eMedicine Specialties > Dermatology > Allergy & Immunology

Urticaria, Solar: Treatment & Medication

Author: Elma D Baron, MD, Assistant Professor of Dermatology, Case Western Reserve University, University Hospitals of Cleveland; Director of Skin Study Center, University Hospitals Research Institute; Acting Chief of Dermatology, Veterans Affairs Medical Center, Cleveland
Coauthor(s): Charles R Taylor, MD, Assistant Professor of Dermatology, Harvard Medical School; Director of Phototherapy Unit, Department of Dermatology, Massachusetts General Hospital
Contributor Information and Disclosures

Updated: Mar 29, 2007

Treatment

Medical Care

In rare systemic cases, supportive medical measures to maintain blood pressure and adequate ventilation may be required if extensive cutaneous surfaces are simultaneously involved.

Medication

Treatment of solar urticaria can be frustrating. A combination of different modalities is often necessary, but the success of these methods is highly variable. Taking measures to avoid or minimize sun exposure is the most important step. Unfortunately, this often requires major adjustments in lifestyle, which might be impractical for some patients.

Antihistamines

Because solar urticaria involves IgE-mediated mast cell degranulation with consequent histamine release, the first line of treatment consists of long-acting, nonsedating H1-receptor blockers. Often, such agents achieve a protective factor of 10 or more. The extent to which this is useful depends on the severity of the disease itself. For example, someone who gets hives after just a few seconds of sun exposure is unlikely to benefit from antihistamine monotherapy. A patient requiring 10 minutes or more of exposure would show more benefit. Antihistamines seem to block wheal response and minimize pruritus, but they do not entirely eliminate an erythematous reaction. This tendency should be explained to the patient.


Cetirizine (Zyrtec)

Forms complex with histamine for H1-receptor sites in blood vessels, GI tract, and respiratory tract.

Adult

5-10 mg PO qd

Pediatric

<2 years: Not established
2-5 years: 2.5 mg PO qd
>5 years: Administer as in adults

Increases CNS toxicity of depressants

Pregnancy

B - Usually safe but benefits must outweigh the risks.

Precautions

Because it is related to the highly sedating antihistamine hydroxyzine, some patients also experience drowsiness; caution in hepatic or renal dysfunction; doses >10 mg/d may cause drowsiness


Fexofenadine (Allegra)

Competes with histamine for H1 receptors in GI tract, blood vessels, and respiratory tract, reducing hypersensitivity reactions. Does not sedate.

Adult

180 mg/d PO

Pediatric

<6 months to 2 years: Not established; 15 mg (2.5 mL) PO bid recommended for chronic idiopathic urticaria
2-12 years: 30 mg PO bid
>12 years: Administer as in adults

Toxicity increases with coadministration of erythromycin and ketoconazole; concurrent administration with aluminum- or magnesium-containing antacids within 15 min decreases absorption

Pregnancy

C - Safety for use during pregnancy has not been established.

Precautions

Cardiac complications (dysrhythmias) may occur in high doses; no data available on use while breastfeeding


Loratadine (Claritin)

Selectively inhibits peripheral H1 receptors.

Adult

10 mg PO qd on empty stomach

Pediatric

<2 years: Not established
2-6 years: 5 mg/d PO
>6 years: Administer as in adults

Ketoconazole, erythromycin, procarbazine, and alcohol may increase levels

Pregnancy

B - Usually safe but benefits must outweigh the risks.

Precautions

Initiate therapy at lower dose in liver or renal impairment


Desloratadine (Clarinex)

Long-acting tricyclic histamine antagonist selective for H1 receptor. Relieves nasal congestion and systemic effects of seasonal allergy. A major metabolite of loratadine, which, after ingestion, is metabolized extensively to active metabolite 3-hydroxydesloratadine.

Adult

5 mg PO qd

Pediatric

<6 months: Not established
6-12 months: 2 mL (1 mg) syr PO qd
1-6 years: 2.5 mL (1.25 mg) syr PO qd
6-12 years: 5 mL (2.5 mg) syr or 2.5 mg PO qd
>12 years: Administer as in adults

Limited data exist; erythromycin and ketoconazole increase desloratadine and 3-hydroxydesloratadine plasma concentrations, but no increase in clinically relevant adverse effects, including QTc, has been observed

Pregnancy

C - Safety for use during pregnancy has not been established.

Precautions

Decrease dose in hepatic impairment; rarely causes pharyngitis or dry mouth; adjust dose in renal impairment

Antimalarials

Used to treat certain photosensitive eruptions, including solar urticaria. Efficacy is unpredictable.


Hydroxychloroquine (Plaquenil)

Inhibits chemotaxis of eosinophils and locomotion of neutrophils. Impairs complement-dependent antigen-antibody reactions.
Hydroxychloroquine sulfate 200 mg is equivalent to 155 mg hydroxychloroquine base and 250 mg chloroquine phosphate.

Adult

200 mg PO bid

Pediatric

10 mg base/kg initially, followed by 5 mg/kg at 6, 24, and 48 h

Serum levels increase with cimetidine; magnesium trisilicate may decrease absorption

Documented hypersensitivity; psoriasis; retinal and visual field changes attributable to 4-aminoquinolones

Pregnancy

C - Safety for use during pregnancy has not been established.

Precautions

Caution in hepatic disease, G-6-PD deficiency, psoriasis, and porphyria; not recommended for long-term use in children; perform periodic (q6mo) ophthalmologic examinations (include visual acuity, slit-lamp, funduscopic, and visual field tests); periodically test for muscle weakness; periodic CBC counts should be checked; hemolysis, aplastic anemia, agranulocytosis, and leukopenia can occur

Histamine H2-receptor antagonists

Usually given in addition to H1 blockers.


Ranitidine (Zantac)

H2 antagonist that, when combined with H1 type, may be useful in treating allergic reactions that do not respond to H1 antagonists alone.

Adult

150 mg PO bid

Pediatric

<1 month: Not established
>1 month to 12 years: 2-4 mg/kg PO qd; not to exceed 150 mg/d
>12 years: 1.25-2.5 mg/kg/dose PO q12h; not to exceed 300 mg/d; alternatively, 0.75-1.5 mg/kg/dose IV/IM q6-8h; not to exceed 400 mg/d

May decrease effects of ketoconazole and itraconazole; may alter serum levels of ferrous sulfate, diazepam, nondepolarizing muscle relaxants, and oxaprozin; may decrease effectiveness of bisacodyl if given within 1 h of H2 blocker; drugs that raise gastric pH, such as H2 blockers, reduce cefpodoxime absorption

Pregnancy

B - Usually safe but benefits must outweigh the risks.

Precautions

Caution in renal or liver impairment; if changes in renal function occur during therapy, consider adjusting dose or discontinuing treatment; elevation of transaminase enzymes has occurred with prolonged IV therapy

More on Urticaria, Solar

Overview: Urticaria, Solar
Differential Diagnoses & Workup: Urticaria, Solar
Treatment & Medication: Urticaria, Solar
Follow-up: Urticaria, Solar
References
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References

  1. Collins P, Ahamat R, Green C, Ferguson J. Plasma exchange therapy for solar urticaria. Br J Dermatol. Jun 1996;134(6):1093-7. [Medline].

  2. Dawe RS, Ferguson J. Prolonged benefit following ultraviolet A phototherapy for solar urticaria. Br J Dermatol. Jul 1997;137(1):144-8. [Medline].

  3. Fotiades J, Soter NA, Lim HW. Results of evaluation of 203 patients for photosensitivity in a 7.3-year period. J Am Acad Dermatol. Oct 1995;33(4):597-602. [Medline].

  4. Fukunaga A, Horikawa T, Yamamoto A, Yamada Y, Nishigori C. The inhibition spectrum of solar urticaria suppresses the wheal-flare response following intradermal injection with photo-activated autologous serum but not with compound 48/80. Photodermatol Photoimmunol Photomed. Jun 2006;22(3):129-32. [Medline].

  5. Harris A, Burge SM, George SA. Solar urticaria in an infant. Br J Dermatol. Jan 1997;136(1):105-7. [Medline].

  6. Khoo SW, Tay YK, Tham SN. Photodermatoses in a Singapore skin referral centre. Clin Exp Dermatol. Jul 1996;21(4):263-8. [Medline].

  7. Miyauchi H, Horio T. Detection of action, inhibition and augmentation spectra in solar urticaria. Dermatology. 1995;191(4):286-91. [Medline].

  8. Roelandts R, Ryckaert S. Solar urticaria: the annoying photodermatosis. Int J Dermatol. Jun 1999;38(6):411-8. [Medline].

  9. Roelandts R. Diagnosis and treatment of solar urticaria. Dermatol Ther. 2003;16(1):52-6. [Medline].

  10. Ryckaert S, Roelandts R. Solar urticaria. A report of 25 cases and difficulties in phototesting. Arch Dermatol. Jan 1998;134(1):71-4. [Medline].

  11. Shimauchi T, Kabashima K, Tokura Y. Solar urticaria as a manifestation of Churg-Strauss syndrome. Clin Exp Dermatol. Mar 2007;32(2):209-10. [Medline].

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Further Reading

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Keywords

solar urticaria, sun hives, allergy, allergic reaction, anaphylaxis, anaphylactoid reaction, angioedema, photodermatosis, pruritus, solar irradiation, minimum urticarial dose, MUD, polymorphous light eruption, PMLE, erythropoietic protoporphyria, lupus erythematosus, photocontact dermatitis, miliaria rubra, psoralen–UV-A, PUVA, phototherapy, UV-A, broadband UV-B, narrowband UV-B, photochemotherapy, methoxsalen

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Contributor Information and Disclosures

Author

Elma D Baron, MD, Assistant Professor of Dermatology, Case Western Reserve University, University Hospitals of Cleveland; Director of Skin Study Center, University Hospitals Research Institute; Acting Chief of Dermatology, Veterans Affairs Medical Center, Cleveland
Elma D Baron, MD is a member of the following medical societies: American Academy of Dermatology, American Society for Photobiology, Photomedicine Society, and Society for Investigative Dermatology
Disclosure: Nothing to disclose.

Coauthor(s)

Charles R Taylor, MD, Assistant Professor of Dermatology, Harvard Medical School; Director of Phototherapy Unit, Department of Dermatology, Massachusetts General Hospital
Charles R Taylor, MD is a member of the following medical societies: American Academy of Dermatology, American Medical Association, American Society for Laser Medicine and Surgery, Massachusetts Medical Society, and Society for Investigative Dermatology
Disclosure: Nothing to disclose.

Medical Editor

Donald Belsito, MD, Clinical Professor, Department of Internal Medicine, Division of Dermatology, University of Missouri at Kansas City; Private Practice, American Dermatology Associates, LLC
Donald Belsito, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Dermatology, American Contact Dermatitis Society, Dermatology Foundation, Kansas Medical Society, Noah Worcester Dermatological Society, Phi Beta Kappa, and Phi Beta Kappa
Disclosure: Nothing to disclose.

Pharmacy Editor

Michael J Wells, MD, Associate Professor, Department of Dermatology, Texas Tech University Health Sciences Center
Michael J Wells, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Dermatology, American Medical Association, and Texas Medical Association
Disclosure: Nothing to disclose.

Managing Editor

Jeffrey Meffert, MD, Assistant Clinical Professor of Dermatology, University of Texas Health Science Center-San Antonio
Jeffrey Meffert, MD is a member of the following medical societies: American Academy of Dermatology
Disclosure: Nothing to disclose.

CME Editor

Joel M Gelfand, MD, MSCE, Medical Director, Clinical Studies Unit, Assistant Professor, Department of Dermatology, Associate Scholar, Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania
Joel M Gelfand, MD, MSCE is a member of the following medical societies: Society for Investigative Dermatology
Disclosure: Nothing to disclose.

Chief Editor

Dirk M Elston, MD, Director, Department of Dermatology, Geisinger Medical Center
Dirk M Elston, MD is a member of the following medical societies: American Academy of Dermatology
Disclosure: Nothing to disclose.

 
 
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