From the FDA Drug Label
6 Immediate Hypersensitivity Reactions: Immediate hypersensitivity reactions may occur after administration of albuterol sulfate, as demonstrated by rare cases of urticaria, angioedema, rash, bronchospasm, anaphylaxis, and oropharyngeal edema. Rare cases of urticaria, angioedema, rash, bronchospasm, and oropharyngeal edema have been reported after the use of inhaled albuterol
Salbutamol (albuterol) should not be given in cases of pruritus and urticaria as it may worsen the condition or cause an allergic reaction, as indicated by the reports of urticaria and other hypersensitivity reactions in the drug label 1 and 1.
From the Research
Salbutamol (albuterol) is not recommended for treating pruritus and urticaria as first-line treatment. These conditions are primarily mediated by histamine release and are better managed with antihistamines such as cetirizine, loratadine, or diphenhydramine as first-line treatments 2, 3. Salbutamol is a beta-2 adrenergic agonist primarily used to treat bronchospasm in conditions like asthma and COPD by relaxing airway smooth muscle. While it theoretically could provide some relief in urticaria due to its mild anti-inflammatory properties and potential to increase intracellular cyclic AMP (which may stabilize mast cells), this effect is minimal compared to standard treatments.
Key Points to Consider
- Antihistamines are the mainstay of treatment for urticaria and pruritus, with second-generation antihistamines like cetirizine, loratadine, and levocetirizine being preferred due to their reduced sedative and anticholinergic effects 2, 3.
- For acute urticaria and pruritus, antihistamines are more effective and appropriate, with corticosteroids or epinephrine reserved for severe cases 4.
- If urticaria is accompanied by bronchospasm or respiratory symptoms in an allergic reaction, salbutamol may be used specifically for those respiratory symptoms, but not as primary treatment for the skin manifestations themselves.
Treatment Recommendations
- Antihistamines should be used as first-line treatment for urticaria and pruritus, with the choice of antihistamine depending on the specific condition and patient factors 2, 3.
- Salbutamol may be considered for use in patients with urticaria and accompanying respiratory symptoms, but only for the treatment of those respiratory symptoms 5.