From the Guidelines
Medications such as NSAIDs, aspirin, codeine, ACE inhibitors, and certain vaccines can cause urticaria, and it is essential to discontinue the offending drug and consult a healthcare provider immediately if symptoms occur. According to the most recent study 1, NSAIDs are common causes of delayed drug hypersensitivity reactions, including urticarial drug eruption, and can also cause more severe reactions such as Stevens-Johnson syndrome and toxic epidermal necrolysis. The study also notes that cross-reactivities within the same chemical class are well described, and for severe reactions, avoidance without rechallenge within that class is recommended.
Some key medications that can cause urticaria include:
- NSAIDs like aspirin, ibuprofen, and naproxen
- Opioid pain medications like codeine and morphine
- ACE inhibitors like lisinopril and enalapril
- Certain vaccines
- Blood products, chemotherapy drugs, and biologics like monoclonal antibodies
It is crucial to note that the reaction typically occurs through either an allergic IgE-mediated mechanism or direct mast cell activation, resulting in histamine release that causes the characteristic itchy, raised welts 1. If you develop hives after taking medication, discontinuing the drug and consulting a healthcare provider immediately is essential. For mild cases, antihistamines like cetirizine or diphenhydramine may help manage symptoms while the offending drug clears from your system. Severe reactions with breathing difficulties require emergency medical attention as they may indicate anaphylaxis.
From the FDA Drug Label
Ibuprofen tablets should not be given to patients who have experienced asthma, urticaria, or allergic-type reactions after taking aspirin or other NSAIDs. The hypersensitivity reactions reported are skin eruptions (maculopapular to exfoliative dermatitis), urticaria and other serum sickness-like reactions, laryngeal edema and anaphylaxis. Skin and Appendages: Eczema, fungal dermatitis, pruritus, sweating, urticaria and vesiculobullous rash. Allergic: Arthralgia, edema, urticaria and angioedema.
Medications that can cause urticaria include:
These medications can cause urticaria as part of a hypersensitivity reaction or allergic response.
From the Research
Medications that can cause Urticaria
- Penicillins, sulfonamides, and nonsteroidal anti-inflammatory drugs (NSAIDs) are the most common causes of drug-induced urticaria 5
- Antihistamines can also cause urticaria, especially in patients with NSAID sensitivity, as seen in the case of NSAID-sensitive antihistamine-induced urticaria/angioedema 6
- Aspirin and other NSAIDs that inhibit cyclooxygenase-1 (COX-1) can exacerbate chronic urticaria and cause urticaria in some patients 7, 8
- COX-2 inhibitors do not cross-react with other NSAIDs, but can still sensitize patients and induce urticaria or anaphylaxis on next exposure to the drug 8
Management of Urticaria caused by Medications
- Avoidance of the causative drug and treatment with antihistamines may suffice for mild reactions 5
- For anaphylactic shock, treatment with epinephrine (adrenaline), corticosteroids, and antihistamines is required 5
- Patients with a history of urticaria/angioedema induced by multiple NSAIDs require a different clinical approach, and expert panel reviews provide recommendations for their management 9