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#80 Antihistamines for the Common Cold: Facts on a Possible Fix?


CLINICAL QUESTION
QUESTION CLINIQUE
Are antihistamines effective in treating symptoms of the common cold?


BOTTOM LINE
RÉSULTAT FINAL
Antihistamines alone have little meaningful impact on the common cold. Weak evidence suggests antihistamine-combination products improve global symptoms of the cold for one in every 4 to 7 treated. “Cough and cold products should not be used in children under 6. 



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EVIDENCE
DONNÉES PROBANTES
Four systematic reviews of antihistamines alone and one of antihistamine combination.  Antihistamines alone 
  • Cochrane1 review of 18 randomized controlled trials (RCTs) including 4,342 patients: Compared to placebo, antihistamines resulted in: 
    • Any improvement in severity of general symptoms at days one - two: 55.3% versus 62.3%, number needed to treat (NNT)=15 
      • But not at days >3. 
    • Inconsistent, non-clinically meaningful changes in individual symptoms on 4-5-point scales 
      • No change in nasal congestion 
      • Improved rhinorrhea on days 2 and 4 only: Best day 2, change 0.15 (95% confidence interval [CI], 0.04-0.27) 
      • Improved sneezing on days 1-4: Best day 3, change 0.31 (95% CI 0.15-0.46) 
  • Three other systematic reviews:2-4 Similar results to Cochrane review. 
Antihistamine combination 
  • Cochrane:5 Compared to placebo, 
    • Antihistamine with decongestants (12 RCTs) improved global symptoms, NNT=4 
    • Antihistamine with analgesia (3 RCTs) improved global symptoms, NNT=4-7 
    • Antihistamine with decongestant and analgesia (5 RCTs) improved global symptoms, NNT=6 
    • The included studies did not compare these combinations to products without antihistamines to assess the contribution of antihistamines on symptom improvement. 
Context:  
  • Estimated 40% of time lost from work is attributable to the common cold.6 
  • All of the studies reported are at high or unclear risk of bias.1,5 
  • Adverse events were poorly reported, but more common with antihistamines versus placebo, number needed to harm (NNH)=34.1  
    • Combination therapies may increase adverse event rates.5 
  • Benefits seen in anti-histamine combination products likely arise from the additive effects of 2-3 products with minimal individual effects.  
  • Health Canada7 recommends against using over-the-counter cold medicines in children under age 6 because 
    • Children do not benefit from antihistamines alone1 or in combinations5 
    • Antihistamines and “cough and cold preparations” are 2nd and 6th (respectively) most common substances involved in (age <5 years) pediatric deaths.8 
 updated aug 4 2016 by ricky


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Author(s)
Auteur(s)
  • Anu Joneja MD CCFP
  • G. Michael Allan MD CCFP

1. De Sutter AIM, Saraswat A, van Driel ML. Cochrane Database Syst Rev 2015;11:CD009345.

2. De Sutter AI, Lemiengre M, Campbell H, et al. Cochrane Database Syst Rev 2003; (3):CD001267.

3. D'Agostino RB Sr, Weintraub M, Russell HK, et al. Clin Pharmacol Ther 1998;64:579– 96.

4. Luks D, Anderson MR. J Gen Intern Med 1996;11:240-4.

5. De Sutter AIM, van Driel ML, Kumar AA, et al. Cochrane Database Syst Rev 2012;2:CD004976.

6. Kirkpatrick GL. Prim Care 1996;23:657-75.

7. http://healthycanadians.gc.ca/recall-alert-rappel-avis/hc-sc/2016/57622a-eng.php [Accessed 4 Aug 2016]

8. Bronstein AC, Spyker DA, Cantilena LR Jr, et al. 2010 Annual Report of the American Association of Poison Control Centers' National Poison Data System (NPDS): 28th Annual Report. Clin Toxicol (Phila). 2011 Dec;49:910-41.

Authors do not have any conflicts of interest to declare.

Les auteurs n’ont aucun conflit d’intérêts à déclarer.

Most recent review: 04/08/2016

By: Ricky Turgeon BSc(Pharm) ACPR PharmD

Comments:

Evidence Updated: Updated Cochrane review; Bottom Line: Minor change.

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