Effectiveness And Safety Evaluation Of H1 Antihistamins In Children With Asthma

Background : Asthma is a heterogeneous disease characterized by chronic airway inflammation.The typical symptoms of asthma are recurrent respiratory symptoms such as wheeze,shortness of breath,chest tightness and cough,and reversible airflow limitation.Asthma is a serious global health problem affecting all age groups,and causes significant damage to learning,work and quality of life of all mankind.In addition to treat with inhaled corticosteroids,the use of H1-antihistamines is gaining more and more attention.The H1-antihistamines has antiallergic and antiinflammatory effects,and can be used as a adjuvant in the treatment of asthma.The effectiveness and safety of H1-antihistamines for children with asthma are still disputed.Objective: Evaluation of the effectiveness and safety of H1-antihistamines in children with asthma.Methods : We searched Cochrane library,Cochrane clinical trials,PubMed,EMBASE,CNKI,CBMdisc,VIP chinese periodical Database,Wan Fang Chinese periodical Database from the establishment of the database to February 29,2018.We screened the Chinese and Englishrandomized controlled trials.we assessed the clinical trials by Jadad scale.Meta analysis was done by RevMan 5.3.Results:A total of seventeen trials were inclued.And nine of them are high in quality,while eight are low in quality.ketotifen can improve the symptom score of asthma,[SMD=-0.06,95%CI(-0.97,-0.23),P=0.002].Ketotifen has no statistical significance for improving the individual symptoms of asthma,namely cough and wheezing,[SMD=-0.17,95%CI(-0.48,0.15),P=0.30] and [SMD=-0.16,95%CI(-0.48,0.15),P=0.31].The effect of ketotifen on forced expiratory volume in 1 second(FEV1)cannot be evaluated.Ketotifen is more sedative than placebo,[RR=1.7,95%CI(1.07,2.61),P=0.02].Cetirizine can improve the symptom score of asthma,[WMD=-1.61,95%CI(-1.90,-1.31),P<0.00001],and is more effective than the control group,[RR=1.23,95%CI(1.14,1.33),P<0.00001].Cetirizine can improve the FEV1,[WMD=0.13,95%CI(0.07,0.20),P<0.0001],and has no statistical significance in sedative between cetirizine and control group,[RR=1,95%CI(0.26,3.92),P=1].Loratadine can improve the symptom score of asthma,[SMD=-0.91,95%CI(-1.47,-0.35),P=0.001].No serious side effects were reported in this study.Conclusion: Treatment of asthma in children with H1-antihistamines,ketotifen,cetirizine and loratadine were better than the control group in improving asthma symptoms in children.Cetirizine can improve FEV1 in asthmatic children.The effect of ketotifen on FEV1 is not clear,whichneeds more trials to comfirm.In this study,ketotifen,cetirizine and loratadine were not reported to have serious side effects,and the overall safety was high.Ketotifen is more sedative than placebo,but cetirizine and loratadine did not.Because of the lack of research data,the efficacy and safety of different H1-antihistamines could not be evaluated.It is necessary to carry out a large sample,high in quality RCT study to explore.