Dermographism Urticaria Medication

Updated: Mar 29, 2016
  • Author: Simone Laube, MD, MRCP; Chief Editor: Dirk M Elston, MD  more...
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Medication

Medication Summary

The goals of pharmacotherapy are to reduce morbidity and to prevent complications. Antihistamines are the mainstay of pharmacologic therapy for dermographism urticaria.

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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.

Antihistamines act through competitive inhibition of histamine at the H1 receptor, the H2 receptor, or both. This action mediates wheal and flare reactions, bronchial constriction, mucus secretion, smooth muscle contraction, edema, hypotension, central nervous system (CNS) depression, and cardiac arrhythmias.

Cetirizine (Zyrtec, Zyrtec Chewable Tablets)

Cetirizine forms a complex with histamine for H1-receptor sites in blood vessels, the gastrointestinal (GI) tract, and the respiratory tract.

Loratadine (Claritin)

Loratadine selectively inhibits peripheral histamine H1 receptors.

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. It is a major metabolite of loratadine, which, after ingestion, is metabolized extensively to the active metabolite 3-hydroxydesloratadine.

Levocetirizine (Xyzal)

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

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.

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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.

Antihistamines act through competitive inhibition of histamine at the H1 receptor, the H2 receptor, or both. This action mediates wheal and flare reactions, bronchial constriction, mucus secretion, smooth muscle contraction, edema, hypotension, central nervous system (CNS) depression, and cardiac arrhythmias.

Hydroxyzine (Vistaril)

Hydroxyzine is a sedative antihistamine that also has an anxiolytic effect. It antagonizes H1 receptors in the periphery. It may suppress histamine activity in the subcortical region of the CNS.

Diphenhydramine (Benadryl, Diphenhist, Allerdryl)

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

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Monoclonal Antibodies

Class Summary

Omalizumab (Xolair) is a recombinant DNA-derived humanized immunoglobulin G monoclonal antibody that binds selectively to human immunoglobulin E on the surface of mast cells and basophils. The drug reduces mediator release, which promotes an allergic response.

Omalizumab (Xolair)

Omalizumab, a recombinant humanized monoclonal antibody against immunoglobulin E (IgE), has been successfully used in patients with physical urticaria, including symptomatic dermographism. It is administered subcutaneously at an initial dosage of 150 mg/mo, but the dosage can be increased to 300 mg/mo. Some patients have reported complete symptom resolution within days after the first injection.

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