Dermatology Oasis

Editor: Dr. Nameer Al-Sudany (IRAQ)

Urticaria

Urticaria

Simplified Approach to the Management of Chronic Urticaria
1. Try to find any underlying cause through history, physical examination and relevant investigations and correct it if possible.
2. Start with second generation AHs first in full dose and if no response you may duplicate their dose: Loratadine, Desloratadine, Fexofenadine, Cetirizine, Levocetirizine
3. Take first generation AHs at bed time: Hydroxyzine, Diphenhydramine, Chlorpheniramine
4. If antihistamines alone don’t relieve your symptoms, other drugs that may help include:
A. H-2 blockers: Cimetidine, Ranitidine, Famotidine
B. Anti-inflammatory medications such as oral corticosteroids, such as prednisone. These usually are used only for a short time to control severe hives or angioedema because they can cause serious side effects.
C. Antidepressants: The tricyclic antidepressant doxepin (Zonalon), used in cream form, can help relieve itching.
D. Omalizumab (Xolair) is very effective against difficult-to-treat chronic hives, without side effects. However, it is more costly than other options. It is an anti-asthma drug and given by injection.
E. Montelukast (Singulair) and zafirlukast (Accolate): These are leukotriene modifiers used in asthma. They can be given with AHs in chronic urticaria. However, Side effects may include behavior and mood changes.
F. Immunosupressives: Such as: Ciclosporine, Tacrolimus and Mycophenolate.The last increases the risk of miscarriage and birth defects.

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