management according to presentation

Last reviewed 01/2018

Management according to presentation

If the patient presents with urticaria for the first time:

• the patient should be reassured that the it is not a serious disease and usually self limiting
• a non-sedating oral antihistamine (e.g. cetirizine, fexofenadine, or loratadine) can be given to control the day time symptoms
• if itching interferes with sleep an additional sedating antihistamine can be prescribed at night
• for generalised acute urticaria, a short course of oral corticosteroids (e.g. prednisolone 40 mg daily for 3-5 days) can be given in addition to the oral antihistamine
• people should be advised to return if there is worsening of symptoms
• in cases where there is no improvement after 2 weeks of treatment, an alternative non-sedating antihistamine can be tried or should reconsider the diagnosis (1)

In persistent (chronic urticaria):

• patient should be advised about avoiding possible trigger factors
• a non-sedating antihistamine to control day time symptoms
• an additional sedating antihistamine to control nocturnal itching
• additionally to antihistamine or as a substitute to antihistamine, a topical menthol 1% cream can be used " for 'severe flare-ups' a short course of oral prednisolone (e.g. 40 mg daily 3-5 days) can be given. Repeat of steroids is not recommended (1)

Reference:

• 1. Clinical Knowledge Summaries 2007. Urticaria
• 2. British Association of Dermatologists 2007. Guidelines for evaluation and management of urticaria in adults and children