Urticaria medical therapy

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

Overview

Urticarias can be very difficult to treat. There are no guaranteed treatments or means of controlling attacks, and some sub-populations are treatment resistant, with medications spontaneously losing their effectiveness and requiring new medications to control attacks. It can be difficult to determine appropriate medications since some such as loratadine require a day or two to build up to effective levels, and since the condition is intermittent and outbreaks typically clear up without any treatment.

Most treatment plans for urticaria involve being aware of one's triggers, but this can be difficult since there are several different forms of urticaria and people often exhibit more than one type. Also, since symptoms are often idiopathic there might not be any clear trigger. If one's triggers can be identified then outbreaks can often be managed by limiting one's exposure to these situations.

Medical Therapy

Histamine Antagonists

Drug treatment is typically in the form of antihistamines such as diphenhydramine, hydroxyzine, cetirizine and other H1 receptor antagonists.[1] These are taken on a regular basis to protective effect, lessening or halting attacks.

The H2-receptor antagonists such as cimetidine and ranitidine may help control symptoms either prophylactically or by lessening symptoms during an attack.[2] When taken in combination with a H1 antagonist it has been shown to have a synergistic effect which is more effective than either treatment alone. The use of ranitidine (or other H2 antagonist) for urticaria is considered an off-label use, since these drugs are primarily used for the treatment of peptic ulcer disease and gastroesophageal reflux disease.

Corticosteroids

An oral corticosteroid such as Prednisone is sometimes prescribed. However, in a randomized controlled trial of adults with urticaria of less than 24 hours duration, prednisone plus levocetirizine, as compared to levocetirizine alone, yielded rates of resolution at two days of 62% and 72&, respectively.[3]

Others

Tricyclic antidepressants such as doxepin, also are often potent H1 and H2 antagonists and may have a role in therapy, although side effects limit their use.

As of 2008 an Australian company is performing clinical trials with an analogue of alpha-melanocyte-stimulating hormone called Melanotan (CUV1647) for the treatment of solar urticaria, [4] a type of urticaria that develops in response to exposure to specific wavelengths of light.[5]

Contraindicated medications

Urticaria is considered an absolute contraindication to the use of the following medications:

References

  1. Greaves MW, Tan KT (2007). "Chronic Urticaria: Recent Advances". Clin Rev Allergy Immunol. 33 (1–2): 134–143. doi:10.1007/s12016-007-0038-3. PMID 18094952.
  2. Lee EE, Maibach HI (2001). "Treatment of urticaria. An evidence-based evaluation of antihistamines". Am J Clin Dermatol. 2 (1): 27–32. PMID 11702618.
  3. Barniol C, Dehours E, Mallet J, Houze-Cerfon CH, Lauque D, Charpentier S (2017). "Levocetirizine and Prednisone Are Not Superior to Levocetirizine Alone for the Treatment of Acute Urticaria: A Randomized Double-Blind Clinical Trial". Ann Emerg Med. doi:10.1016/j.annemergmed.2017.03.006. PMID 28476259.
  4. McDonald, Kate (2007-04-13). "Tackling skin cancer in organ transplant patients". Australian Life Scientist. Retrieved 2007-12-24.
  5. Baron, ED (2007-03-29). "Urticaria, Solar". WebMD. Retrieved 2007-12-26. Unknown parameter |coauthors= ignored (help)



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