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Anti-histamines for prolonged non-specific cough in children

Chang, Anne B., Peake, J. and Mcelrea, M. (2008). Anti-histamines for prolonged non-specific cough in children. Cochrane Database of Systematic Reviews,2008(2):1-27.

Document type: Journal Article

IRMA ID 10491xPUB120
Title Anti-histamines for prolonged non-specific cough in children
Author Chang, Anne B.
Peake, J.
Mcelrea, M.
Journal Name Cochrane Database of Systematic Reviews
Publication Date 2008
Volume Number 2008
Issue Number 2
ISSN 1469-493X   (check CDU catalogue open catalogue search in new window)
Start Page 1
End Page 27
Total Pages 27
Place of Publication UK
Publisher Update Software Ltd.
Field of Research 1114 - Paediatrics and Reproductive Medicine
HERDC Category C1 - Journal Article (DEST)
Abstract Background
Non-specific cough is defined as non-productive cough in the absence of identifiable respiratory disease or known aetiology. It is commonly seen in paediatric practice. These children are treated with a variety of therapies including anti-histamines. Also, anti-histamines are advocated as an empirical treatment in adults with chronic cough.

To evaluate the effectiveness of anti-histamines in treating children with prolonged non-specific cough.

Search strategy
We searched the Cochrane Register of Controlled Trials (CENTRAL), MEDLINE, OLDMEDLINE and EMBASE databases. The latest searches were performed in November 2008.

Selection criteria
All randomised controlled trials comparing anti-histamines with a placebo or placebo-like medication with cough as an outcome, where cough is not primarily related to an underlying respiratory disorder such as cystic fibrosis, asthma, or suppurative lung disease.

Data collection and analysis
Two review authors independently assessed study quality and extracted data.

Main results
Three included therapeutic studies had 182 randomised participants with 162 completing the trials although in one study, children with recurrent wheeze were also included. The four included safety evaluation studies randomised 3166 participants with 2862 completing the trials. Clinical heterogeneity was evident and limited data prevented combining data for meta-analysis. The two larger therapeutic studies described significant improvement in both the intervention and the placebo/placebo-like arms with no significant difference between the two groups. In the study with the smallest sample size, cetirizine (a second generation anti-histamine) was significantly more efficacious than placebo in reducing chronic cough in children associated with seasonal allergic rhinitis, and the effect was seen within two weeks of therapy. In contrast three of the larger evaluation studies that enrolled children with allergic rhinitis described a non-significant increase in cough as an adverse event. Combined data from the four safety evaluation studies revealed a non-significant difference between groups (OR 1.47 , 95% CI 0.86, 2.49) for cough as an adverse event but the trend favoured the placebo arm.

Authors' conclusions
This review has significant limitations. However, our finding of uncertain efficacy of anti-histamines for chronic cough are similar to that for acute cough in children. In contrast to recommendations in adults with chronic cough, anti-histamines cannot be recommended as empirical therapy for children with chronic cough. If anti-histamines were to be trialled in these children, current data suggest a clinical response (time to response) occurs within two weeks of therapy. However the use of anti-histamines in children with non-specific cough has to be balanced against the well known risk of adverse events especially in very young children.
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Created: Tue, 12 May 2009, 12:59:27 CST by Sarena Wegener