The Author offers an overview of the pharmacological properties of first, second, and third
generation antihistamines and discusses their indications in paediatric dermatology (urticaria,
insect bites, atopic dermatitis and mastocytosis). Loratadine (or cetirizine in the first 2
years of age) is indicated for acute urticaria. Severe and acute cases should be treated
with parenteral clorpheniramine and prednisone. Acrivastine can be used for prevention of
urticaria when exposure to the trigger is inevitable. When insect bites are recent and particularly
numerous a second generation antihistamine should be used. The same class of
drugs is indicated in mastocytosis. Atopic dermatitis does not respond well to antihistamines
and the use should be confined to treating severe pruritus, particularly at night time.
Antihistamines should not be used to treat pruritus in herpetic dermatitis, scabies or lice,
where etiologic treatment must be prioritised.