Treatment of acute urticaria
General Tips for acute urticaria treatment
- You have to exclude anaphylaxis or laryngeal angioedema.
- Advise your patient to avoid the triggering agent if known.
- Anti-pruritic, cooling skin lotions such as calamine lotion or 1% menthol in aqueous cream may help to improve itching.
- Second generation H1 antihistamines is the first choice.
- If the patient is not responding to the usual dose, you can try Increasing the dose up to fourfold.
- Give the patient urticaria information leaflet.
Medical treatment options of acute urticaria
H1 antihistamines
Second generation H1 antihistamines : The first choice.
- Cetirizine :
- Dose for adults : 10 mg once may be increased to twice daily.
- Dose for children (6 years old or more) : 5 mg or 10 mg once daily.
- Dose for children (2-5 years old): 5 mg once daily.
- Dose for children (6 months to 2 years old): 2.5 mg once daily.
- Levocetirizine
- Dose for adults: 5 mg once daily or twice daily according to patient needs.
- Dose for children (6 -11 years old) : 2.5 mg once daily.
- Loratadine
- Dose for adults : 10 mg once or twice daily.
- Dose for patients (6 years old or more): 10 mg once daily.
- Dose for children (2-5 years old) : 5 mg once daily.
- Desloratidine
- Dose for adults : 5 mg once or twice daily.
- Dose for patients(12 years nd more) : 5 mg once daily.
- Dose for children(6-11 years): 2.5 mg once daily.
- Dose for children (1-5 years): 1.25 mg once daily.
- Dose of children( 6 months – 1 year) : 1 mg once daily.
- Fexofenadine
- Dose for adults : 180 mg once or twice daily.
- Dose for children (2-11 years): 30 mg twice daily.
- Dose for children( 6 months- 2 years): 15 mg twice daily.
Patients should be instructed not to drive while taking antihistamines with sedative effects.
Sedating H1 antihistamines can be used in combination with a daytime non-sedating antihistamine, they can be taken at night if sleep is disturbed by urticaria, but they can have impact on the daily activities the following day
First generation H1 antihistamines
- Hydroxyzine
- Dose for adults: 25 to 50 mg deep IM injection in adults every four to six hours.
- Dose for children: 0.5 to 1 mg/kg (up to 50 mg per dose) IM every six hours.
- Diphenhydramine
- Dose for adults: 25 to 50 mg given by slow intravenous (IV) administration or intramuscular (IM) injection every four to six hours.
- Dose for children: 0.5 to 1.25 mg/kg (up to 50 mg per dose) IV/IM every six hours.
Steroids
A short course of systemic steroids administered with antihistamines may be needed in patients with angioedema or persistent symptoms.
- For adults: Prednisone ( 30 to 60 mg daily with or without tapering over 5-7 days).
- For children: Prednisolone (0.5 to 1 mg/kg/day with or without tapering over 5-7 days).
H2 antihistamines
H2 antihistamines like Ranitidine, Famotidine, and Cimetidine can be used in combination with H1 antihistamines.
For more details : Acute and Chronic Urticaria: Evaluation and Treatment