What is the treatment for a 23-year-old male with pruritus (itching) and urticaria (hives) all over his body?

From the Guidelines

The treatment for a 23-year-old male with generalized pruritus and urticaria should begin with second-generation antihistamines such as cetirizine 10mg daily, loratadine 10mg daily, or fexofenadine 180mg daily, as recommended by the British Association of Dermatologists' guidelines 1. These medications block histamine receptors that trigger itching and hives, with minimal sedating effects.

• The patient should avoid known triggers, take cool baths with colloidal oatmeal, apply calamine lotion for symptomatic relief, and wear loose-fitting cotton clothing.
• If symptoms persist, the dose can be increased up to four times the standard dose (e.g., cetirizine 40mg daily) under medical supervision.
• For severe or breakthrough symptoms, adding an H2 blocker like famotidine 20mg twice daily may help, as suggested by guidelines for evaluation and management of urticaria in adults and children 1.
• Acute severe flares can be managed with a short course of oral corticosteroids such as prednisone 40mg daily for 3-5 days with tapering, as recommended by guidelines for evaluation and management of urticaria in adults and children 1.
• If urticaria persists beyond 6 weeks (becoming chronic), further evaluation by an allergist or dermatologist is recommended to consider additional treatments like omalizumab or cyclosporine.
• The patient should seek immediate medical attention if experiencing difficulty breathing, facial swelling, or lightheadedness, as these may indicate anaphylaxis, and epinephrine injection should be considered in such cases, as advised by the Pediatrics journal 1.

From the FDA Drug Label

PURPOSE Antihistamine The treatment for a 23-year-old male with pruritus (itching) and urticaria (hives) all over his body may include antihistamines such as loratadine (PO) 2.

• Loratadine is an antihistamine that can be used to relieve symptoms of allergies, including itching and hives. However, for a more severe condition, prednisone (PO) may be considered 3.
• Prednisone is a corticosteroid that can be used to treat a variety of conditions, including allergic reactions, and the initial dosage may vary from 5 mg to 60 mg per day.

From the Research

Treatment Options for Urticaria and Pruritus

• The first-line treatment for chronic urticaria is second-generation antihistamines, which can be used at higher than licensed doses if normal doses fail to control the disease 4.
• A short course of oral corticosteroids should be considered for patients not responding to antihistamines before trying other immunosuppressive drugs 4.
• Antihistamines that block the activation of the histamine H₁receptor have been shown to be effective therapeutics for the treatment of pruritus associated with urticaria, allergic rhinitis, and allergic conjunctivitis 5.
• Histamine H₄receptor antagonists have been shown to inhibit histamine-induced itch in humans and may be a therapeutic option for the treatment of pruritus not controlled by antihistamines that target the H₁R 5.

Combination Therapies

• A combination of ranitidine with diphenhydramine was more effective at improving the resolution of urticaria than diphenhydramine administered alone 6.
• A combination of cimetidine with diphenhydramine was more effective than diphenhydramine alone, but cimetidine provided no statistically significant greater overall improvement in symptoms of urticaria when compared to diphenhydramine 6.

General Treatment Guidelines

• Antihistamines should be used on a regular basis and not only after hives occur 7.
• If drowsiness or anticholinergic adverse symptoms limit the use of one drug in effective doses, other H1-blockers should be tried 7.
• For day-time use, the newer, less sedating antihistamines are preferred 7.
• Glucocorticosteroids can be added for short periods if antihistamines fail to control symptoms when used at full doses 7.