Mildra asked
What is the best anti-histamine to take for bodily itchiness. I don't believe I have allergies but I believe histamine is released in areas on my body that I itch. I need something to calm those nerves down. Steroid ointments don't seem to work.
Answer
To answer this question, we must first note that if histamine is being released, it would be considered some sort of immune reaction to a foreign pathogen. In may not be what we consider "typical allergy symptoms" such as watery eyes and a runny nose, but it would nonetheless still be considered an allergy. As such, it is important to try and discern the cause of the allergy and eliminate the allergen if possible.
For your symptoms, looking towards an antihistamine medication is a good idea. There are many different histamine receptors in the body but Histamine-1 (H1) receptors typically cause allergy symptoms including body itchiness. As such, we will look at a few different anti-histamine-1 (H1 antagonist) medications.
Most antihistamine medications can be purchased over the counter (OTC), although one that we are going to recommend is by prescription only. To start, let's look at the OTC histamines we recommend.
Diphenhydramine, which is the active ingredient in Benadryl, is sold over the counter and helps to provide fast-acting itch relief. Diphenhydramine is a first generation antihistamine and works by stopping and reversing the action of histamine on a person’s blood vessels, and can therefore help the symptoms of an allergic reaction, like a persistent itch.
While diphenhydramine is generally a safe medication for those under the age of 65, it does cause drowsiness because it crosses the blood brain barrier and affects the central nervous system. Therefore, it is difficult for some people to take this medication orally throughout the day; In fact, many people use diphenhydramine to help them sleep at night and it is marketed under different names as a sleep aid. So although we typically see the best results with diphenhydramine, many people can't tolerate it during the day.
The good news is Diphenhydramine comes in a topical cream which a person can use to help relieve their itchiness without the drowsiness but it may not be as effective as taking it by mouth.
Although diphenhydramine is considered the first line agent with proven effectiveness, there are some other OTC options that shouldn't sedate you as much. The other OTC options are Claritin (loratadine), Allegra (fexofenadine), Zyrtec (cetirizine), Xyzal (levocetirizine), Chlor-Trimeton (Chlorpheniramine) and Tavist (clemastine).
While any of the above options could work for you, studies indicate that Xyzal (levocetirizine) is the most effective over the counter antihistamine for itching and uticaria (hives). It is the newest antihistamine that has been made available OTC and is the one I would recommend for you based on its evidence.
In terms of prescription medication, I would recommend you ask your doctor about hydroxyzine. It is a histamine-1 antagonist medication that can be used to both stop itchiness due to histamine release as well as the anxiety that may come along with all of the itching. As hydroxyzine is also a first generation antihistamine, it too can make a person sleepy and is typically dosed 3 times daily. It's just another option if everything you have tried thus far has been ineffective.
Finally, we mentioned at the beginning of the article that H1 receptors are mainly responsible for allergy symptoms. There is however, much evidence that suggests taking the combination of a histamine-1 and histamine-2 blocker works better than taking a histamine-1 medication alone for bodily itching. We often see patients prescribed both together and it seems to be more effective in some cases. Some examples of H2 blockers are Pepcid and Zantac. This could be an option to bring up with your doctor as well!
