From the Guidelines
People with urticaria often experience worsening symptoms at night due to a combination of physiological factors, including decreased cortisol levels, increased body temperature, and skin blood vessel dilation. To manage nighttime urticaria, several strategies can be employed.
- Taking antihistamines like loratadine (10mg) during the day and considering first-generation antihistamines like diphenhydramine (25-50mg) or hydroxyzine (25-50mg) at night due to their sedative properties, as suggested by the most recent guidelines 1.
- Using cooling techniques such as light cotton bedding or keeping bedroom temperatures around 65-68°F (18-20°C) to reduce heat triggers.
- Applying cold compresses before bed to reduce itchiness and inflammation.
- Avoiding hot showers before sleeping to prevent further irritation.
- Identifying and removing potential allergens from bedding and using fragrance-free detergents to minimize skin irritation. It's also important to note that individual responses to antihistamines can vary, and adjustments to the timing and dosage of medication may be necessary to achieve optimal symptom control, as indicated by previous studies 1.
From the Research
Urticaria and Nocturnal Symptoms
- Urticaria is a common dermato-allergic disease characterized by dermal edema and erythema, often accompanied by pruritus 2, 3.
- The symptoms of urticaria can be more pronounced at night, leading to sleep disturbances and impaired quality of life 4, 5.
Sleep Disturbances in Urticaria
- Studies have shown that patients with chronic spontaneous urticaria (CSU) experience poor sleep quality, impaired sleep hygiene, and increased daytime sleepiness 4.
- The urticaria activity score-7 (UAS-7) has been correlated with sleep quality, suggesting a link between disease activity and sleep disturbances 4.
- Circadian dysfunction, characterized by excessive daytime sleepiness, may modify the relationship between night shift work and CSU, increasing the risk of CSU in individuals with disrupted circadian rhythms 5.
Potential Factors Contributing to Nocturnal Symptoms
- Histamine release and other mediators may play a role in the exacerbation of urticaria symptoms at night 2, 3.
- Gastric mucosal colonization with Helicobacter pylori and autoantibodies against IgE or the high-affinity IgE-receptor may also contribute to the development of urticaria, potentially influencing nocturnal symptoms 2.
- The use of antihistamines, particularly second-generation antihistamines, may help alleviate symptoms, but their efficacy in reducing nocturnal symptoms is not well established 3, 6.