For the management of people having chronic spontaneous urticaria, loratadine, mizolastine, and cetirizine were found to be the most effective therapeutic agents.

A systematic review and network meta-analysis was performed to compare the effectiveness of various non-sedating antihistamine agents for the management of chronic spontaneous urticaria and to offer a relative ranking of these therapies.

Databases like EMBASE, CENTRAL, MEDLINE as well as several trial registries were searched to find out relevant randomized controlled trials that compared a single non-sedating antihistamine with a placebo or another single non-sedating antihistamine.

In total, 42 randomized controlled trials with 8164 volunteers were included. Overall, 26 studies were incorporated for  additional network meta-analysis. Two researchers assessed the eligibility, performed data extraction, and investigated the risk of bias of included trials.

In patients with chronic spontaneous urticaria, loratadine was found to be the most effective non-sedating antihistamine followed by mizolastine and cetirizine. Following four-week therapy, odds ratio (95% credible intervals) of total overall symptoms alleviation is shown in Table 1:

Regarding clinical outcomes, all the included non-sedating antihistamines demonstrated superiority over placebo in people suffering from chronic spontaneous urticaria. Additional head-to-head trials with a large number of participants are warranted to verify the findings.