Allergic Urticaria

Allergic Urticaria – Treatment Overview

Introduction
Allergic urticaria, also known as hives, is a hypersensitivity reaction of the skin characterized by transient, itchy, raised wheals that can vary in size and location. It is often triggered by foods, medications, insect stings, or environmental allergens. While most cases are acute and self-limiting, chronic or recurrent urticaria may significantly affect quality of life. Treatment focuses on rapid relief of itching and prevention of recurrence, with escalation based on severity and response.

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Treatment Options and Doses

1. Identification and Avoidance of Triggers

• Discontinue suspected medications.

• Avoid foods or environmental allergens linked to the reaction.

• Manage stress, temperature extremes, or physical triggers if applicable.

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2. First-Line Therapy – Non-Sedating Antihistamines (H1 blockers)

• Cetirizine: 10 mg orally once daily.

• Loratadine: 10 mg orally once daily.

• Fexofenadine: 180 mg orally once daily.

• Children (6–12 years): Cetirizine 5–10 mg/day depending on weight.

Note: In resistant cases, the dose of non-sedating antihistamines can be increased up to 4 times the standard dose under medical supervision.

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3. Second-Line Therapy – Adjunctive Agents

• H2 blockers (as add-on):

  • Ranitidine: 150 mg orally twice daily (where available).

• Leukotriene receptor antagonists (useful in NSAID- or exercise-induced urticaria):

  • Montelukast: 10 mg orally once daily (5 mg chewable in children 6–14 years).

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4. Corticosteroids (short course for severe or refractory acute urticaria)

• Prednisolone: 0.5–1 mg/kg/day orally for 3–5 days, then taper.

• Not recommended for long-term use due to side effects.

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5. Severe Urticaria with Angioedema or Anaphylaxis

• Epinephrine (life-saving in airway compromise or systemic reaction):

  • Adults: 0.3–0.5 mg intramuscularly (IM) into mid-thigh.

  • Children: 0.01 mg/kg IM (max 0.3 mg per dose).

  • Repeat every 5–15 minutes if necessary.

• Oxygen, IV fluids, and airway support may be required.

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6. Chronic/Refractory Urticaria

• Omalizumab (anti-IgE monoclonal antibody): 150–300 mg subcutaneously every 4 weeks.

• Cyclosporine: 3–5 mg/kg/day orally (reserved for severe, resistant cases).