What are the indications for prescribing antihistamines versus corticosteroids for insect bite reactions?

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 ¹,².