Dr Kola Tytler MBBS CertHE MBA MRCGPClinical Lead • iatroX
Indications for prescribing antihistamines versus corticosteroids in insect bite reactions:
- Oral antihistamines (e.g., chlorphenamine) and topical corticosteroids (e.g., hydrocortisone 1%) may be used to reduce itching associated with cutaneous insect bite reactions, although their use is generally off-label and supported by limited quality evidence.
- Oral antihistamines and/or corticosteroids are often considered for large local reactions to insect bites and stings to reduce inflammation and swelling, despite the lack of robust trial evidence.
- Topical corticosteroids are licensed for insect bite reactions and commonly used in short courses to reduce inflammation and itching.
- Oral corticosteroids may be prescribed to limit swelling in patients with a history of large local reactions, but should be used at the lowest effective dose for the shortest duration due to potential adverse effects.
- Corticosteroids should not be prescribed if there is any suspicion of secondary infection at the bite site.
- Referral to secondary care with an allergy specialist should be considered for ongoing management and follow-up.
In summary, antihistamines are primarily used to alleviate itching, while corticosteroids (topical or oral) are reserved for more significant inflammatory or large local reactions, with caution regarding infection and side effects NICE CKS,NICE CKS.