From the Guidelines
To treat hives (urticaria), I recommend starting with non-sedating antihistamines like cetirizine (10mg), loratadine (10mg), or fexofenadine (180mg) once daily, and for severe cases, the dose can be safely increased up to four times the standard amount, as suggested by the latest guidelines 1. When treating urticaria, it's essential to consider the following key points:
- Antihistamines are the mainstay of therapy, with over 40% of hospitalized patients showing a good response to them 1.
- For immediate relief of itching and inflammation, 1% hydrocortisone cream can be used on affected areas up to twice daily for no more than two weeks.
- Applying cool compresses to affected areas and wearing loose-fitting clothing can help reduce irritation.
- Avoiding known triggers such as certain foods, medications, or environmental factors that may have caused the outbreak is crucial.
- If hives persist beyond 6 weeks (chronic urticaria) or if symptoms of anaphylaxis like difficulty breathing or throat swelling occur, seeking medical attention immediately is necessary.
- For persistent cases, medications like omalizumab can be prescribed, with a recommended starting dose of 300 mg every 4 weeks, and updosing can be considered if needed, up to a maximum dose of 600 mg every 14 days 1.
- Cyclosporine can 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 due to potential risks 1.
From the FDA Drug Label
The following should be kept in mind when considering alternate day therapy: Basic principles and indications for corticosteroid therapy should apply. 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 treatment for hives may involve corticosteroids like prednisone. The dose should be continued until a satisfactory clinical response is obtained, usually 4 to 10 days.
- Prednisone can be used to treat allergic diseases, including those that may cause hives.
- The treatment should be individualized and tailored to each patient, and the benefits and risks of corticosteroid therapy should be carefully weighed for each patient 2.
From the Research
Hive Treatment Overview
- Hive treatment, also known as urticaria treatment, involves various approaches to manage symptoms such as wheals and angioedema.
- According to 3, second-generation antihistamines are considered first-line agents in the treatment of chronic urticaria due to their safety and efficacy profile.
Treatment Options
- Antihistamines are commonly used to treat urticaria, with some patients requiring higher doses or combination therapy with other medications such as H2 antihistamines, leukotriene receptor antagonists, or first-generation H1 antihistamines 3.
- Omalizumab, a humanized monoclonal anti-immunoglobulin E, has been approved for the treatment of chronic urticaria that is unresponsive to H1 antagonists 3.
- Systemic corticosteroids may be used to treat acute urticaria or chronic urticaria flares, but their benefits and harms are unclear 4.
Efficacy and Safety of Treatment Options
- Up-dosing antihistamines higher than fourfold dosage may be a feasible therapeutic option with regards to effectiveness and safety, decreasing the need for third-line therapies by 49% 5.
- Systemic corticosteroids likely improve urticaria activity and itch severity, but also likely increase adverse events in approximately 15% more patients 4.
- The combination of diphenhydramine and ranitidine or cimetidine may be efficient for relief of urticaria, but most frequent adverse effects are sedation and drowsiness 6.
Research Gaps
- There is a lack of evidence-based approaches for the treatment of acute urticaria, with recent guidelines mainly focusing on chronic urticaria rather than acute urticaria 6.
- Well-designed, high-quality interventional trials are needed to establish evidence-based treatment guidelines for acute urticaria 6.