Medication Summary
The goals of pharmacotherapy are to reduce morbidity and to prevent complications. Oral antihistamines can be of some benefit for the relief of pruritus. Systemic steroids are the standard for severe toxicodendron dermatitis.
Corticosteroids
Class Summary
These agents have anti-inflammatory properties and cause profound and varied metabolic effects. They modify the body's immune response to diverse stimuli.
Prednisone (Deltasone)
Immunosuppressant that may decrease inflammation by reversing increased capillary permeability and suppressing PMN activity. DOC used in moderate-to-severe cases. Blocks type IV hypersensitivity reaction.
Methylprednisolone (Solu-Medrol)
Steroids ameliorate delayed effects of anaphylactoid reactions and may limit biphasic anaphylaxis. In severe cases of serum sickness, parenteral steroids may be beneficial to reduce inflammatory effects of this immune complex–mediated disease. Available as PO/IV preparations.
Antihistamines
Class Summary
These agents provide symptomatic relief of pruritus.
Diphenhydramine (Benadryl)
For symptomatic relief of symptoms caused by release of histamine in allergic reactions.
Hydroxyzine (Vistaril, Atarax)
Antagonizes H1 receptors in periphery. May suppress histamine activity in subcortical region of CNS. Sedating, alternative to diphenhydramine.
Cimetidine (Tagamet)
If no response to H1 antagonist alone, coadministration with this H2 antagonist treats itching and flushing in anaphylaxis, pruritus, urticaria, and contact dermatitis.
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Forearm approximately 10 days after exposure to poison ivy in a garden. Note vesicles and linear areas of the rash.