Second-generation H1 antihistamines for the treatment of chronic urticaria: a network meta-analysis.

What was studied

This study pooled results from many earlier drug trials. It looked at people with chronic urticaria. The team compared 10 antihistamine drugs at their usual licensed doses. The drugs were cetirizine, levocetirizine, loratadine, desloratadine, ebastine and bilastine. The others were olopatadine, rupatadine, fexofenadine and mizolastine. This type of review can compare many drugs at once, even across studies. They searched records up to the end of December 2025.

What they found

The review took in 54 studies with 7,290 patients. Olopatadine, mizolastine, bilastine and levocetirizine eased overall symptoms more than a dummy pill. All 10 drugs seemed to ease itching more than a dummy pill. But only for fexofenadine was this result clear in the numbers. Ebastine shrank the raised skin welts more than mizolastine and loratadine. No drug showed a clear gap in side effects versus the dummy pill. Fexofenadine had the fewest side effects. Leaving out weaker studies did not change these results.

What it means for patients

The authors judge olopatadine to have the strongest effect on overall symptoms. They found fexofenadine did the most for itching. They found ebastine did the most for welts. Fexofenadine also had the lowest rate of side effects. These are the authors' views, based on the evidence so far.

Why it is not certain yet

The authors say new, high-quality trials must check these findings. Some of the studies in the review were judged at high risk of bias. For itching, only one drug showed a clear effect. A review can only be as good as the studies in it.

Source

Second-generation H1 antihistamines for the treatment of chronic urticaria: a network meta-analysis.

We restate facts from the source record in our own words. The original wording belongs to its publisher.