Close
New

Medscape is available in 5 Language Editions – Choose your Edition here.

 

Chronic Urticaria Medication

  • Author: Daniel J Hogan, MD; Chief Editor: William D James, MD  more...
 
Updated: Apr 02, 2015
 

Medication Summary

Medications used to treat chronic urticaria include antihistamines (first- and second-generation), anti-inflammatory agents, and sulfones.

Next

Antihistamines, Second Generation

Class Summary

Second-generation antihistamines, also known as less-sedating or low-sedation antihistamines, produce less sedation than traditional H1 blockers because they are less lipid-soluble and only cross the blood-brain barrier in small amounts. They also have longer half-lives, allowing less frequent dosing.

Cetirizine (Zyrtec)

 

Cetirizine forms a complex with histamine for H1-receptor sites in blood vessels, the gastrointestinal (GI) tract, and the respiratory tract. It is available as a 5- or 10-mg tablet and as a syrup containing 1 mg/mL (5 mg/5 mL [tsp]).

Fexofenadine (Allegra)

 

Fexofenadine competes with histamine for H1 receptors in the GI tract, blood vessels, and the respiratory tract, reducing hypersensitivity reactions. It does not sedate. Fexofenadine is available as a 30-, 60-, or 180-mg tablet. The Allegra ODT tablet is formulated for disintegration in the mouth immediately after administration. Each orally disintegrating tablet contains 30 mg of fexofenadine hydrochloride. The Allegra oral suspension contains 6 mg/mL of fexofenadine hydrochloride (30 mg/5 mL).

Loratadine (Claritin, Alavert)

 

Loratadine selectively inhibits peripheral histamine H1 receptors. It is available in 10-mg tablets or 10-mg RediTabs; the syrup is 5 mg/5 mL (tsp).

Desloratadine (Clarinex)

 

Desloratadine is a long-acting tricyclic histamine antagonist that is selective for H1 receptors. It relieves nasal congestion and alleviates the systemic effects of seasonal allergy. Desloratadine is a major metabolite of loratadine, which, after ingestion, is extensively metabolized to the active metabolite 3-hydroxydesloratadine. The tablet is 5 mg; the syrup is 0.5 mg/mL (2.5 mg/5 mL [tsp]); and the RediTabs (orally disintegrating desloratadine tablets) are 2.5 mg and 5 mg.

Levocetirizine (Xyzal)

 

Levocetirizine is an H1-receptor antagonist, an active enantiomer of cetirizine. It is a second-generation prescription antihistamine.

Previous
Next

Antihistamines, First Generation

Class Summary

First-generation antihistamines compete with histamine at the tissue-receptor level, preventing it from carrying out its mediator functions in urticaria.

Diphenhydramine (Benadryl, Diphenhist, Allerdryl)

 

Diphenhydramine is given for symptomatic relief of symptoms caused by release of histamine in allergic reactions.

Hydroxyzine (Vistaril)

 

Hydroxyzine antagonizes H1 receptors in the periphery. It may suppress histamine activity in subcortical region of the central nervous system (CNS). Hydroxyzine is available in 10-, 25-, and 50-mg tablets or capsules and in a 100-mg capsule. The suspension is 25 mg/5 mL, and the syrup is 10 mg/5 mL (tsp).

Previous
Next

Leukotriene Receptor Antagonists

Class Summary

Leukotriene antagonists have been shown to be superior to placebo in the treatment of patients with chronic urticaria but are considered less effective than nonsedating antihistamines; however, the 2 classes of agents can be combined. Montelukast 10 mg/day may be particularly helpful for patients experiencing flare-ups due to aspirin or other NSAIDs. Montelukast is approved for treatment of perennial allergic rhinitis in children aged 6 months and older.

Montelukast (Singulair)

 

Montelukast is a selective competitive inhibitor of the cysteinyl leukotriene receptor. Montelukast is the last agent introduced in its class. The advantages are that it is chewable, it has a once-a-day dosing, and it has no significant adverse effects.

Previous
Next

Anti-Inflammatory Agents

Class Summary

Anti-inflammatory agents modify the immune response to diverse stimuli.

Prednisone

 

Prednisone is an immunosuppressant used to treat autoimmune disorders; it may decrease inflammation by reversing increased capillary permeability and suppressing polymorphonuclear leukocyte (PMN) activity. It stabilizes lysosomal membranes and suppresses lymphocytes and antibody production.

Colchicine (Colcrys)

 

Colchicine decreases leukocyte motility and phagocytosis in inflammatory responses.

Previous
Next

Immunosuppressants

Class Summary

These agents inhibit immune reactions that result from diverse stimuli. Patients with autoimmune urticaria may benefit from the administration of methotrexate or cyclosporine.

Cyclosporine (Gengraf, Neoral, Sandimmune)

 

Cyclosporine is a cyclic polypeptide that suppresses some humoral immunity and, to a greater extent, cell-mediated immune reactions, such as delayed hypersensitivity, allograft rejection, experimental allergic encephalomyelitis, and graft versus host disease for a variety of organs. For children and adults, base the dosing on ideal body weight. Cyclosporine 4-6 mg/kg/day has been shown in randomized double-blind studies to be effective for chronic urticaria. Cyclosporine has a better risk-to-benefit ratio than systemic corticosteroids.

Cyclosporine is recommended only for patients with severe disease refractory to high doses of oral antihistamines. Cyclosporine therapy for chronic urticaria should be limited to 3 months or less. A sustained remission is observed in approximately one third of patients treated with this medication.

Methotrexate (Rheumatrex, Trexall)

 

Methotrexate has an unknown mechanism of action in the treatment of inflammatory reactions; it may affect immune function. Methotrexate ameliorates symptoms of inflammation (eg, pain, swelling, stiffness). It is an antimetabolite that inhibits deoxyribonucleic acid (DNA) synthesis and it may suppress immune system. Adjust the dose gradually to attain a satisfactory response.

Previous
Next

Monoclonal Antibody

Class Summary

Monoclonal antibodies directed to immunoglobulin E (IgE) binding may reduce the release of mediators that provoke an allergic response. These agents may be considered when H 1 -receptor antagonists are ineffective.

Omalizumab (Xolair)

 

Omalizumab is a recombinant humanized monoclonal antibody administered by SC injection every 4 weeks. It selectively binds to IgE and inhibits binding to IgE receptors on the surface of mast cells and basophils. It is indicated for chronic idiopathic urticaria in adults and children aged 12 years or older who remain symptomatic despite anti-H 1 antihistamine treatment.

Previous
Next

Antidepressants, TCAs

Class Summary

Agents in this class antagonize the histamine (H1) receptor, preventing histamine from causing urticaria. The tricyclic antidepressant doxepin is used in urticaria for its sedative and antihistaminic properties. Oral doxepin may be considered if oral antihistamines are not helpful.

Doxepin

 

Doxepin inhibits histamine and acetylcholine activity and has proven useful in the treatment of allergic dermatologic disorders. The oral form is marketed as an antidepressant but is used also for its antihistaminic/antipruritic effects. The dosage is 10-25 mg at night in adults; if necessary, this can be gradually increased to a maximum dose of 75 mg/d for dermatoses.

Previous
Next

Antibiotics, Other

Class Summary

Certain antibiotics may modulate the immune system.

Dapsone

 

The mechanism of action of dapsone is similar to that of sulfonamides, in which competitive antagonists of para-aminobenzoic acid (PABA) prevent formation of folic acid. The effects of this agent on inflammatory reactions are unknown.

Previous
Next

Thyroid Hormones

Class Summary

Thyroid hormones may be used to suppress thyroid activity and possibly the immune process.

Levothyroxine (Levothroid, Levoxyl, Synthroid, Unithroid)

 

In active form, levothyroxine influences the growth and maturation of tissues. It is involved in normal growth, metabolism, and development.

Some patients with chronic urticaria and antithyroid antibodies benefit from levothyroxine treatment, perhaps because of suppression of thyroid activity and, possibly, the autoimmune process. The goal of treatment is to suppress thyrotropin maximally without rendering the patient clinically hyperthyroid. The urticaria may respond within 2 weeks of initiation of adequate treatment. Some patients may maintain a sustained remission after 3-6 months of treatment, at which point the levothyroxine can be tapered and then discontinued.

Previous
 
Contributor Information and Disclosures
Author

Daniel J Hogan, MD Clinical Professor of Internal Medicine (Dermatology), Nova Southeastern University College of Osteopathic Medicine; Investigator, Hill Top Research, Florida Research Center

Daniel J Hogan, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Dermatology, American Contact Dermatitis Society, Canadian Dermatology Association

Disclosure: Nothing to disclose.

Chief Editor

William D James, MD Paul R Gross Professor of Dermatology, Vice-Chairman, Residency Program Director, Department of Dermatology, University of Pennsylvania School of Medicine

William D James, MD is a member of the following medical societies: American Academy of Dermatology, Society for Investigative Dermatology

Disclosure: Nothing to disclose.

Acknowledgements

Warren R Heymann, MD Head, Division of Dermatology, Professor, Department of Internal Medicine, University of Medicine and Dentistry of New Jersey-New Jersey Medical School

Warren R Heymann, MD is a member of the following medical societies: American Academy of Dermatology, American Society of Dermatopathology, and Society for Investigative Dermatology

Disclosure: Nothing to disclose.

Robert A Schwartz, MD, MPH Professor and Head, Dermatology, Professor of Pathology, Pediatrics, Medicine, and Preventive Medicine and Community Health, University of Medicine and Dentistry of New Jersey-New Jersey Medical School

Robert A Schwartz, MD, MPH is a member of the following medical societies: Alpha Omega Alpha, American Academy of Dermatology, American College of Physicians, and Sigma Xi

Disclosure: Nothing to disclose.

Dina D Strachan, MD Assistant Clinical Professor, Department of Dermatology, St Vincent's Medical Center

Dina Strachan, MD is a member of the following medical societies: American Academy of Dermatology

Disclosure: Nothing to disclose.

Richard P Vinson, MD Assistant Clinical Professor, Department of Dermatology, Texas Tech University Health Sciences Center, Paul L Foster School of Medicine; Consulting Staff, Mountain View Dermatology, PA

Richard P Vinson, MD is a member of the following medical societies: American Academy of Dermatology, Association of Military Dermatologists, Texas Dermatological Society, and Texas Medical Association

Disclosure: Nothing to disclose.

References
  1. Dreyfus DH, Schocket AL, Milgrom H. Steroid-resistant chronic urticaria associated with anti-thyroid microsomal antibodies in a nine-year-old boy. J Pediatr. 1996 Apr. 128(4):576-8. [Medline].

  2. Ellis MH. Successful treatment of chronic urticaria with leukotriene antagonists. J Allergy Clin Immunol. 1998 Nov. 102(5):876-7. [Medline].

  3. Spector S, Tan RA. Antileukotrienes in chronic urticaria. J Allergy Clin Immunol. 1998 Apr. 101(4 Pt 1):572. [Medline].

  4. [Guideline] Powell RJ, Du Toit GL, Siddique N, et al. BSACI guidelines for the management of chronic urticaria and angio-oedema. Clin Exp Allergy. 2007 May. 37(5):631-50. [Medline].

  5. Morgan M, Khan DA. Therapeutic alternatives for chronic urticaria: an evidence-based review, part 1. Ann Allergy Asthma Immunol. 2008 May. 100(5):403-11; quiz 412-4, 468. [Medline].

  6. Tong LJ, Balakrishnan G, Kochan JP, Kinet JP, Kaplan AP. Assessment of autoimmunity in patients with chronic urticaria. J Allergy Clin Immunol. 1997 Apr. 99(4):461-5. [Medline].

  7. Kaplan AP, Greaves M. Pathogenesis of chronic urticaria. Clin Exp Allergy. 2009 Jun. 39(6):777-87. [Medline].

  8. Bossi F, Frossi B, Radillo O, et al. Mast cells are critically involved in serum-mediated vascular leakage in chronic urticaria beyond high-affinity IgE receptor stimulation. Allergy. 2011 Dec. 66(12):1538-1545. [Medline].

  9. Mathelier-Fusade P. Drug-induced urticarias. Clin Rev Allergy Immunol. 2006 Feb. 30(1):19-23. [Medline].

  10. Ventura MT, Napolitano S, Menga R, Cecere R, Asero R. Anisakis simplex Hypersensitivity Is Associated with Chronic Urticaria in Endemic Areas. Int Arch Allergy Immunol. 2013. 160(3):297-300. [Medline].

  11. Tebbe B, Geilen CC, Schulzke JD, Bojarski C, Radenhausen M, Orfanos CE. Helicobacter pylori infection and chronic urticaria. J Am Acad Dermatol. 1996 Apr. 34(4):685-6. [Medline].

  12. Valsecchi R, Pigatto P. Chronic urticaria and Helicobacter pylori. Acta Derm Venereol. 1998 Nov. 78(6):440-2. [Medline].

  13. Heymann WR. Chronic urticaria and angioedema associated with thyroid autoimmunity: review and therapeutic implications. J Am Acad Dermatol. 1999 Feb. 40(2 Pt 1):229-32. [Medline].

  14. Bansal AS, Hayman GR. Graves disease associated with chronic idiopathic urticaria: 2 case reports. J Investig Allergol Clin Immunol. 2009. 19(1):54-6. [Medline].

  15. Baty V, Hoen B, Hudziak H, Aghassian C, Jeandel C, Canton P. Schnitzler's syndrome: two case reports and review of the literature. Mayo Clin Proc. 1995 Jun. 70(6):570-2. [Medline].

  16. Sigurgeirsson B. Skin disease and malignancy. An epidemiological study. Acta Derm Venereol Suppl (Stockh). 1992. 178:1-110. [Medline].

  17. Torresani C, Bellafiore S, De Panfilis G. Chronic urticaria is usually associated with fibromyalgia syndrome. Acta Derm Venereol. 2009. 89(4):389-92. [Medline].

  18. Yosipovitch G, Greaves M. Chronic idiopathic urticaria: a "Cinderella" disease with a negative impact on quality of life and health care costs. Arch Dermatol. 2008 Jan. 144(1):102-3. [Medline].

  19. O'Donnell BF, Lawlor F, Simpson J, Morgan M, Greaves MW. The impact of chronic urticaria on the quality of life. Br J Dermatol. 1997 Feb. 136(2):197-201. [Medline].

  20. Maurer M, Ortonne JP, Zuberbier T. Chronic urticaria: a patient survey on quality-of-life, treatment usage and doctor-patient relation. Allergy. 2009 Apr. 64(4):581-8. [Medline].

  21. Brodell LA, Beck LA. Differential diagnosis of chronic urticaria. Ann Allergy Asthma Immunol. 2008 Mar. 100(3):181-8; quiz 188-90, 215. [Medline].

  22. Kanazawa K, Yaoita H, Tsuda F, Okamoto H. Hepatitis C virus infection in patients with urticaria. J Am Acad Dermatol. 1996 Aug. 35(2 Pt 1):195-8. [Medline].

  23. Zuberbier T, Asero R, Bindslev-Jensen C, Walter Canonica G, Church MK, Giménez-Arnau A, et al. EAACI/GA(2)LEN/EDF/WAO guideline: definition, classification and diagnosis of urticaria. Allergy. 2009 Oct. 64(10):1417-26. [Medline].

  24. [Guideline] Powell RJ, Leech SC, Till S, Huber PA, Nasser SM, Clark AT. BSACI guideline for the management of chronic urticaria and angioedema. Clin Exp Allergy. 2015 Mar. 45(3):547-65. [Medline].

  25. Egan CA, Rallis TM. Treatment of chronic urticaria with ketotifen. Arch Dermatol. 1997 Feb. 133(2):147-9. [Medline].

  26. Jauregui I, Ferrer M, Montoro J, et al. Antihistamines in the treatment of chronic urticaria. J Investig Allergol Clin Immunol. 2007. 17 Suppl 2:41-52. [Medline].

  27. Grob JJ, Auquier P, Dreyfus I, Ortonne JP. How to prescribe antihistamines for chronic idiopathic urticaria: desloratadine daily vs PRN and quality of life. Allergy. 2009 Apr. 64(4):605-12. [Medline].

  28. Staevska M, Popov TA, Kralimarkova T, Lazarova C, Kraeva S, Popova D, et al. The effectiveness of levocetirizine and desloratadine in up to 4 times conventional doses in difficult-to-treat urticaria. J Allergy Clin Immunol. 2010 Mar. 125(3):676-82. [Medline].

  29. Maurer M, Rosén K, Hsieh HJ, Saini S, Grattan C, Gimenéz-Arnau A, et al. Omalizumab for the treatment of chronic idiopathic or spontaneous urticaria. N Engl J Med. 2013 Mar 7. 368(10):924-35. [Medline].

  30. Brooks M. FDA OKs Omalizumab (Xolair) for Chronic Hives. Medscape Medical News. Mar 21 2014. [Full Text].

  31. Rorie A, Goldner WS, Lyden E, Poole JA. Beneficial role for supplemental vitamin D3 treatment in chronic urticaria: a randomized study. Ann Allergy Asthma Immunol. 2014 Feb 5. [Medline].

  32. Janeczko LL. High-dose vitamin D supplements may benefit people with chronic urticaria. Reuters Health Information. February 24, 2014. [Full Text].

 
Previous
Next
 
Urticaria developed after bites from an imported fire ant.
Urticaria associated with a drug reaction.
 
 
 
All material on this website is protected by copyright, Copyright © 1994-2016 by WebMD LLC. This website also contains material copyrighted by 3rd parties.