dermatologic disorders
Urticaria
Treatment of Urticaria
Any identified causes are treated or remedied. Implicated medications or foods should be stopped. Nonspecific symptomatic treatment (eg, taking cool baths, avoiding hot water and scratching, wearing loose clothing) may be helpful. Antihistamines remain the mainstay of treatment. They must be taken on a regular basis, rather than as needed. Newer oral antihistamines often are preferred because of once-daily dosing and because some are less sedating. Appropriate choices include Cetirizine10 mg once/day Fexofenadine180 mg once/day Desloratadine5 mg once/day Levocetirizine5 mg once/day Older oral antihistamines (eg,hydroxyzine10 to 25 mg every 4 to 6 hours;diphenhydramine25 to 50 mg every 6 hours) are sedating but inexpensive and sometimes quite effective. Systemic corticosteroids (eg,prednisone30 to 40 mg orally once/day) are given for severe symptoms but should not be used long term. Topical corticosteroids or topical antihistamines are not beneficial. , a monoclonal antibody that can suppress certain allergic reactions, may help relieve symptoms ( Treatment reference ). Patients who have angioedema involving the oropharynx or any involvement of the airway should receive subcutaneousepinephrine0.3 mL of 1:1000 solution and be admitted to the hospital. On discharge, patients should be supplied with and trained in the use of an auto-injectableepinephrinepen. 1.Zhao ZT, Ji CM, Yu WJ, et al:Omalizumabfor the treatment of chronic spontaneous urticaria: A meta-analysis of randomized clinical trials.J Allergy Clin Immunol137(6):1742-1750.e4, 2016. doi: 10.1016/j.jaci.2015.12.1342 