Urticaria medical therapy

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Urticaria Microchapters


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Differentiating Urticaria from other Diseases

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] ; Associate Editor(s)-in-Chief: Anahita Deylamsalehi, M.D.[2]


Medical treatment is required for patients who are annoyed by wheals appearance and pruritus. First line treatment is H1 antihistamine medications, such as diphenhydramine, hydroxyzine, cetirizine and other H1 antihistamine. Some patients might require high doses of antihistamines for a complete control of their symptoms, but fortunately it's high doses are tolerated by most patients. If antihistamines as the first line treatment didn't successfully controlled the symptoms, omalizumab and cyclosporine should be tried as the second line treatment. Omalizumab has been effective in different sub-types of urticaria, such as solar urticaria, cold urticaria, cholinergic urticaria, urticarial vasculitis and symptomatic dermatographic urticaria. There are some other alternatives if the aforementioned medications didn't help, alternatives such as dapsone, hydroxychloroquine, sulfasalazine, colchicine, methotrexate, intravenous gamma globulin, plasmapheresis, corticosteroids, H2 antagonists and leukotriene antagonists. Some studies recommended specific alternative treatment for each subtypes of urticaria.

Medical Therapy

Histamine Antagonists





The following table is a summary of first and second line urticaria treatments and other alternatives:[15]

First line treatment Second line treatment Third line treatment Fourth line treatment
Antihistamines Omalizumab
Intravenous gamma globulin
H2 antagonist
Leukotriene antagonists

The following table is a summary of recommended treatment in different types of urticaria:[2]

Types of urticaria Standard treatment Alternate treatment
Acute urticaria H1 antihistamines (nonsedative)
Chronic urticaria H1 antihistamines (nonsedative)
Dermographic urticaria H1 antihistamines (nonsedative) -
Delayed pressure urticaria H1 antihistamines (nonsedative)
Cold urticaria H1 antihistamines (nonsedative)
Solar urticaria Physical tolerance induction by UV light
Cholinergic urticaria H1 antihistamines (nonsedative)

Contraindicated medications

Urticaria is considered an absolute contraindication to the use of the following medications:


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  4. Giménez-Arnau AM, Toubi E, Marsland AM, Maurer M (2016). "Clinical management of urticaria using omalizumab: the first licensed biological therapy available for chronic spontaneous urticaria". J Eur Acad Dermatol Venereol. 30 Suppl 5: 25–32. doi:10.1111/jdv.13697. PMID 27286500.
  5. Kayiran MA, Akdeniz N (2019). "Diagnosis and treatment of urticaria in primary care". North Clin Istanb. 6 (1): 93–99. doi:10.14744/nci.2018.75010. PMC 6526977 Check |pmc= value (help). PMID 31180381.
  6. Stellato C, de Paulis A, Ciccarelli A, Cirillo R, Patella V, Casolaro V; et al. (1992). "Anti-inflammatory effect of cyclosporin A on human skin mast cells". J Invest Dermatol. 98 (5): 800–4. doi:10.1111/1523-1747.ep12499960. PMID 1373749.
  7. Vena GA, Cassano N, Colombo D, Peruzzi E, Pigatto P, Neo-I-30 Study Group (2006). "Cyclosporine in chronic idiopathic urticaria: a double-blind, randomized, placebo-controlled trial". J Am Acad Dermatol. 55 (4): 705–9. doi:10.1016/j.jaad.2006.04.078. PMID 17010756.
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  9. Shelley WB, Shelley ED (1985). "Adrenergic urticaria: a new form of stress-induced hives". Lancet. 2 (8463): 1031–3. doi:10.1016/s0140-6736(85)90905-5. PMID 2865515.
  10. Olafsson JH, Larkö O, Roupe G, Granerus G, Bengtsson U (1986). "Treatment of chronic urticaria with PUVA or UVA plus placebo: a double-blind study". Arch Dermatol Res. 278 (3): 228–31. doi:10.1007/BF00412929. PMID 2425755.
  11. Horio T (2000). "Indications and action mechanisms of phototherapy". J Dermatol Sci. 23 Suppl 1: S17–21. doi:10.1016/s0923-1811(99)00069-9. PMID 10764986.
  12. Godt O, Proksch E, Streit V, Christophers E (1997). "Short- and long-term effectiveness of oral and bath PUVA therapy in urticaria pigmentosa and systemic mastocytosis". Dermatology. 195 (1): 35–9. doi:10.1159/000245681. PMID 9267734.
  13. Baron, ED (2007-03-29). "Urticaria, Solar". WebMD. Retrieved 2007-12-26. Unknown parameter |coauthors= ignored (help)
  14. McDonald, Kate (2007-04-13). "Tackling skin cancer in organ transplant patients". Australian Life Scientist. Retrieved 2007-12-24.
  15. Kaplan AP (2017). "Chronic Spontaneous Urticaria: Pathogenesis and Treatment Considerations". Allergy Asthma Immunol Res. 9 (6): 477–482. doi:10.4168/aair.2017.9.6.477. PMC 5603475. PMID 28913986.

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