From the Guidelines
The recommended treatment for itching associated with allergic reactions typically involves oral antihistamines as first-line therapy, with second-generation antihistamines being preferred over first-generation antihistamines like hydroxyzine due to their reduced risk of sedation and anticholinergic effects. According to the most recent and highest quality study 1, oral second-generation/less sedating antihistamines are recommended for patients with allergic rhinitis and primary complaints of sneezing and itching. Some key options for oral antihistamines include:
- Non-sedating options like cetirizine (10mg daily), loratadine (10mg daily), or fexofenadine (180mg daily) for daytime use
- Sedating antihistamines such as diphenhydramine (25-50mg every 4-6 hours) or hydroxyzine (25-50mg every 6-8 hours) may be more appropriate at bedtime, but are not the first choice due to their side effects. For localized itching, topical treatments can provide relief, including:
- 1% hydrocortisone cream applied 2-3 times daily for up to two weeks
- Calamine lotion as needed
- Cooling menthol-containing lotions Cold compresses applied for 10-15 minutes can also help reduce inflammation and itching. Avoiding triggers, wearing loose cotton clothing, keeping fingernails short to prevent skin damage from scratching, and maintaining cool, humid environments can further minimize discomfort. These treatments work by blocking histamine receptors or reducing inflammation, which are key mechanisms in allergic reactions that trigger nerve endings and cause the itching sensation. For severe or persistent symptoms that don't respond to these measures, consulting a healthcare provider is recommended as prescription-strength medications may be necessary, as suggested by 1 and 1.
From the FDA Drug Label
For use in the management of pruritus due to allergic conditions such as chronic urticaria and atopic and contact dermatoses and in histamine-mediated pruritus: adults, 25 mg t.i.d. or q.i.d. ; children under 6 years, 50 mg daily in divided doses; children over 6 years, 50 to 100 mg daily in divided doses. The recommended treatment for itching associated with allergic reactions using hydroxyzine is:
- Adults: 25 mg three to four times a day
- Children under 6 years: 50 mg daily in divided doses
- Children over 6 years: 50 to 100 mg daily in divided doses 2
From the Research
Treatment for Itching Associated with Allergic Reactions
The recommended treatment for itching associated with allergic reactions often involves the use of antihistamines. However, it's crucial to note that some antihistamines can cause hypersensitivity reactions, including itching.
Antihistamines and Hypersensitivity Reactions
- Studies have shown that antihistamines, particularly those derived from phenothiazine and piperazine, can induce allergic hypersensitivity reactions 3, 4.
- Hydroxyzine, a piperazine-derived antihistamine, has been reported to cause cutaneous drug eruptions, including pruritic rashes and desquamation 3.
- Cetirizine, another antihistamine, has also been implicated in causing hypersensitivity reactions, including urticaria and anaphylaxis 4.
Evidence-Based Use of Antihistamines
- Second-generation H1 antihistamines are generally recommended for the treatment of allergic conditions, such as allergic rhinitis and urticaria, due to their safer adverse effect profile compared to first-generation antihistamines 5.
- These antihistamines can be used in oral and intranasal formulations, and in combination with intranasal corticosteroids, to provide effective relief from allergic symptoms 5.
- Patient preference, access, and costs should be considered when selecting an antihistamine for treatment 5.
Considerations for Hydroxyzine Use
- Given the potential for hydroxyzine to cause hypersensitivity reactions, including itching, its use should be carefully considered and monitored 3, 4.
- Alternative antihistamines may be preferred for the treatment of itching associated with allergic reactions, especially in patients with a history of hypersensitivity reactions to antihistamines 4, 5.