Treating Chronic Urticaria With Antihistamines

People with chronic urticaria often experience feelings of frustration and helplessness. They may not understand why their symptoms are recurring, and they feel isolated from others who do not share their condition.

Hives are itchy red or skin-colored welts that can appear on any part of the body. They can be shaped like rings, a map-like pattern, or giant patches. They usually last for less than 24 hours.

Antihistamines

Hives are a skin condition that can be extremely uncomfortable and debilitating. The rash and itching can interfere with sleep, work or school. Despite the discomfort, it is important to try and treat chronic urticaria with antihistamines as they are an effective treatment for the disease.

There are many antihistamines that can be prescribed or found over-the-counter, including Clarityn, loratadine (Claritin), Zirtek, Benadryl and others. The most commonly prescribed is a second generation oral antihistamine called levocetirizine, also known as Xyzal. The drug is a long acting antihistamine with a low rate of adverse side effects. Levocetirizine has been shown to be more effective than hydroxyzine, with four tablets of levocetirizine being equivalent to one tablet of hydroxyzine [9].

Antihistamines are used to control allergic reactions, such as seasonal allergies and hay fever or other environmental allergens. They are also used to help people with colds, coughing and gastrointestinal issues like nausea, motion sickness and vomiting. Some of the medications are sedating and can be used to help patients get to sleep or to reduce anxiety and nervousness.

The first step in treating urticaria is to determine whether it is spontaneous or inducible. Spontaneous urticaria has no known cause, while chronic inducible urticaria has a specific trigger. Once the type of urticaria is determined, the doctor will look for clues about what may be causing it. This may involve a process of elimination, which can take time and patience for the patient. Some of the most common underlying causes of urticaria include food allergy, autoimmune conditions and bacterial infection. For this reason, a thorough medical history and physical examination is important.

Corticosteroids

Several forms of corticosteroids are used in the treatment of chronic spontaneous urticaria. They are effective for many patients and are generally well tolerated. Medications that are usually prescribed include prednisone, cyclosporine and adalimumab (a monoclonal antibody against IgE). These medications are often more effective than antihistamines alone.

The first step in the management of urticaria is to identify the cause, if possible. If you can determine what triggers the rash, you can avoid it in the future. In addition, you should also consider treating any underlying conditions, such as autoimmune thyroiditis or peptic ulcers.

In the majority of cases, urticaria is caused by inflammatory mediators from the classic complement pathway. The activation of factor C5A results in a cascade of events, including mast-cell and basophil degranulation and chemotaxis of neutrophils and eosinophils. The resulting wheals may be red, swollen and itchy. They typically last for a few minutes to hours and sometimes change shape before disappearing. Weals can be found anywhere on the body, including the scalp, palms and soles. They can also form rings, a map-like pattern or giant patches.

Wheals are characterized by a variable dermal infiltrate, and the severity of the lesions depends on their age. Histopathology reveals vascular and lymphatic dilatation, oedema and a variable perivascular cellular infiltrate. The perivascular infiltrate is composed of a mixture of leukotrienes, mast cells and inflammatory dendritic cells. The presence of eosinophils and IgE in the skin is also characteristic of autoimmune urticaria. Plasmapheresis has been successfully used in a limited number of patients with severe and refractory chronic urticaria. It is a time-consuming and expensive therapy, but it can be effective in some patients.

Topical ointments

There are a number of different topical ointments available, each designed to treat a specific condition or injury. Some are formulated with natural ingredients to provide soothing relief and hydration. These types of ointments are commonly used in first aid situations, as they can help to prevent infection by killing bacteria that may get on or under the skin. Other topical ointments are formulated for other health conditions, including wounds and burns, and include pain relievers and antibiotics. Many people keep a variety of these ointments in their medicine cabinet or first aid kit to use when needed.

Atopic urticaria, more commonly known as hives, is a medical condition that results in itchy blotches or lumps on the skin. The lesions can be red, white or skin coloured, and vary in size from a pin head to the width of a dinner plate. They are often surrounded by itchy areas of the skin, called pruritus. They can be triggered by a variety of things, and can last for a short time or for a longer period. In some cases, the hives can cause swelling under the skin (angioedema), which can affect the throat, eyes and lips.

The diagnosis of hives is made based on history and physical exam, with a process of elimination to figure out what might be causing the symptoms. Your healthcare provider may also do allergy tests, laboratory tests or a skin biopsy to rule out other issues.

Chronic spontaneous urticaria is characterized by the occurrence of itchy, red or skin-colored hives for six weeks or more. These hives, or weals, are a result of the release of histamine and other substances in response to an allergen. They may be distributed over the body or in a specific area, and can last for up to 24 hours. They can be itchy or not, and they can change shape over the course of a day.

Over-the-counter medications

If the hives are caused by an allergic reaction, doctors usually treat it with antihistamines. These include cetirizine (Zyrtec), fexofenadine (Allegra) and loratadine (Claritin). They are available in tablets or liquids. Most are non-drowsy. A few are also available as an ointment or cream. A doctor may also prescribe a drug called an epinephrine autoinjector, known as an EpiPen. This injection can treat anaphylaxis, a severe allergic reaction that causes excessive swelling, trouble breathing and other life-threatening symptoms. A healthcare provider can teach you how to use the device and give yourself an injection if needed.

The healthcare provider will look at the hives and ask you about your past health problems and symptoms. He or she may do allergy tests to see if there is an allergen that could be causing the hives. He or she may also do a blood test to check for high levels of antibodies, which are proteins that help your body fight off germs and allergies.

However, a cause cannot always be found for chronic hives. Your doctor may refer to this condition as idiopathic urticaria or chronic spontaneous urticaria (CSU). Despite the best efforts of your dermatologist and other specialists, you might not be able to find a trigger for your hives.

Many of the same tips that your doctor may recommend for treating acute hives can also be used to help you cope with CSU, including avoidance of certain drugs such as alcohol and nonsteroidal anti-inflammatory medications (NSAIDs). Your healthcare provider may suggest trying an oral corticosteroid to reduce the swelling and itching. These drugs are available only by prescription and typically come as a tablet or an injection (prednisone). They are intended for short-term use.

Exercise

The body releases a protein called histamine when an allergen triggers an allergic reaction. This causes tiny blood vessels to leak fluid under the skin. The resulting fluid accumulation forms a rash called hives. Typically, each hive lasts for 24 hours or less. Hives are itchy. If you have hives that recur frequently, you may have chronic spontaneous urticaria. This condition is different from contact dermatitis and is not caused by an allergy to medication or food.

You might hear at the gym of a runner who is “allergic to their own sweat.” Although perspiration can cause hives, it is usually not what causes exercise-induced urticaria (EIA). The cause of EIA is most likely heat produced through physical exertion. This can be from jogging, aerobic exercise, hot showers or baths, cooking, eating spicy foods and emotional stress. The reaction starts within minutes of the activity with flushing, itching and then half-inch or larger hives (unlike cholinergic urticaria’s small hives). It can progress to bronchospasm that can lead to breathing problems, swelling in the mouth, throat and hands and low blood pressure. If anaphylaxis occurs, use an epinephrine auto-injector as prescribed and seek emergency care.

You can minimize symptoms of EIU by avoiding known triggers and taking oral antihistamines before exercising. Make sure to drink plenty of water before and during your workouts as dehydration can exacerbate the symptoms. Some people also find relief from acupuncture and certain herbal supplements, like quercetin and bromelain. By establishing a partnership with your doctor to create a management plan that fits your lifestyle, you can continue to enjoy the many benefits of exercise. A healthcare provider can help you find the right balance between your health goals and the challenges of EIU.