What medications can treat urticaria?

From the Guidelines

Antihistamines, specifically second-generation options like cetirizine, loratadine, or fexofenadine, are the first-line treatment for urticaria, with dosing potentially increased up to four times the standard dose for persistent symptoms. The management of urticaria has evolved, with recent guidelines emphasizing a stepped approach to treatment, starting with antihistamines and progressing to other options like omalizumab or cyclosporine if necessary 1.

First-Line Treatment

• Antihistamines: Second-generation antihistamines such as cetirizine (10mg daily), loratadine (10mg daily), or fexofenadine (180mg daily) are preferred due to their minimal sedating effects.
• Dosing Adjustment: For patients who do not respond to standard doses, increasing the dose up to four times the standard dose may be beneficial, as suggested by recent guidelines 1.

Second-Line and Further Treatment

• Omalizumab: For patients with severe or refractory urticaria, omalizumab, an anti-IgE monoclonal antibody, is effective at 300mg subcutaneously every 4 weeks, with the option to increase the dose or frequency if needed 1.
• Cyclosporine: In cases where omalizumab is not effective or suitable, cyclosporine may be considered, although its use requires careful monitoring due to potential side effects like hypertension and renal impairment 1.
• Corticosteroids: Short courses of oral corticosteroids, such as prednisone, can provide relief for acute severe urticaria but are not recommended for long-term use due to side effects 1.

Additional Considerations

• Leukotriene Receptor Antagonists: Adding leukotriene receptor antagonists like montelukast may help in some cases where antihistamines are insufficient.
• Epinephrine: For acute urticaria with angioedema or anaphylaxis, epinephrine may be necessary.
• Identifying and Avoiding Triggers: Important for management, as is maintaining good skin hydration with regular moisturizing.

The approach to treating urticaria should be individualized, considering the severity of symptoms, response to initial treatments, and the presence of any complicating factors or comorbidities. Recent guidelines emphasize the importance of a tailored approach, stepping up or down treatment based on disease control and patient needs 1.

From the Research

Medications for Urticaria Treatment

The following medications can be used to treat urticaria:

• Antihistamines: They are the first line of therapy for chronic urticaria 2, 3, 4, 5, 6
• Glucocorticosteroids: Can be added if antihistamines fail to control symptoms, but should be used for short periods 2, 3, 6
• Omalizumab: Can be used if antihistamines and glucocorticosteroids fail to control symptoms 3, 5, 6
• Cyclosporine: Can be used if omalizumab fails to control symptoms, but requires careful monitoring of side effects 3, 5, 6
• Leukotriene receptor antagonists: Were previously used, but are no longer recommended due to lack of efficacy 3, 5
• Other agents: Such as dapsone, sulfasalazine, and methotrexate can be tried in patients unresponsive to other treatments 3, 5

Dosage and Administration

• Antihistamines: Should be used on a regular basis, and not just after hives occur 2
• Antihistamines: Can be used at higher than licensed doses if normal doses fail to control the disease 3, 6
• Omalizumab: Typically administered at a dose of 300 mg/month 3
• Cyclosporine: Requires careful monitoring of side effects, particularly on blood pressure and renal function 3, 6