Cetirizine for the treatment of allergic diseases in children: A systematic review and meta-analysis

Abstract

ObjectiveThe global prevalence of allergic diseases has led to a negative and extensive impact on the health and lives of a large population of children. This study investigates the efficacy, acceptability, and safety of cetirizine (CTZ) for treating allergic diseases in children and provides evidence-based assertions for decision-making.MethodsPubMed, Embase, the Cochrane Library, World Health Organization International Clinical Trials Registry Platform, ClinicalTrials.gov, and the European Union Clinical Trials Register were systematically searched from inception to April 21, 2022. Randomized controlled trials (RCTs) or quasi-RCTs of children with allergic diseases receiving CTZ compared with those receiving placebo or other drugs were included without language limitations. Two investigators independently identified articles, extracted data, conducted meta-analyses, assessed the Cochrane risk of bias of individual studies, and evaluated the evidence certainty using the Grading of Recommendations Assessment, Development, and Evaluation approach; any discrepancies were resolved by consulting with a third investigator. Primary outcomes included scales that evaluated the recovery of allergic conditions in AR, such as the total symptom score (TSS). Secondary outcomes included laboratory test changes, safety (adverse events, AEs), and quality of life (QOL). Data were pooled using the Cochrane Review Manager 5.4, and a fixed-effects model was used if heterogeneity was evaluated as low (I2 < 50%); otherwise, a random-effects model was adopted.ResultsA total of 22 studies (5,867 patients) were ultimately included [eight with perennial AR, six with seasonal AR, four with atopic dermatitis (AD), and four with other allergic diseases], most of which had a low or unclear risk of bias. Moderate certainty evidence showed that CTZ was found to benefit allergic symptom control [mean difference (MD) of TSS at 1 week: MD, –0.32 (–0.52, –0.12); at 2 weeks: MD, –0.25 (–0.35, –0.14); at 4 weeks: MD, –4.07 (–4.71, –3.43); at 8 weeks: MD, –4.22 (–4.73, –3.72); at 12 weeks: MD, –5.63 (–6.14, –5.13); all P-values were less than 0.05] and QOL [at 12 weeks: MD, –23.16 (–26.92, –19.39); P < 0.00001] in children with AR. It had similar efficacy compared with other antihistamines (AHs) or montelukast, without showing better control of AD severity in children. Moderate-to-low certainty evidence demonstrated that CTZ was well tolerated and did not increase the risk of severe and overall AEs, cardiotoxicity, damage to the central nervous and digestive systems, or other systems in children, except for the risk of somnolence [risk ratio, 1.62 (1.02, 2.57); P = 0.04, compared with placebo].ConclusionModerate-to-low certainty evidence revealed that CTZ could improve clinical improvement and QOL in children with AR and have comparable efficacy with other AHs. CTZ is well tolerated in the pediatric population, except for an increased risk of somnolence.Systematic review registration[https://www.crd.york.ac.uk/PROSPERO/], identifier [CRD42021262767].

Cetirizine in Children with Coexisting Allergic Rhinitis and Asthma: A Randomized Trial

“…Cetirizine could inhibit antigeninduced eosinophil recruitment in the nose and lung, protect against the asthmatic late-phase reaction and decrease eosinophil and neutrophil infiltration and eosinophil cationic protein and eosinophil peroxidase in nasal lavage from patients with allergic rhinitis [39,40]. A recent meta-analysis performed that cetirizine could improve clinical improvement and quality of life in children with AR and is well tolerated in the pediatric population [41]. In a previous study, the therapeutic effect of cetirizine, nasal fluticasone and the combination of cetirizine and nasal fluticasone were compared in AR patients [42].…”

Formulation optimization, in vitro and in vivo evaluation of niosomal nanocarriers for enhanced topical delivery of cetirizine

“…Cetirizine (CTZ) is a second-generation histamine (H1) antagonist used to treat urticaria, dermatitis, and allergic rhinitis ( Zhou et al, 2022 ). It acts by inhibiting the release of inflammatory mediators such as histamine and bradykinin, associated with allergies ( Goindi et al, 2013 ).…”