on doing a study of antihistamines and AD ourselves. I was just taken back by the finality of some of the statements made by a few speakers at the last ACAAI meeting about theri efficacy with this condition.

I'm glad you are planning to do a study. The choice of antihistamine will be important. If you want to avoid confounding effect of sedation, you will probably select one of the 'non-sedating' ones. In my personal experience, loratidine has little effect, but about half of (mostly moderate to severe AD children) seemed to benefit from cetirazine. Not that their parents always noticed a huge benefit, but they certainly flared when we had to stop antihistamines prior to scratch testing.

Respected Nevin! My experience prompts that antihistamines at AD are effective as means eliminating the itch in aggravation AD.

In atopic dermatitis itching is due to xerosis of skin ?

If that true we should to depend on emollient more than anti histaminic and to avoid sleep disturbance sedating antihistaminic take the upper hand.

After having recently finished with my PhD student a systematic review on this topic, I would dare to summarise the current state of knowledge in this field as follows:

There is very little evidence regarding the effectiveness of antihistamines in AD, and what is available comes from a very few studies that, as a rule, are rather poorly designed (e.g. small size, poor control, confounders, etc.). Some of these studies failed to demonstrate any effect. On the other hand, there is a lot of faith in antihistamines from the side of "practitioners". And "faith cures", no doubt about it. So, personally, as a non-believer, I never prescribe antihistamines for AD, and never miss them. I have to admit, though, I prescribe hydroxizine or doxepin to help the patients sleep over the itch. But again, this is a personal view, and scietific evidence is lacking either way.

If you know any good, randomised, controlled study demonstrating the benefits of antihistamines in AD, please send me a reference. ? Would appreciate very much, indeed. Perhaps we have missed something...

BTW: I would be very cautious about the using so-called "emollients" in AD (be warned - most of these are registered as cosmetics, not drugs). We have analysed 177 cosmetics marketed in pharmacies as emollients, of which only 37 (21%) were free of potential sensitizers listed in the European Cosmetics Directive's annexes III and VI. (Kordus K, Spiewak R. [Emollients from the pharmacy - a help or a threat to patients with eczema?] Alergia Astma Immunologia 2012;17(3):147-53 - can be downloaded from my profile on RG).

Again - does anybody know any good randomised, controlled study demonstrating the benefits of "emollients" in AD? Would greatly appreciate any hint.

Take a look at the references cited in Simpson's 2010 review (Curr Med Res and Opin 26:633-40, 2010)

Thanks a lot, the abstract seems promising, I will try to locate the paper, as it is not available though our library. Cheers.

I am in the group of those that don,t use usually antihistamines in clinical AD. As some of you I use, at night, a sedative antihistamine for itch. I don,t believe also that histamine is important in the pathogenesis of AD. Also, like some of you, I will be happy with a well designed study of antihistamines in AD.

Differences in the histamine-induced weal and flare inhibition between cetirizine and loratadine

http://pharmacologyonline.silae.it/files/archives/2012/vol3/PhOL_2012_3_A002_003_Kastriot.pdf

Kastriot - OK, but we are not discussion urticaria. All of us agree that antihistamines are very useful in the treatment of histamine-derived diseases. But is AD also a histamine derived- disease ? This is the main question and I think, No.

I agree with you Américo Figueiredo that AD not related to histamine. Role of antihistaminic is only sedating to help baby to sleep.

As failure of sleep is considered the main cause for retarted growth in atopic child.

hello, atopic dermatitis, the most common in children and adults, Regarding the itch, i do find it interesting to note that many of the children were much satisfied with a scratch itch cycle, which sometimes did respond to hydroxyzine or doxepin. avoiding soap was beneficial, along with emolients.

atopic dermatitis is not just histamine related but beyond. it is immunological, eosinophil and mast cell mediators, play an important role.

Good morning to all colleagues. I agree with the proposed treatment, but I think that the antihistaminic therapy, limiting the scratching and a further inflammatory stimulus, may be useful in reducing the manifestations of atopic dermatitis.

Greetings. Paolo

IL33 (and Histamine4 receptors) seem a target for itch in AD, anyway cyclosporin is more helpfull than any antihistaminic in our opinion.

Marianne Morren

Do you mean cyclosporin for itch ? Or, if necessary, and only in exceptional circunstancies, cyclosporin for atopic dermatitis ? So, yes, if you treat atopic dermatitis you treat itch ...

The itch in AD is not mediated through histamine. Here the keratinocytes, free nerve endings, its exposure to ambient temperature and wind, various inflammatory mediators and many other unknown factors are essentially the cause for itch in AD. So antihistamine as such has very minimal role in itching in AD

I would suggest that a mast cell stabilizer in combination with an antihistamine would work better in these cases.

What role does Ig E play in atopic dermatitis since its levels are high. the itch is also more or less cutaneous rather than generalised. evening rise of itch may have some relation to diurnal temparature.variation.

https://www.google.co.in/url?q=http://www.jimmunol.org/cgi/content/meeting_abstract/188/1_MeetingAbstracts/177.16&sa=U&ei=3YcqU7ucOKHeigfiqoFg&ved=0CEEQFjAH&usg=AFQjCNGmgnGXxFGH8iPLXWvna6Ra5f4dUQ

Mast cells have also different receptors from H1. Antihistamines only block H1 receptors. Marie-Anne alarmed us about H4 receptors. Thank you. H4 receptor blockers may be helpfull to prevent itching in atopic dermatitis. Till H4 receptor blockers I prefer to give mast cell stabilizatör to atopic dermatitis.

ıtching in atopic dermatitis not only depends histamin but also kseroderma. I prefer to add evening primerose oil in my treatment schedule.

Recent observations revealed that beside histamine, several mediators appear to play an important role for the induction of pruritus during AD such as neuropeptides, neurotransmitters, cytokines, proteinases and arachidonic derivates. Several receptors have been cloned and characterized which may have a high impact in regulating itch responses during cutaneous inflammation. The interactive network of nerve fibres expressing high affinity receptors for various immune- and inflammatory mediators may explain why different trigger factors are capable of modulating pruritus perception in AD patients. For example, the pathophysiological role of cytokines such as GMCSF, which are known to induce pruritus, has to be determined in the pathway of pruritus in AD. Finally, we wish that new experimental tools and therapeutic agents offer new therapeutical approaches for the treatment of itch in AD patients.

There are many pruritogen causing pruritus. Histamine is imporant one, but in atopic dermatitis. TRPV1 can provoke neuropeptide releases and induce neurogenic inflammation. Substance P causes and potentiates itch. We know the benefits of antihistamine treatment in atopic dermatitis is low clinically. Therefore, the main target for the treatment of pruritus in atopic dermatitis may be TRPV-1 or other cation channells. I think that we need to focus neurogenic inflammation, and neurogenic pathways of pruritus in atopic dermatitis.

atopic dermatitis is a common entity but poorly understood especially in children. pediatricians and physicians have limited understanding of this entity.

Steroids are being used topically along with moisturizers for many cases. calcineurin inhibitors are beneficial in some individuals,