From the Guidelines
Treatment options for pruritus from drug allergies should prioritize discontinuing the offending medication and using oral antihistamines such as loratadine 10mg daily or cetirizine 10mg daily as first-line treatment. The management of pruritus resulting from a drug allergy involves both non-pharmacological and pharmacological approaches. For immediate relief, cool compresses, oatmeal baths, and wearing loose cotton clothing can help reduce itching.
- First-line medications include oral antihistamines such as diphenhydramine (Benadryl) 25-50mg every 4-6 hours or non-sedating options like cetirizine (Zyrtec) 10mg daily or loratadine (Claritin) 10mg daily 1.
- Topical treatments include calamine lotion, 1% hydrocortisone cream applied 2-3 times daily for up to two weeks, or prescription-strength corticosteroids for severe cases.
- For extensive or severe reactions, oral corticosteroids like prednisone (40-60mg daily with a taper over 1-2 weeks) may be prescribed 1.
- In cases of anaphylaxis, immediate epinephrine administration and emergency care are essential.
- Severe or persistent symptoms warrant medical evaluation, as some drug reactions can progress to serious conditions requiring specialized treatment. The choice of treatment should be guided by the severity of the pruritus and the presence of any underlying conditions, with a focus on minimizing morbidity, mortality, and improving quality of life 1.
From the FDA Drug Label
Control of severe or incapacitating allergic conditions intractable to adequate trials of conventional treatment: ... Drug hypersensitivity reactions
- The treatment options for pruritus resulting from a drug allergy include prednisone (PO), as it is indicated for the control of severe or incapacitating allergic conditions, such as drug hypersensitivity reactions 2.
- Prednisone may be used to manage the allergic reaction and relieve pruritus symptoms.
- It is essential to note that the treatment should be tailored to the individual patient's needs and the severity of the reaction.
From the Research
Treatment Options for Pruritus from a Drug Allergy
- The treatment of pruritus resulting from a drug allergy typically involves avoiding the causative drug and using antihistamines for mild reactions 3.
- In cases of anaphylactic shock, treatment with epinephrine (adrenaline), corticosteroids, and antihistamines is required 3.
- For chronic pruritus, first-line treatment includes topical anti-inflammatory therapies such as hydrocortisone (2.5%), triamcinolone (0.1%), or tacrolimus ointment 4.
- Topical neuropathic agents such as menthol, pramoxine, or lidocaine can be used for neuropathic causes of chronic pruritus, either alone or in combination with immunomodulatory agents such as topical steroids 4.
- Other effective therapies for neuropathic pruritus include gabapentin, antidepressants such as sertraline or doxepin, or opioid receptor agonist/antagonists such as naltrexone or butorphanol 4.
- Current guidelines suggest antihistamines, pain modulators, opioid receptor antagonist, and antidepressants for the treatment of chronic pruritus 5.
- Recent experiences with neurokinin receptor 1 antagonists suggest that target-specific antipruritic drugs are of high efficacy and desirable in chronic pruritus treatments 5.
- General management of pruritus includes trigger avoidance, liberal emollient use, limiting water exposure, and administration of oral antihistamines and topical corticosteroids 6.
- Topical corticosteroids are an essential tool for treating inflammatory skin conditions and can be used safely and effectively in patients who are pregnant or lactating 7.
Additional Considerations
- A thorough history, review of symptoms, and laboratory evaluation should be performed to determine the underlying cause of pruritus 4, 6.
- Clinicians should consider evaluation for malignancy in older patients with chronic generalized pruritus 6.
- Patients should be educated to inform medical staff about previous drug reactions and to avoid these and cross-reacting drugs if possible 3.