From the Guidelines
The recommended treatment for chronic urticaria and hives typically begins with second-generation H1 antihistamines, and oral corticosteroids like prednisone are generally preferred over oral triamcinolone due to their faster onset of action and shorter duration of treatment. The treatment approach should prioritize minimizing morbidity, mortality, and improving quality of life.
Key Considerations
- Second-generation H1 antihistamines such as cetirizine (10mg daily), loratadine (10mg daily), fexofenadine (180mg daily), or desloratadine (5mg daily) are the first line of treatment, which can be increased up to four times the standard dose if symptoms persist 1.
- For patients who don't respond adequately to antihistamines, omalizumab (300mg subcutaneous injection every 4 weeks) is often added as a second-line treatment, with the option to updose if necessary 1.
- In severe cases that don't respond to these approaches, short courses of oral corticosteroids like prednisone (20-40mg daily for 3-5 days) may provide temporary relief, though they're not recommended for long-term use due to side effects 1.
- Cyclosporine (3-5mg/kg/day in divided doses) can be considered for refractory cases under specialist supervision, with careful monitoring of potential side effects 1.
Treatment Approach
- Identifying and avoiding triggers is crucial, as is treating any underlying conditions.
- Treatment typically continues until symptoms have been controlled for several months before attempting a gradual reduction in medication.
- The choice between oral triamcinolone and prednisone should be based on the individual patient's response and the side effect profile, with prednisone generally being preferred due to its faster onset of action and shorter duration of treatment.
- It is essential to follow the most recent guidelines and consider the patient's specific needs and circumstances when making treatment decisions, as recommended by the latest studies 1.
From the FDA Drug Label
The FDA drug label does not answer the question.
From the Research
Treatment Options for Chronic Urticaria and Hives
- The recommended treatment for chronic urticaria and hives typically involves antihistamines as the first line of therapy 2, 3.
- For cases where antihistamines are not effective, oral corticosteroids such as prednisone may be considered 4, 5.
- A study comparing cetirizine and fexofenadine found that cetirizine had a therapeutic advantage over fexofenadine in the treatment of chronic idiopathic urticaria 6.
Oral Triamcinolone Compared to Prednisone
- There is limited direct comparison between oral triamcinolone and prednisone for the treatment of chronic urticaria and hives.
- However, prednisone has been shown to be effective in treating acute urticaria 5 and autoimmune urticaria 4.
- The choice between oral triamcinolone and prednisone may depend on individual patient factors and the specific characteristics of their urticaria.
Treatment Guidelines
- The Asian Pacific journal of allergy and immunology recommends non-sedating H1-antihistamine as the first-line treatment for chronic spontaneous urticaria (CSU) 3.
- If urticaria is not controlled, increasing the dose of antihistamines up to 4 times is recommended 3.
- For cases where antihistamines are not effective, alternative treatments such as omalizumab may be considered 3.