Scolaris Content Display Scolaris Content Display

Study flow diagram.
Figures and Tables -
Figure 1

Study flow diagram.

Risk of bias graph: review authors' judgements about each risk of bias item presented as percentages across all included studies.
Figures and Tables -
Figure 2

Risk of bias graph: review authors' judgements about each risk of bias item presented as percentages across all included studies.

Risk of bias summary: review authors' judgements about each risk of bias item for each included study.
Figures and Tables -
Figure 3

Risk of bias summary: review authors' judgements about each risk of bias item for each included study.

Comparison 1 Loratadine 10 mg versus placebo, Outcome 1 Proportion of participants with 'good' or 'excellent' response whilst taking H1‐antihistamines.
Figures and Tables -
Analysis 1.1

Comparison 1 Loratadine 10 mg versus placebo, Outcome 1 Proportion of participants with 'good' or 'excellent' response whilst taking H1‐antihistamines.

Comparison 2 Loratadine 10 mg versus cetirizine 10 mg, Outcome 1 Proportion of participants with complete suppression of urticaria whilst taking H1‐antihistamines.
Figures and Tables -
Analysis 2.1

Comparison 2 Loratadine 10 mg versus cetirizine 10 mg, Outcome 1 Proportion of participants with complete suppression of urticaria whilst taking H1‐antihistamines.

Comparison 3 Loratadine 10 mg versus desloratadine 5 mg, Outcome 1 Proportion of participants with complete suppression of urticaria whilst taking H1‐antihistamines.
Figures and Tables -
Analysis 3.1

Comparison 3 Loratadine 10 mg versus desloratadine 5 mg, Outcome 1 Proportion of participants with complete suppression of urticaria whilst taking H1‐antihistamines.

Comparison 3 Loratadine 10 mg versus desloratadine 5 mg, Outcome 2 Proportion of participants with 'good' or 'excellent' response whilst taking H1‐antihistamines.
Figures and Tables -
Analysis 3.2

Comparison 3 Loratadine 10 mg versus desloratadine 5 mg, Outcome 2 Proportion of participants with 'good' or 'excellent' response whilst taking H1‐antihistamines.

Comparison 4 Loratadine 10 mg versus mizolastine 10 mg, Outcome 1 Proportion of participants with complete suppression of urticaria whilst taking H1‐antihistamines.
Figures and Tables -
Analysis 4.1

Comparison 4 Loratadine 10 mg versus mizolastine 10 mg, Outcome 1 Proportion of participants with complete suppression of urticaria whilst taking H1‐antihistamines.

Comparison 4 Loratadine 10 mg versus mizolastine 10 mg, Outcome 2 Proportion of participants with 'good' or 'excellent' response whilst taking H1‐antihistamines.
Figures and Tables -
Analysis 4.2

Comparison 4 Loratadine 10 mg versus mizolastine 10 mg, Outcome 2 Proportion of participants with 'good' or 'excellent' response whilst taking H1‐antihistamines.

Comparison 4 Loratadine 10 mg versus mizolastine 10 mg, Outcome 3 Proportion of participants with at least 50% improvement in QoL whilst taking H1‐antihistamines.
Figures and Tables -
Analysis 4.3

Comparison 4 Loratadine 10 mg versus mizolastine 10 mg, Outcome 3 Proportion of participants with at least 50% improvement in QoL whilst taking H1‐antihistamines.

Comparison 4 Loratadine 10 mg versus mizolastine 10 mg, Outcome 4 Serious adverse events (i.e. serious enough to require withdrawal of treatment).
Figures and Tables -
Analysis 4.4

Comparison 4 Loratadine 10 mg versus mizolastine 10 mg, Outcome 4 Serious adverse events (i.e. serious enough to require withdrawal of treatment).

Comparison 5 Loratadine 10 mg versus emedastine 2 mg, Outcome 1 Proportion of participants with complete suppression of urticaria whilst taking H1‐antihistamines.
Figures and Tables -
Analysis 5.1

Comparison 5 Loratadine 10 mg versus emedastine 2 mg, Outcome 1 Proportion of participants with complete suppression of urticaria whilst taking H1‐antihistamines.

Comparison 5 Loratadine 10 mg versus emedastine 2 mg, Outcome 2 Proportion of participants with good or excellent response whilst taking H1‐antihistamines.
Figures and Tables -
Analysis 5.2

Comparison 5 Loratadine 10 mg versus emedastine 2 mg, Outcome 2 Proportion of participants with good or excellent response whilst taking H1‐antihistamines.

Comparison 5 Loratadine 10 mg versus emedastine 2 mg, Outcome 3 Serious adverse events (i.e. serious enough to require withdrawal of treatment).
Figures and Tables -
Analysis 5.3

Comparison 5 Loratadine 10 mg versus emedastine 2 mg, Outcome 3 Serious adverse events (i.e. serious enough to require withdrawal of treatment).

Comparison 6 Loratadine 10 mg versus hydroxyzine 25 mg, Outcome 1 Proportion of participants with complete suppression of urticaria whilst taking H1‐antihistamines.
Figures and Tables -
Analysis 6.1

Comparison 6 Loratadine 10 mg versus hydroxyzine 25 mg, Outcome 1 Proportion of participants with complete suppression of urticaria whilst taking H1‐antihistamines.

Comparison 7 Cetirizine 10 to 20 mg versus placebo, Outcome 1 Proportion of participants with complete suppression of urticaria whilst taking H1‐antihistamines.
Figures and Tables -
Analysis 7.1

Comparison 7 Cetirizine 10 to 20 mg versus placebo, Outcome 1 Proportion of participants with complete suppression of urticaria whilst taking H1‐antihistamines.

Comparison 7 Cetirizine 10 to 20 mg versus placebo, Outcome 2 Serious adverse events (i.e. serious enough to require withdrawal of treatment).
Figures and Tables -
Analysis 7.2

Comparison 7 Cetirizine 10 to 20 mg versus placebo, Outcome 2 Serious adverse events (i.e. serious enough to require withdrawal of treatment).

Comparison 8 Cetirizine 10 mg versus hydroxyzine 25 mg, Outcome 1 Serious adverse events (i.e. serious enough to require withdrawal of treatment).
Figures and Tables -
Analysis 8.1

Comparison 8 Cetirizine 10 mg versus hydroxyzine 25 mg, Outcome 1 Serious adverse events (i.e. serious enough to require withdrawal of treatment).

Comparison 9 Desloratadine 5 to 20 mg versus placebo, Outcome 1 Proportion of participants with complete suppression of urticaria whilst taking H1‐antihistamines.
Figures and Tables -
Analysis 9.1

Comparison 9 Desloratadine 5 to 20 mg versus placebo, Outcome 1 Proportion of participants with complete suppression of urticaria whilst taking H1‐antihistamines.

Comparison 9 Desloratadine 5 to 20 mg versus placebo, Outcome 2 Serious adverse events (i.e. serious enough to require withdrawal of treatment).
Figures and Tables -
Analysis 9.2

Comparison 9 Desloratadine 5 to 20 mg versus placebo, Outcome 2 Serious adverse events (i.e. serious enough to require withdrawal of treatment).

Comparison 10 Hydroxyzine 25 mg versus placebo, Outcome 1 Serious adverse events (i.e. serious enough to require withdrawal of treatment to withdrawal).
Figures and Tables -
Analysis 10.1

Comparison 10 Hydroxyzine 25 mg versus placebo, Outcome 1 Serious adverse events (i.e. serious enough to require withdrawal of treatment to withdrawal).

Comparison 11 Levocetirizine 5 to 20 mg versus placebo, Outcome 1 Proportion of participants with complete suppression of urticaria whilst taking H1‐antihistamines.
Figures and Tables -
Analysis 11.1

Comparison 11 Levocetirizine 5 to 20 mg versus placebo, Outcome 1 Proportion of participants with complete suppression of urticaria whilst taking H1‐antihistamines.

Comparison 12 Rupatadine 10 to 20 mg versus placebo, Outcome 1 Proportion of participants with 'good' or 'excellent' response whilst taking H1‐antihistamines.
Figures and Tables -
Analysis 12.1

Comparison 12 Rupatadine 10 to 20 mg versus placebo, Outcome 1 Proportion of participants with 'good' or 'excellent' response whilst taking H1‐antihistamines.

Summary of findings for the main comparison. Cetirizine 10 to 20 mg versus placebo for chronic spontaneous urticaria

Cetirizine 10 to 20 mg versus placebo for chronic spontaneous urticaria

Patient or population: patients with chronic spontaneous urticaria
Setting: research clinic
Intervention: cetirizine 10 to 20 mg versus placebo

Outcomes

Illustrative comparative risks* (95% CI)

Relative effect
(95% CI)

Number of participants
(studies)

Quality of the evidence
(GRADE)

Comments

Assumed risk

Corresponding risk

Control (placebo)

Cetirizine 10 to 20 mg

Complete suppression of urticaria
Global assessment of symptom scores

Study population

RR 2.72
(1.51 to 4.91)

178
(2 studies)

⊕⊕⊝⊝
Lowa,b

Favours cetirizine

133 per 1000

363 per 1000
(201 to 655)

Moderate

146 per 1000

397 per 1000
(220 to 717)

Adverse events leading to withdrawal

Study population

RR 3
(0.68 to 13.22)

389
(3 studies)

⊕⊕⊝⊝
Lowa,b

Favours neither intervention nor control

10 per 1000

30 per 1000
(7 to 132)

Moderate

14 per 1000

42 per 1000
(10 to 185)

*The basis for the assumed risk (e.g. median control group risk across studies) is provided in footnotes. The corresponding risk (and its 95% confidence interval) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI).
CI: Confidence interval; RR: Risk ratio.

GRADE Working Group grades of evidence.
High quality: Further research is very unlikely to change our confidence in the estimate of effect.
Moderate quality: Further research is likely to have an important impact on our confidence in the estimate of effect and may change the estimate.
Low quality: Further research is very likely to have an important impact on our confidence in the estimate of effect and is likely to change the estimate.
Very low quality: We are very uncertain about the estimate.

aDesign limitation (risk of bias).
bRelatively few participants and few events and/or wide confidence intervals.

Figures and Tables -
Summary of findings for the main comparison. Cetirizine 10 to 20 mg versus placebo for chronic spontaneous urticaria
Summary of findings 2. Desloratadine 5 to 20 mg versus placebo for chronic spontaneous urticaria

Desloratadine 5 to 20 mg versus placebo for chronic spontaneous urticaria

Patient or population: patients with chronic spontaneous urticaria
Setting: research clinic
Intervention: desloratadine 5 to 20 mg versus placebo

Outcomes

Illustrative comparative risks*
(95% CI)

Relative effect
(95% CI)

Number of participants
(studies)

Quality of the evidence
(GRADE)

Comments

Assumed risk

Corresponding risk

Control (placebo)

Desloratadine

5 to 20 mg

Complete suppression of urticaria: short‐term duration of intervention (desloratadine 5 mg)
Global assessment of symptom scores

See comment

See comment

Not estimable

46
(1 study)

⊕⊕⊝⊝
Lowa,b

Favours neither intervention nor control

Only 1 study, a conference abstract (Hoxha 2011)

Complete suppression of urticaria: short‐term duration of intervention (desloratadine 10 mg)
Global assessment of symptom scores

See comment

See comment

Not estimable

46
(1 study)

⊕⊕⊝⊝
Lowa,b

Favours neither intervention nor control

Only 1 study, a conference abstract (Hoxha 2011)

Complete suppression of urticaria: short‐term duration of intervention (desloratadine 20 mg)
Global assessment of symptom scores

See comment

See comment

Not estimable

46
(1 study)

⊕⊕⊝⊝
Lowa,b

Favours desloratadine

Only 1 study, a conference abstract (Hoxha 2011)

Complete suppression of urticaria: intermediate‐term duration of intervention (desloratadine 5 mg)
Global assessment of symptom scores

See comment

See comment

Not estimable

80
(1 study)

⊕⊕⊝⊝
Lowa,b

Favours desloratadine

Only 1 study (Di Lorenzo 2004)

Adverse effects leading to withdrawal: intermediate‐term duration of 5 mg of intervention

Study population

RR 1.46
(0.42 to 5.1)

466
(3 studies)

⊕⊕⊝⊝
Lowa,b

Favours neither intervention nor control

17 per 1000

25 per 1000
(7 to 89)

Moderate

18 per 1000

26 per 1000
(8 to 92)

*The basis for the assumed risk (e.g. median control group risk across studies) is provided in footnotes. The corresponding risk (and its 95% confidence interval) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI).
CI: Confidence interval; RR: Risk ratio.

GRADE Working Group grades of evidence.
High quality: Further research is very unlikely to change our confidence in the estimate of effect.
Moderate quality: Further research is likely to have an important impact on our confidence in the estimate of effect and may change the estimate.
Low quality: Further research is very likely to have an important impact on our confidence in the estimate of effect and is likely to change the estimate.
Very low quality: We are very uncertain about the estimate.

aDesign limitation (risk of bias).
bRelatively few participants and few events and/or wide confidence intervals.

Figures and Tables -
Summary of findings 2. Desloratadine 5 to 20 mg versus placebo for chronic spontaneous urticaria
Summary of findings 3. Levocetirizine 5 to 20 mg versus placebo for chronic spontaneous urticaria

Levocetirizine 5 to 20 mg versus placebo for chronic spontaneous urticaria

Patient or population: patients with chronic spontaneous urticaria
Setting: research clinic
Intervention: levocetirizine 5 to 20 mg versus placebo

Outcomes

Illustrative comparative risks*
(95% CI)

Relative effect
(95% CI)

Number of participants
(studies)

Quality of the evidence
(GRADE)

Comments

Assumed risk

Corresponding risk

Control (placebo)

Levocetirizine

5 to 20 mg

Complete suppression of urticaria: short‐term duration of intervention (levocetirizine 5 mg)
Global assessment of symptom scores

See comment

See comment

Not estimable

49
(1 study)

⊕⊕⊝⊝
Lowa,b

Favours neither intervention nor control

Only 1 study, a conference abstract (Hoxha 2011)

Complete suppression of urticaria: short‐term duration of intervention (levocetirizine 10 mg)
Global assessment of symptom scores

See comment

See comment

Not estimable

49
(1 study)

⊕⊕⊝⊝
Lowa,b

Favours neither intervention nor control

Only 1 study, a conference abstract (Hoxha 2011)

Complete suppression of urticaria: short‐term duration of intervention (levocetirizine 20 mg)
Global assessment of symptom scores

See comment

See comment

Not estimable

49
(1 study)

⊕⊕⊝⊝
Lowa,b

Favours levocetirizine

Only 1 study, a conference abstract (Hoxha 2011)

Complete suppression of urticaria: intermediate‐term duration of intervention (levocetirizine 5 mg)
Global assessment of symptom scores

See comment

See comment

Not estimable

100
(1 study)

⊕⊕⊝⊝
Lowa,b

Favours levocetirizine

Only 1 study (Nettis 2006)

*The basis for the assumed risk (e.g. median control group risk across studies) is provided in footnotes. The corresponding risk (and its 95% confidence interval) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI).
CI: Confidence interval.

GRADE Working Group grades of evidence.
High quality: Further research is very unlikely to change our confidence in the estimate of effect.
Moderate quality: Further research is likely to have an important impact on our confidence in the estimate of effect and may change the estimate.
Low quality: Further research is very likely to have an important impact on our confidence in the estimate of effect and is likely to change the estimate.
Very low quality: We are very uncertain about the estimate.

aDesign limitation (risk of bias).
bRelatively few participants and few events and/or wide confidence intervals.

Figures and Tables -
Summary of findings 3. Levocetirizine 5 to 20 mg versus placebo for chronic spontaneous urticaria
Summary of findings 4. Rupatadine 10 to 20 mg versus placebo for chronic spontaneous urticaria

Rupatadine 10 to 20 mg versus placebo for chronic spontaneous urticaria

Patient or population: patients with chronic spontaneous urticaria
Setting: research clinic
Intervention: rupatadine 10 to 20 mg versus placebo

Outcomes

Illustrative comparative risks* (95% CI)

Relative effect
(95% CI)

Number of participants
(studies)

Quality of the evidence
(GRADE)

Comments

Assumed risk

Corresponding risk

Control

(placebo)

Rupatadine

10 to 20 mg

Good or excellent response
Global assessment of symptom scores

Study population

RR 1.35
(1.03 to 1.77)

245
(1 study)

⊕⊕⊝⊝
Lowa,b

Favours rupatadine

509 per 1000

687 per 1000
(524 to 901)

Moderate

509 per 1000

687 per 1000
(524 to 901)

*The basis for the assumed risk (e.g. median control group risk across studies) is provided in footnotes. The corresponding risk (and its 95% confidence interval) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI).
CI: Confidence interval; RR: Risk ratio.

GRADE Working Group grades of evidence.
High quality: Further research is very unlikely to change our confidence in the estimate of effect.
Moderate quality: Further research is likely to have an important impact on our confidence in the estimate of effect and may change the estimate.
Low quality: Further research is very likely to have an important impact on our confidence in the estimate of effect and is likely to change the estimate.
Very low quality: We are very uncertain about the estimate.

aDesign limitation (risk of bias).
bRelatively few participants and few events and/or wide confidence intervals.

Figures and Tables -
Summary of findings 4. Rupatadine 10 to 20 mg versus placebo for chronic spontaneous urticaria
Summary of findings 5. Loratadine 10 mg versus placebo for chronic spontaneous urticaria

Loratadine 10 mg versus placebo for chronic spontaneous urticaria

Patient or population: patients with chronic spontaneous urticaria
Setting: research clinic
Intervention: loratadine 10 mg versus placebo

Outcomes

Illustrative comparative risks* (95% CI)

Relative effect
(95% CI)

Number of participants
(studies)

Quality of the evidence
(GRADE)

Comments

Assumed risk

Corresponding risk

Control (placebo)

Loratadine

10 mg

Good or excellent response
Global assessment of symptom scores

Study population

RR 1.86
(0.91 to 3.79)

124
(2 studies)

⊕⊕⊝⊝
Lowa,b

Favours neither intervention nor control

155 per 1000

289 per 1000
(141 to 588)

Moderate

160 per 1000

298 per 1000
(146 to 606)

*The basis for the assumed risk (e.g. median control group risk across studies) is provided in footnotes. The corresponding risk (and its 95% confidence interval) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI).
CI: Confidence interval; RR: Risk ratio.

GRADE Working Group grades of evidence.
High quality: Further research is very unlikely to change our confidence in the estimate of effect.
Moderate quality: Further research is likely to have an important impact on our confidence in the estimate of effect and may change the estimate.
Low quality: Further research is very likely to have an important impact on our confidence in the estimate of effect and is likely to change the estimate.
Very low quality: We are very uncertain about the estimate.

aDesign limitation (risk of bias).
bRelatively few participants and few events and/or wide confidence intervals.

Figures and Tables -
Summary of findings 5. Loratadine 10 mg versus placebo for chronic spontaneous urticaria
Summary of findings 6. Loratadine 10 mg versus cetirizine 10 mg for chronic spontaneous urticaria

Loratadine 10 mg versus cetirizine 10 mg for chronic spontaneous urticaria

Patient or population: patients with chronic spontaneous urticaria
Setting: research clinic
Intervention: loratadine 10 mg versus cetirizine 10 mg

Outcomes

Illustrative comparative risks* (95% CI)

Relative effect
(95% CI)

Number of participants
(studies)

Quality of the evidence
(GRADE)

Comments

Assumed risk

Corresponding risk

Control

(cetirizine

10 mg)

Loratadine

10 mg

Complete cessation of urticaria
Global assessment of symptom scores

Study population

RR 1.05
(0.76 to 1.43)

103
(2 studies)

⊕⊕⊝⊝
Lowa,b

Combined short and intermediate‐term duration of intervention.

Favours neither intervention nor control

588 per 1000

618 per 1000
(447 to 841)

Moderate

574 per 1000

603 per 1000
(436 to 821)

*The basis for the assumed risk (e.g. median control group risk across studies) is provided in footnotes. The corresponding risk (and its 95% confidence interval) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI).
CI: Confidence interval; RR: Risk ratio.

GRADE Working Group grades of evidence.
High quality: Further research is very unlikely to change our confidence in the estimate of effect.
Moderate quality: Further research is likely to have an important impact on our confidence in the estimate of effect and may change the estimate.
Low quality: Further research is very likely to have an important impact on our confidence in the estimate of effect and is likely to change the estimate.
Very low quality: We are very uncertain about the estimate.

aDesign limitation (risk of bias).
bRelatively few participants and few events and/or wide confidence intervals.

Figures and Tables -
Summary of findings 6. Loratadine 10 mg versus cetirizine 10 mg for chronic spontaneous urticaria
Summary of findings 7. Loratadine 10 mg versus desloratadine 5 mg for chronic spontaneous urticaria

Loratadine 10 mg versus desloratadine 5 mg for chronic spontaneous urticaria

Patient or population: patients with chronic spontaneous urticaria
Setting: research clinic
Intervention: loratadine 10 mg versus desloratadine 5 mg

Outcomes

Illustrative comparative risks*
(95% CI)

Relative effect
(95% CI)

Number of participants
(studies)

Quality of the evidence
(GRADE)

Comments

Assumed risk

Corresponding risk

Control

(desloratadine
5 mg)

Loratadine

10 mg

Complete suppression of urticaria: intermediate‐term duration of intervention

Study population

RR 0.91
(0.78 to 1.06)

369
(2 studies)

⊕⊕⊝⊝
Lowa,b

Favours neither intervention nor control

658 per 1000

598 per 1000
(513 to 697)

Moderate

670 per 1000

610 per 1000
(523 to 710)

Good or excellent response: intermediate‐term duration of intervention
Global assessment of symptom scores

Study population

RR 1.04
(0.64 to 1.71)

410
(3 studies)

⊕⊕⊝⊝
Lowa,b

Favours neither intervention nor control

No participants reported a good or excellent response in the loratadine group in Zou 2002

We found low levels of statistical heterogeneity in this analysis I2 = 40%)

263 per 1000

274 per 1000
(169 to 450)

Moderate

228 per 1000

237 per 1000
(146 to 390)

*The basis for the assumed risk (e.g. median control group risk across studies) is provided in footnotes. The corresponding risk (and its 95% confidence interval) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI).
CI: Confidence interval; RR: Risk ratio.

GRADE Working Group grades of evidence.
High quality: Further research is very unlikely to change our confidence in the estimate of effect.
Moderate quality: Further research is likely to have an important impact on our confidence in the estimate of effect and may change the estimate.
Low quality: Further research is very likely to have an important impact on our confidence in the estimate of effect and is likely to change the estimate.
Very low quality: We are very uncertain about the estimate.

aDesign limitation (risk of bias).
bRelatively few participants and few events and/or wide confidence intervals.

Figures and Tables -
Summary of findings 7. Loratadine 10 mg versus desloratadine 5 mg for chronic spontaneous urticaria
Summary of findings 8. Loratadine 10 mg versus mizolastine 10 mg for chronic spontaneous urticaria

Loratadine 10 mg compared to mizolastine 10 mg for chronic spontaneous urticaria

Patient or population: patients with chronic spontaneous urticaria
Setting: research clinic
Intervention: loratadine 10 mg
Comparison: mizolastine 10 mg

Outcomes

Illustrative comparative risks* (95% CI)

Relative effect
(95% CI)

Number of participants
(studies)

Quality of the evidence
(GRADE)

Comments

Assumed risk

Corresponding risk

Control

(mizolastine
10 mg)

Loratadine

10 mg

Complete cessation of urticaria: intermediate‐term duration of intervention
Global assessment of symptom scores

Study population

RR 0.86
(0.64 to 1.16)

316
(3 studies)

⊕⊝⊝⊝
Very lowa,b,c

Overall, favours neither loratadine nor mizolastine

In Guo 2003, more participants in mizolastine group had complete cessation of urticaria than in the other 2 studies (Liu 2003 and Yin 2003b)

675 per 1000

581 per 1000
(432 to 783)

Moderate

667 per 1000

574 per 1000
(427 to 774)

Good or excellent response: intermediate‐term duration of intervention
Global assessment of symptom scores

Study population

RR 0.88
(0.55 to 1.42)

314
(3 studies)

⊕⊕⊝⊝
Lowa,c

Favours neither loratadine nor mizolastine

187 per 1000

165 per 1000
(103 to 266)

Moderate

174 per 1000

153 per 1000
(96 to 247)

Adverse events leading to withdrawal: intermediate‐term duration of intervention

Study population

RR 0.38
(0.04 to 3.6)

267
(2 studies)

⊕⊕⊝⊝
Lowa,c

Favours neither loratadine nor mizolastine

15 per 1000

6 per 1000
(1 to 53)

Moderate

19 per 1000

7 per 1000
(1 to 68)

Proportion of participants with at least 50% improvement in QoL: intermediate‐term duration of intervention
Symptom score reducing index (SSRI)

Study population

RR 3.21
(0.32 to 32.33)

252
(2 studies)

⊕⊝⊝⊝
Very lowa,b,c

Favours neither loratadine nor mizolastine

No participants in the mizolastine group in Guo 2003 reported at least 50% improvement in QoL

104 per 1000

334 per 1000
(33 to 1000)

Moderate

64 per 1000

205 per 1000
(20 to 1000)

*The basis for the assumed risk (e.g. median control group risk across studies) is provided in footnotes. The corresponding risk (and its 95% confidence interval) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI).
CI: Confidence interval; RR: Risk ratio.

GRADE Working Group grades of evidence.
High quality: Further research is very unlikely to change our confidence in the estimate of effect.
Moderate quality: Further research is likely to have an important impact on our confidence in the estimate of effect and may change the estimate.
Low quality: Further research is very likely to have an important impact on our confidence in the estimate of effect and is likely to change the estimate.
Very low quality: We are very uncertain about the estimate.

aDesign limitation (risk of bias).
bWidely differing estimates of the treatment effect (i.e. heterogeneity or variability in results) across studies.
cRelatively few participants and few events and/or wide confidence intervals.

Figures and Tables -
Summary of findings 8. Loratadine 10 mg versus mizolastine 10 mg for chronic spontaneous urticaria
Summary of findings 9. Loratadine 10 mg versus emedastine 2 mg for chronic spontaneous urticaria

Loratadine 10 mg versus emedastine 2 mg for chronic spontaneous urticaria

Patient or population: patients with chronic spontaneous urticaria
Setting: research clinic
Intervention: loratadine 10 mg versus emedastine 2 mg

Outcomes

Illustrative comparative risks* (95% CI)

Relative effect
(95% CI)

Number of participants
(studies)

Quality of the evidence
(GRADE)

Comments

Assumed risk

Corresponding risk

Control

(emedastine 2 mg)

Loratadine

10 mg

Complete cessation of urticaria: intermediate‐term duration of intervention
Global assessment of symptom scores

Study population

RR 1.04
(0.78 to 1.39)

161
(1 study)

⊕⊕⊕⊝
Moderatea

Favours neither loratadine nor emedastine

Only 1 study (Pons‐Guiraud 2006)

524 per 1000

545 per 1000
(409 to 728)

Moderate

524 per 1000

545 per 1000
(409 to 728)

Good or excellent response: intermediate‐term duration of intervention
Global assessment of symptom scores

Study population

RR 1.09
(0.96 to 1.24)

160
(1 study)

⊕⊕⊕⊝
Moderatea

Favours neither loratadine nor emedastine

Only 1 study (Pons‐Guiraud 2006)

819 per 1000

893 per 1000
(787 to 1000)

Moderate

819 per 1000

893 per 1000
(786 to 1000)

Adverse events leading to withdrawal: intermediate‐term duration of intervention

Study population

RR 1.09
(0.07 to 17.14)

161
(1 study)

⊕⊕⊕⊝
Moderatea

Favours neither loratadine nor emedastine

Only 1 study (Pons‐Guiraud 2006)

12 per 1000

13 per 1000
(1 to 204)

Moderate

12 per 1000

13 per 1000
(1 to 206)

*The basis for the assumed risk (e.g. median control group risk across studies) is provided in footnotes. The corresponding risk (and its 95% confidence interval) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI).
CI: Confidence interval; RR: Risk ratio.

GRADE Working Group grades of evidence.
High quality: Further research is very unlikely to change our confidence in the estimate of effect.
Moderate quality: Further research is likely to have an important impact on our confidence in the estimate of effect and may change the estimate.
Low quality: Further research is very likely to have an important impact on our confidence in the estimate of effect and is likely to change the estimate.
Very low quality: We are very uncertain about the estimate.

aRelatively few participants and few events and/or wide confidence intervals.

Figures and Tables -
Summary of findings 9. Loratadine 10 mg versus emedastine 2 mg for chronic spontaneous urticaria
Summary of findings 10. Loratadine 10 mg versus hydroxyzine 25 mg for chronic spontaneous urticaria

Loratadine 10 mg versus hydroxyzine 25 mg for chronic spontaneous urticaria

Patient or population: patients with chronic spontaneous urticaria
Setting: research clinic
Intervention: loratadine 10 mg versus hydroxyzine 25 mg

Outcomes

Illustrative comparative risks* (95% CI)

Relative effect
(95% CI)

Number of participants
(studies)

Quality of the evidence
(GRADE)

Comments

Assumed risk

Corresponding risk

Control

(hydroxyzine

25 mg)

Loratadine

10 mg

Complete suppression of urticaria: short‐term duration of intervention
Global assessment of symptom scores

Study population

RR 1
(0.32 to 3.1)

12
(1 study)

⊕⊕⊝⊝
Lowa,b

Favours neither intervention or control

Only 1 study (Monroe 1992)

500 per 1000

500 per 1000
(160 to 1000)

Moderate

500 per 1000

500 per 1000
(160 to 1000)

*The basis for the assumed risk (e.g. median control group risk across studies) is provided in footnotes. The corresponding risk (and its 95% confidence interval) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI).
CI: Confidence interval; RR: Risk ratio.

GRADE Working Group grades of evidence.
High quality: Further research is very unlikely to change our confidence in the estimate of effect.
Moderate quality: Further research is likely to have an important impact on our confidence in the estimate of effect and may change the estimate.
Low quality: Further research is very likely to have an important impact on our confidence in the estimate of effect and is likely to change the estimate.
Very low quality: We are very uncertain about the estimate.

aDesign limitation (risk of bias).
bRelatively few participants and few events and/or wide confidence intervals.

Figures and Tables -
Summary of findings 10. Loratadine 10 mg versus hydroxyzine 25 mg for chronic spontaneous urticaria
Summary of findings 11. Cetirizine 10 mg versus hydroxyzine 25 mg for chronic spontaneous urticaria

Cetirizine 10 mg versus hydroxyzine 25 mg for chronic spontaneous urticaria

Patient or population: patients with chronic spontaneous urticaria
Setting: research clinic
Intervention: cetirizine 10 mg versus hydroxyzine 25 mg

Outcomes

Illustrative comparative risks* (95% CI)

Relative effect
(95% CI)

Number of participants
(studies)

Quality of the evidence
(GRADE)

Comments

Assumed risk

Corresponding risk

Control

(hydroxyzine

25 mg)

Cetirizine

10 mg

Adverse events leading to withdrawal

Study population

RR 0.78
(0.25 to 2.45)

261
(2 studies)

⊕⊕⊝⊝
Lowa,b

Favours neither cetirizine nor hydroxyzine

53 per 1000

41 per 1000
(13 to 130)

Moderate

54 per 1000

42 per 1000
(14 to 132)

*The basis for the assumed risk (e.g. median control group risk across studies) is provided in footnotes. The corresponding risk (and its 95% confidence interval) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI).
CI: Confidence interval; RR: Risk ratio.

GRADE Working Group grades of evidence.
High quality: Further research is very unlikely to change our confidence in the estimate of effect.
Moderate quality: Further research is likely to have an important impact on our confidence in the estimate of effect and may change the estimate.
Low quality: Further research is very likely to have an important impact on our confidence in the estimate of effect and is likely to change the estimate.
Very low quality: We are very uncertain about the estimate.

aDesign limitation (risk of bias).
bRelatively few participants and few events and/or wide confidence intervals.

Figures and Tables -
Summary of findings 11. Cetirizine 10 mg versus hydroxyzine 25 mg for chronic spontaneous urticaria
Summary of findings 12. Hydroxyzine 25 mg versus placebo for chronic spontaneous urticaria

Hydroxyzine 25 mg versus placebo for chronic spontaneous urticaria

Patient or population: patients with chronic spontaneous urticaria
Setting: research clinic
Intervention: hydroxyzine 25 mg versus placebo

Outcomes

Illustrative comparative risks* (95% CI)

Relative effect
(95% CI)

Number of participants
(studies)

Quality of the evidence
(GRADE)

Comments

Assumed risk

Corresponding risk

Control (placebo)

Hydroxyzine

25 mg

Adverse events leading to withdrawal: intermediate‐term duration of intervention

Study population

RR 3.64
(0.77 to 17.23)

270
(2 studies)

⊕⊕⊝⊝
Lowa,b

Favours neither intervention nor control

14 per 1000

53 per 1000
(11 to 250)

Moderate

15 per 1000

55 per 1000
(12 to 258)

*The basis for the assumed risk (e.g. median control group risk across studies) is provided in footnotes. The corresponding risk (and its 95% confidence interval) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI).
CI: Confidence interval; RR: Risk ratio.

GRADE Working Group grades of evidence.
High quality: Further research is very unlikely to change our confidence in the estimate of effect.
Moderate quality: Further research is likely to have an important impact on our confidence in the estimate of effect and may change the estimate.
Low quality: Further research is very likely to have an important impact on our confidence in the estimate of effect and is likely to change the estimate.
Very low quality: We are very uncertain about the estimate.

aDesign limitation (risk of bias).
bRelatively few participants and few events and/or wide confidence intervals.

Figures and Tables -
Summary of findings 12. Hydroxyzine 25 mg versus placebo for chronic spontaneous urticaria
Comparison 1. Loratadine 10 mg versus placebo

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Proportion of participants with 'good' or 'excellent' response whilst taking H1‐antihistamines Show forest plot

2

124

Risk Ratio (M‐H, Random, 95% CI)

1.86 [0.91, 3.79]

1.1 Short‐term duration of intervention (10 mg)

1

12

Risk Ratio (M‐H, Random, 95% CI)

3.0 [0.42, 21.30]

1.2 Intermediate‐term duration of intervention (10 mg)

1

112

Risk Ratio (M‐H, Random, 95% CI)

1.73 [0.81, 3.72]

Figures and Tables -
Comparison 1. Loratadine 10 mg versus placebo
Comparison 2. Loratadine 10 mg versus cetirizine 10 mg

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Proportion of participants with complete suppression of urticaria whilst taking H1‐antihistamines Show forest plot

2

103

Risk Ratio (M‐H, Random, 95% CI)

1.05 [0.76, 1.43]

1.1 Short‐term duration of intervention

1

37

Risk Ratio (M‐H, Random, 95% CI)

1.13 [0.64, 2.01]

1.2 Intermediate‐term duration of intervention

1

66

Risk Ratio (M‐H, Random, 95% CI)

1.01 [0.69, 1.47]

Figures and Tables -
Comparison 2. Loratadine 10 mg versus cetirizine 10 mg
Comparison 3. Loratadine 10 mg versus desloratadine 5 mg

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Proportion of participants with complete suppression of urticaria whilst taking H1‐antihistamines Show forest plot

2

Risk Ratio (M‐H, Random, 95% CI)

Subtotals only

1.1 Intermediate‐term duration of intervention

2

369

Risk Ratio (M‐H, Random, 95% CI)

0.91 [0.78, 1.06]

2 Proportion of participants with 'good' or 'excellent' response whilst taking H1‐antihistamines Show forest plot

3

Risk Ratio (M‐H, Random, 95% CI)

Subtotals only

2.1 Intermediate‐term duration of intervention

3

410

Risk Ratio (M‐H, Random, 95% CI)

1.04 [0.64, 1.71]

Figures and Tables -
Comparison 3. Loratadine 10 mg versus desloratadine 5 mg
Comparison 4. Loratadine 10 mg versus mizolastine 10 mg

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Proportion of participants with complete suppression of urticaria whilst taking H1‐antihistamines Show forest plot

3

Risk Ratio (M‐H, Random, 95% CI)

Subtotals only

1.1 Intermediate‐term duration of intervention

3

316

Risk Ratio (M‐H, Random, 95% CI)

0.86 [0.64, 1.16]

2 Proportion of participants with 'good' or 'excellent' response whilst taking H1‐antihistamines Show forest plot

3

Risk Ratio (M‐H, Random, 95% CI)

Subtotals only

2.1 Intermediate‐term duration of intervention

3

314

Risk Ratio (M‐H, Random, 95% CI)

0.88 [0.55, 1.42]

3 Proportion of participants with at least 50% improvement in QoL whilst taking H1‐antihistamines Show forest plot

2

Risk Ratio (M‐H, Random, 95% CI)

Subtotals only

3.1 Intermediate‐term duration of intervention

2

252

Risk Ratio (M‐H, Random, 95% CI)

3.21 [0.32, 32.33]

4 Serious adverse events (i.e. serious enough to require withdrawal of treatment) Show forest plot

2

Risk Ratio (M‐H, Random, 95% CI)

Subtotals only

4.1 Intermediate‐term duration of intervention

2

267

Risk Ratio (M‐H, Random, 95% CI)

0.38 [0.04, 3.60]

Figures and Tables -
Comparison 4. Loratadine 10 mg versus mizolastine 10 mg
Comparison 5. Loratadine 10 mg versus emedastine 2 mg

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Proportion of participants with complete suppression of urticaria whilst taking H1‐antihistamines Show forest plot

1

Risk Ratio (M‐H, Random, 95% CI)

Totals not selected

1.1 Intermediate‐term duration of intervention

1

Risk Ratio (M‐H, Random, 95% CI)

0.0 [0.0, 0.0]

2 Proportion of participants with good or excellent response whilst taking H1‐antihistamines Show forest plot

1

Risk Ratio (M‐H, Random, 95% CI)

Totals not selected

2.1 Intermediate‐term duration of intervention

1

Risk Ratio (M‐H, Random, 95% CI)

0.0 [0.0, 0.0]

3 Serious adverse events (i.e. serious enough to require withdrawal of treatment) Show forest plot

1

Risk Ratio (M‐H, Random, 95% CI)

Totals not selected

3.1 Intermediate‐term duration of intervention

1

Risk Ratio (M‐H, Random, 95% CI)

0.0 [0.0, 0.0]

Figures and Tables -
Comparison 5. Loratadine 10 mg versus emedastine 2 mg
Comparison 6. Loratadine 10 mg versus hydroxyzine 25 mg

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Proportion of participants with complete suppression of urticaria whilst taking H1‐antihistamines Show forest plot

1

Risk Ratio (M‐H, Random, 95% CI)

Totals not selected

1.1 Short‐term duration of intervention

1

Risk Ratio (M‐H, Random, 95% CI)

0.0 [0.0, 0.0]

Figures and Tables -
Comparison 6. Loratadine 10 mg versus hydroxyzine 25 mg
Comparison 7. Cetirizine 10 to 20 mg versus placebo

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Proportion of participants with complete suppression of urticaria whilst taking H1‐antihistamines Show forest plot

2

178

Risk Ratio (M‐H, Random, 95% CI)

2.72 [1.51, 4.91]

1.1 Short‐term duration of intervention (cetirizine 10 mg)

1

56

Risk Ratio (M‐H, Random, 95% CI)

2.8 [1.17, 6.73]

1.2 Intermediate‐term duration of intervention (cetirizine 10 mg)

1

122

Risk Ratio (M‐H, Random, 95% CI)

2.66 [1.20, 5.90]

2 Serious adverse events (i.e. serious enough to require withdrawal of treatment) Show forest plot

3

389

Risk Ratio (M‐H, Random, 95% CI)

3.00 [0.68, 13.22]

2.1 Intermediate‐term duration of intervention (cetirizine 10 mg)

2

247

Risk Ratio (M‐H, Random, 95% CI)

4.60 [0.79, 26.67]

2.2 Intermediate‐term duration of intervention (cetirizine 10 to 20 mg)

1

142

Risk Ratio (M‐H, Random, 95% CI)

1.06 [0.07, 16.59]

Figures and Tables -
Comparison 7. Cetirizine 10 to 20 mg versus placebo
Comparison 8. Cetirizine 10 mg versus hydroxyzine 25 mg

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Serious adverse events (i.e. serious enough to require withdrawal of treatment) Show forest plot

2

261

Risk Ratio (M‐H, Random, 95% CI)

0.78 [0.25, 2.45]

1.1 Intermediate‐term duration of intervention (cetirizine 10 mg)

1

123

Risk Ratio (M‐H, Random, 95% CI)

1.05 [0.27, 4.01]

1.2 Intermediate‐term duration of intervention (cetirizine 5 to 25 mg)

1

138

Risk Ratio (M‐H, Random, 95% CI)

0.33 [0.04, 3.13]

Figures and Tables -
Comparison 8. Cetirizine 10 mg versus hydroxyzine 25 mg
Comparison 9. Desloratadine 5 to 20 mg versus placebo

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Proportion of participants with complete suppression of urticaria whilst taking H1‐antihistamines Show forest plot

2

Risk Ratio (M‐H, Random, 95% CI)

Totals not selected

1.1 Short‐term duration of intervention (desloratadine 5 mg)

1

Risk Ratio (M‐H, Random, 95% CI)

0.0 [0.0, 0.0]

1.2 Short‐term duration of intervention (desloratadine 10 mg)

1

Risk Ratio (M‐H, Random, 95% CI)

0.0 [0.0, 0.0]

1.3 Short‐term duration of intervention (desloratadine 20 mg)

1

Risk Ratio (M‐H, Random, 95% CI)

0.0 [0.0, 0.0]

1.4 Intermediate‐term duration of intervention (desloratadine 5 mg)

1

Risk Ratio (M‐H, Random, 95% CI)

0.0 [0.0, 0.0]

2 Serious adverse events (i.e. serious enough to require withdrawal of treatment) Show forest plot

3

Risk Ratio (M‐H, Random, 95% CI)

Subtotals only

2.1 Intermediate‐term duration of 5 mg of intervention

3

466

Risk Ratio (M‐H, Random, 95% CI)

1.46 [0.42, 5.10]

Figures and Tables -
Comparison 9. Desloratadine 5 to 20 mg versus placebo
Comparison 10. Hydroxyzine 25 mg versus placebo

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Serious adverse events (i.e. serious enough to require withdrawal of treatment to withdrawal) Show forest plot

2

Risk Ratio (M‐H, Random, 95% CI)

Subtotals only

1.1 Intermediate‐term duration of intervention

2

270

Risk Ratio (M‐H, Random, 95% CI)

3.64 [0.77, 17.23]

Figures and Tables -
Comparison 10. Hydroxyzine 25 mg versus placebo
Comparison 11. Levocetirizine 5 to 20 mg versus placebo

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Proportion of participants with complete suppression of urticaria whilst taking H1‐antihistamines Show forest plot

2

Risk Ratio (M‐H, Random, 95% CI)

Totals not selected

1.1 Short‐term duration of intervention (levocetirizine 5 mg)

1

Risk Ratio (M‐H, Random, 95% CI)

0.0 [0.0, 0.0]

1.2 Short‐term duration of intervention (levocetirizine 10 mg)

1

Risk Ratio (M‐H, Random, 95% CI)

0.0 [0.0, 0.0]

1.3 Short‐term duration of intervention (levocetirizine 20 mg)

1

Risk Ratio (M‐H, Random, 95% CI)

0.0 [0.0, 0.0]

1.4 Intermediate‐term duration of intervention (levocetirizine 5 mg)

1

Risk Ratio (M‐H, Random, 95% CI)

0.0 [0.0, 0.0]

Figures and Tables -
Comparison 11. Levocetirizine 5 to 20 mg versus placebo
Comparison 12. Rupatadine 10 to 20 mg versus placebo

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Proportion of participants with 'good' or 'excellent' response whilst taking H1‐antihistamines Show forest plot

1

245

Risk Ratio (M‐H, Random, 95% CI)

1.35 [1.03, 1.77]

1.1 Intermediate‐term duration of intervention (rupatadine 10 mg)

1

122

Risk Ratio (M‐H, Random, 95% CI)

1.28 [0.86, 1.91]

1.2 Intermediate‐term duration of intervention (rupatadine 20 mg)

1

123

Risk Ratio (M‐H, Random, 95% CI)

1.42 [0.98, 2.06]

Figures and Tables -
Comparison 12. Rupatadine 10 to 20 mg versus placebo