Assessing the Role of Antihistamines in the Treatment of Pruritus Among Patients with Chronic Kidney Disease: A Critical Appraisal of Current Literature
Faculty Mentor
Timothy Nguyen
Major/Area of Research
Pharmacy
Description
INTRODUCTION: Chronic kidney disease-associated pruritus (CKD-aP) is highly prevalent, affecting more than 40% of patients. The exact pathophysiology remains unclear; however, possible causes include chronic antihistamine use, increased levels of parathyroid hormone, magnesium, and calcium, opioid-receptor abnormalities, and micro-inflammation. Although histamine is not considered the primary mediator of CKD-aP, it is frequently utilized in clinical practice for symptomatic relief. The perceived value of first-generation antihistamines is likely attributed to their central sedative effects rather than true antipruritic activity. In contrast, second generation antihistamines offer improved tolerability due to reduced blood brain barrier penetration, but they still demonstrate minimal efficacy as well in non-histamine mediated pruritic conditions. The discrepancy between widespread clinical use and limited supporting evidence underscores the need for critical evaluation of their role in CKD-aP management. This research project aims to evaluate the safety and clinical effectiveness of first- and second-generation antihistamines in HD patients with pruritus to identify evidence-based considerations for their optimal use.
METHODS: A structured literature search of PubMed using the terms “Kidney Disease AND pruritus AND antihistamine”. Filters applied included: human studies, English language, and publication within the past 10 years. The results included studies/trials that compare various antihistamines.
RESULTS: Initial search showed 120 results, from which 36 studies met the screening criteria, but only 11 studies (6 RCT, 5 non-RCT), were included relating to antihistamines. Comparative data on hydroxyzine, ketotifen, dexchlorpheniramine, loratadine, and other antihistamines were extracted and qualitatively summarized.
DISCUSSION/CONCLUSION: The use of antihistamines in the treatment of pruritus in CKD had mixed results. Antihistamines used were associated with more side effects related to histamine reactions. Comparator medications demonstrated similar efficacy or better with fewer side effect profiles. Antihistamines are often resorted to as a first line of treatment; however, there is minimal research proving their efficacy in pruritus reduction in patients with CKD.
Assessing the Role of Antihistamines in the Treatment of Pruritus Among Patients with Chronic Kidney Disease: A Critical Appraisal of Current Literature
INTRODUCTION: Chronic kidney disease-associated pruritus (CKD-aP) is highly prevalent, affecting more than 40% of patients. The exact pathophysiology remains unclear; however, possible causes include chronic antihistamine use, increased levels of parathyroid hormone, magnesium, and calcium, opioid-receptor abnormalities, and micro-inflammation. Although histamine is not considered the primary mediator of CKD-aP, it is frequently utilized in clinical practice for symptomatic relief. The perceived value of first-generation antihistamines is likely attributed to their central sedative effects rather than true antipruritic activity. In contrast, second generation antihistamines offer improved tolerability due to reduced blood brain barrier penetration, but they still demonstrate minimal efficacy as well in non-histamine mediated pruritic conditions. The discrepancy between widespread clinical use and limited supporting evidence underscores the need for critical evaluation of their role in CKD-aP management. This research project aims to evaluate the safety and clinical effectiveness of first- and second-generation antihistamines in HD patients with pruritus to identify evidence-based considerations for their optimal use.
METHODS: A structured literature search of PubMed using the terms “Kidney Disease AND pruritus AND antihistamine”. Filters applied included: human studies, English language, and publication within the past 10 years. The results included studies/trials that compare various antihistamines.
RESULTS: Initial search showed 120 results, from which 36 studies met the screening criteria, but only 11 studies (6 RCT, 5 non-RCT), were included relating to antihistamines. Comparative data on hydroxyzine, ketotifen, dexchlorpheniramine, loratadine, and other antihistamines were extracted and qualitatively summarized.
DISCUSSION/CONCLUSION: The use of antihistamines in the treatment of pruritus in CKD had mixed results. Antihistamines used were associated with more side effects related to histamine reactions. Comparator medications demonstrated similar efficacy or better with fewer side effect profiles. Antihistamines are often resorted to as a first line of treatment; however, there is minimal research proving their efficacy in pruritus reduction in patients with CKD.