Treatment Of Urticaria

Differential Diagnosis

Hebra's erythema multiforme: Systemic fever, malaise, and mouth lesions are noted in children and young adults (see the next section of this chapter).

Dermographism: A common finding in young adults, especially those who present complaining of welts on their skin or vague itching of the skin with no residual lesions. To make the diagnosis, stroke the skin firmly to see if an urticarial response develops. The course can be chronic, but hydroxyzine, 10 mg b.i.d. or t.i.d., is quite helpful. (Warn the patient about the possibility of drowsiness.)

Urticarial vasculitis: Lesions may last more than 24 hours, be painful, leave a bruise, and be associated with hypocomplementemia.

1.Antihistamine H1

Diphenhidramine HCl i.m

                Adult     : 10-20 mg/dose, 3-4 times/24 hours

                Children: 0,5 mg/kg/dose, 3-4 times/24 hours

Chlorphenyramine maleat

                Adults   : 3-4 mg/dose, 3-4 times/24 hours

                Children: 0,09 mg/kg/dose, 3-4 times/24 hours

Hydroxyzin HCl

                Adults   : 25 mg/dose, 3-4 times/24 hours

                Children: 0,5 g/kg/dose, 3-4 times/24 hours

I becomes the best option for chronic urticaria, dermatographic urticaria, and cholinergic urticaria. It has an anti stress effect and could be combined with other antihistamine H1.

Cryptoheptadine HCl

                Adults   : 4 mg/dose, 3-4 times/24 hours

                Effective for cold urticaria

Loratadine 10 mg/dose, once a day

Cetirizine 10 mg/dose, once a day

2.Combination Antihistamine H1 and Antihistamine H2

 (Cimetidine ablet 200-400 mg, 2-4 times/day or 1 X 800 mg at nght sleep)

This therapy is for dermographisme urticaria, cold urticaria, and chronic urticaria.

3. Corticoseroid

Used for acute and severe urticaria

Due to type III reaction

Prednisone

                Adults : 5-10 g/dose, 3 times/24 hours.

                Children : 1 mg/kg body weight/day

Dexamethasone

                Adults   : 0,5-1 mg/dose, 3 times/2 hours.

                Children : 0,1 mg/kg body weight/day

                Use combination with antihistamine for 2 weeks, usually it will not relapse

4. Adrenaline subcutaneous injection for acute, intense, and wide urticaria

 (angioedemea + dyspnoea, thick urticaria on all part of the body)

                Adults   : 0,3-0,5 ml/time, could be repeated 15-30 minutes after

                Children: 0,1-0,3 ml/time (body weight < 35 kg)

5. Ephedrine ablet

                Adults   : 2 x 0,5 tablet, minmal use for 3 days

                Children: 0,2-0,3 mg/kg body weight/time, 2-3 times/dy

                Substitution for adrenaline injection