From the Guidelines
The recommended treatment for hives (urticaria) should start with non-sedating second-generation H1 antihistamines, with the option to increase the dose up to four times the standard under medical supervision, as suggested by the latest guidelines 1. The treatment approach for urticaria has been streamlined into a three-step algorithm, featuring antihistamines as the first-line treatment, omalizumab as the second-line, and cyclosporine as the third-line option 1.
- Key points to consider in the management of urticaria include:
- The use of antihistamines, such as cetirizine (10mg daily), loratadine (10mg daily), fexofenadine (180mg daily), or desloratadine (5mg daily), as the initial treatment 1.
- For patients with insufficient response, updosing of antihistamines or the addition of other agents like H2 antihistamines or omalizumab may be considered 1.
- Omalizumab is recommended to be started at a dose of 300 mg every 4 weeks, with the option to increase the dose if needed, up to a maximum of 600 mg every 14 days 1.
- Cyclosporine may be considered for patients who do not respond to higher than standard doses of omalizumab, but its use requires careful monitoring of blood pressure and renal function 1.
- A step-up and step-down approach to treatment should be used, based on the level of disease control, to minimize treatment burden and assess for spontaneous remission 1. It is essential to identify and avoid triggers, such as certain foods, medications, or physical stimuli, to prevent urticaria episodes 1. During acute episodes, cool compresses can provide symptomatic relief, and patients should seek immediate medical attention if they experience difficulty breathing, facial swelling, or dizziness, as these may indicate anaphylaxis requiring emergency treatment with epinephrine.
From the FDA Drug Label
The initial suppressive dose level should be continued until satisfactory clinical response is obtained, usually four to ten days in the case of many allergic and collagen diseases.
The recommended treatment guideline for hives (urticaria) is to use corticosteroids, such as prednisone, at an initial suppressive dose for 4 to 10 days to achieve satisfactory clinical response.
- The dose may then be reduced to the lowest effective level as rapidly as possible.
- Alternate day therapy may be considered after control of the disease process has been established. 2
From the Research
Treatment Guidelines for Hives (Urticaria)
The treatment for hives, also known as urticaria, typically involves a combination of medications and lifestyle changes. The following are some of the recommended treatment guidelines:
- First-line treatment: Antihistamines are usually the first line of treatment for urticaria, as they can help relieve symptoms such as itching and reduce the appearance of hives 3.
- Types of antihistamines: There are several types of antihistamines that can be used to treat urticaria, including sedating and non-sedating options. Non-sedating antihistamines, such as cetirizine and loratadine, are often preferred for daytime use, while sedating antihistamines, such as diphenhydramine, may be used at night to help with sleep 3, 4.
- Dosage and administration: Antihistamines should be taken regularly, rather than just when symptoms occur, to help prevent hives from forming 3. The dosage and administration of antihistamines may vary depending on the specific medication and the individual's response to treatment.
- Addition of glucocorticosteroids: If antihistamines are not effective in controlling symptoms, glucocorticosteroids, such as prednisone, may be added to the treatment regimen for short periods of time 3, 5.
- Alternative treatments: In some cases, alternative treatments, such as immunosuppressants or biologics, may be necessary for individuals who do not respond to traditional treatments 6.
Special Considerations
- H1-antihistamine-induced urticaria: In some cases, H1-antihistamines can actually induce urticaria, rather than relieve symptoms. This is often due to cross-reactivity between metabolites of different antihistamines 7.
- Angioedema: Angioedema, which is a type of swelling that occurs beneath the skin, can occur in conjunction with urticaria or on its own. Treatment for angioedema may involve different medications and strategies than those used for urticaria 6.