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Three Part Question

In [patients with an itchy insect bite] is [antihistamine cream better than placebo] at [reducing itch and other symptoms]?

Clinical Scenario

You are preparing the formulary for an international sporting event and are considering some of the more minor conditions that may require treatment in an English summer. You propose that the formulary should contain some antihistamine cream for application on itchy insect bites. A local primary care physician expresses surprise that you didn't know that these creams make the problem worse. This is not your personal experience and you wonder whether he is right.

Search Strategy

Medline 1966- week 3/09/04 using the OVID interface.
[(exp Insect Bites and Stings OR insect bite$.mp) OR {(exp insects OR insect$.mp) AND (exp Bites and Stings OR bite$.mp OR sting$.mp)}] AND [exp Histamine H1 Antagonists OR antihistamine$.mp OR exp chlorpheniramine OR chlorpheniramine.mp OR exp pyrilamine OR mepyramine.mp] AND [exp Administration, Topical OR topical.mp OR cream$.mp OR exp ointments OR ointment.mp] LIMIT to human and English Language

Search Outcome

Altogether 9 papers were found of which none were relevant to the original question.

Comment(s)

There would appear to be no work to either support or refute the use of topical antihistamines to treat itchy insect bites.

Clinical Bottom Line

Local advice should be followed.