Comment

The lack of emergent clarity in these trials reflects the way many dermatology studies are powered: low patient numbers in trials intrinsically demand large treatment effects to be statistically significant. It is therefore likely, from an intuitive point of view, that no large effects will be derived from the use of antihistamines, as the everyday experience of dermatologists will already attest. The individual merits of antihistamine treatments cannot be covered by such a review, and in particular, the patient-specificity of drug effects is necessarily lost when considering aggregated cohorts and statistical means, this is not to mention those differences in "utility" that occur for the same drug in differing contexts. The impact of a specific context of drug administration is nowhere better seen than when comparing the sedative and non-sedative antihistamines across daytime and night-time administrations. It is therefore reasonable to expect that some patients may derive benefits from such interventions, irrespective of the lack of demonstrable effect at a group level. Given the likelihood that further work will return only a mild or non-existent effect and that work is therefore unlikely to inform change, it is debatable whether further large trials are required in this area.

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