Efficacy

We found no systematic review.

Oral antihistamines versus placebo

We found two randomised controlled trials (RCTs) of oral cetirizine versus placebo given prophylactically to 23 healthy adult volunteers and to 18 patients with previous dramatic cutaneous reactions.30,31 A significant decrease in wheal size and pruritus was found in the healthy subjects at 15 minutes after the controlled bites, and in the previously reacting patients at 15 minutes and 24 hours after the controlled bites. In a non-randomised controlled trial, oral ebastine was administered before controlled mosquito exposure to 25 adults with previous cutaneous reactions.32 A significant decrease in bite size and pruritus was found at 15 minutes after the controlled bites.

Topical treatments versus placebo

We found two RCTs in adults with previous immediate cutaneous reactions of ammonium solution (n = 25) and of a topical homeopathic treatment ("Prrrikweg gel" n = 100).33,34 The ammonium solution significantly relieved symptoms after bites (itching, burning and/or pain) whereas no significant effect was observed with the homoeopathic gel.

Drawbacks

In RCTs, sedation was reported for 18% (two patients) who received cetirizine, and for 8% (one patient) who received placebo,30,31 and for 21% (six patients) treated with ebastine, and 7%

(two subject) who received placebo.32 No skin irritation or other side-effects occurred in patients after the application of topical treatments.33,34

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