Antihistaminics in Urticaria

Depending on the duration of clinical symptoms (the time  since  the  first  episode  of  urticarial  wheals),  urticaria can  be  classified  as  acute  (up  to  6  weeks)  or  chronic  (over 6  weeks). In acute urticaria second-generation antihistamines are the first choice. For refractory cases, use a combination of H1 and H2 antihistamines(Ranitidine). A short course of an oral corticosteroid (administered daily for 5-7 d, with or without a taper) or a single dose of a long-acting injectable steroid is not usually associated with long-term sequelae and can be helpful when used for an acute episode of urticaria nonresponsive to antihistamines.

Chronic  urticaria (presenting with wheals, angioedema, or both) is of two types i.e. Idiopathic and Induced(where the cause is known). Urticaria in children should be  treated  with  modern second generation  antihistamines ( Cetirizine,  Fexofenadine,Loratadine ) .When the response is not good for over two weeks increase the doses of  the second generation antihistamines by  two-to-four times . 

In the treatment of chronic urticaria two or more antihistamines should never be combined. It is also important to  remember  that  the first  generation  of  antihistamine are not indicated in the treatment of chronic urticaria.

Bilastine is one of the newest drugs in the second generation antihistamines which is being evaluated.

When despite such management the symptoms  still  persist add montelukast. Further additions like cyclosporine A, omalizumab or other modalities should be considered.


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