1. Antihistamine Treatment for Atopic Dermatitis
Katarina Donkers, Research Advisor: Angel Butron
DePaul University
Findings
Methods
Background
Design
This literature review will provide a comprehensive analysis of research from the last ten years surrounding the use of antihistamines in treating atopic dermatitis. This review will provide the further clarification that is needed for the healthcare industry in determining if this treatment option is viable.
Data and Data Collection
Sample Articles were in English and full-text, published between , and were of nursing or medical disciplines. Articles that were selected discussed the relationship between antihistamines and treatment for atopic dermatitis. Human subjects of any age were included in order to determine overall effectiveness of antihistamines as a viable treatment option.
Search Strategies There were 40 articles on CINAHL and 74 on PubMed from the preliminary search that could be used in the literature review, but only 18 and 15 respectively were published in 2008 or after. Though monotherapeutic use of antihistamines would be the idea target for this review, inclusion of multiple therapeutic regimens were necessary to simulate effective real world therapeutic strategies. Keywords that were included for this article were: antihistamine, treatment, atopic dermatitis, eczema, and, treatment.
Data Analysis The process of data reduction, display, and comparison, the data was summarized in an organized manner for the reader to access. Using data reduction, the studies were divided into subgroups as a way to focus the relevant data from each article for analysis. Next, a matrix was used to group data for display as a means of comparison. There were initially 114 articles found, while 7 of them are displayed in Figure 1. Finally, the data was compared and analyzed for patterns or relationships in order to answers the aforementioned research questions.
First and second-generation antihistamines can be beneficial for patients with atopic dermatitis, though there are many factors that contribute to the possibility of long-term use. The primary use of first-generation antihistamines is to mildly sedate the patient so they don’t itch any flare-ups and further exacerbate their atopic dermatitis, which does not make them a suitable option for patients who have to focus on things such as work or driving. Second-generation antihistamines are regarded as a newer model of antihistamines and are selective H1-receptor antagonists and do not have the sedative effects of first generation drugs. It is unknown if tolerance can occur with first generation antihistamines, but patients do not develop tolerance to second generation antihistamines with regular use.
Over 30 million individuals in the United States have some form of eczema. Eczema is an overarching term for an autoimmune disease that is characterized by dry, red, itchy skin. Many different types of eczema exist that vary in degree of severity, location, and relief. Atopic dermatitis (AD) is the most common variation of eczema. It can develop in pediatric and adult populations, with approximately 60-80% of patients’ cases occurring before 12 months. Atopic dermatitis often presents with the atopic triad: a compilation of eczema, asthma, and allergic rhinitis. Management of eczema involves avoiding exacerbating factors that disrupt the epidermal barrier. Factors can include: hot water, allergens, stressors, and dry skin. Abstaining from these factors can aid in decreasing acute exacerbations.
Conclusion
There can be a positive influence in the long-term use of antihistamines as supportive therapy, though second generation antihistamines are preferred due to their lack of CNS adverse effects and anti-inflammatory properties with continued use. Further research is needed pertaining to specific drug interactions as well as newer treatment options for moderate to severe atopic dermatitis in conjunction with first line treatment.
Objectives
Conceptual Framework: Faye Abdellah’s 21 Nursing Problems Theory
The purpose of this literature review is to determine of effectiveness of antihistamine use in treating atopic dermatitis. The aim of this research is to (1) determine when antihistamines should be used (2) decipher if there are limitations for use, or if tolerance to antihistamines can develop and (3) identify implications for nurses working in dermatology.
A human needs theory that depicts steps and skills to identify and develop a treatment typology
This allows the nurse to use a step-by-step procedure by utilizing the patient and relevant evidence based practice to determine the root of the problem and what therapeutic techniques that can be performed
11 nursing skills include: observation of health status, application of knowledge, teaching patients and families, using resource materials, and nursing procedure
Tactics such as these allow the nurse to reinforce the nursing process and determine the effectiveness of the treatment.
The patient’s needs are viewed as problems, which can be apparent or concealed and must be resolved to fulfill a normal health status.
Nursing Implications
This information is beneficial to the field of nursing by providing more detailed information about secondary treatments for a disease that is commonly managed both in the clinic and at home.