Urticaria, treatment

Do Valle SO, Franca AT, Fires GV, Guimaraes P, Dias GA, Levy SA. Dapsone hypersensitivity syndrome during delayed pressure urticaria treatment. Ann Allergy Asthma Immunol 2010 104(2) 181-2. 

Treatment of superficial Local irritation (jtching, burning, infections involving angioneurotic edema, urticaria,... 

Patients with chronic idiopathic urticaria, who develop cutaneous reactions in response to aspirin, display certain similarities in eicosanoid profile with AIA. The mechanism of the reactions is often related to COX-1 inhibition [18]. Therefore, aspirin and all drugs that inhibit COX-1 should be avoided in patients who already have had cutaneous reactions to NSAID. Coxibs are usually well tolerated, although occasional adverse reactions have been reported [19, 20]. For treatment of the reactions, antihistamines are usually sufficient, but in more severe cases adrenaline and corticosteroids may be warranted. 

The anti-inflammatory agent benzoxaprofen (229) was withdrawn from clinical use in 1982 because of its photosensitizing effects [83]. Many patients experienced itching and urticaria, while some suffered onycholysis - separation of the finger nails from the nail beds [138], In a trial, healthy volunteers were sensitive by the 4th day of treatment. UVA provoked itching and a burning sensation followed by development of a classical wheal and flare response within 2 to 4 min [139]. 

Calcium chloride and gluconate - A6 unct /e therapy in the treatment of insect bites or stings, such as Black Widow spider bites to relieve muscle cramping sensitivity reactions, particularly when characterized by urticaria depression due to overdosage of magnesium sulfate acute symptoms of lead colic rickets osteomalacia. 

Allergic effects - Generalized urticaria has been observed rarely. If this or other allergic symptoms appear, discontinue treatment unless it is deemed... 

Unlabeled uses Cromolyn has been used as an alternative therapy in refractory forms of chronic urticaria/angioedema. Oral cromolyn has been used for the treatment of food allergies and mucosal and serosal eosinophilic gastroenteritis. 

Brompheniramine VaZol also is indicated for the temporary relief of runny nose and sneezing caused by the common cold treatment of allergic and nonallergic pruritic symptoms temporary relief of mild, uncomplicated urticaria and angioedema amelioration of allergic reactions to blood or plasma adjunctive therapy in anaphylactic reactions. 

Adverse reactions include nausea, nervousness, headache, insomnia, anxiety. Sexual dysfunction with loss of libido is a common complaint. Insomnia can be a problem. Urticaria and rashes have been described. Venlafaxine may significantly increase the risk of suicide and is therefore not recommended as a first line treatment of depression. The view that also fluoxetine and other SSRIs can lead to suicide is under debate for quite some time now. In most countries SSRIs are not approved for use in pediatric populations. In the UK and in the USA only fluoxetine can be prescribed for children. 

Carbamazepine stimulates antidiuretic hormone activity and has been used for the treatment of neurohypophyseal diabetes insipidus. Carbamazepine induces microsomal enzymes and its metabolism is subject to auto-induction. Frequently occurring adverse effects are sedation, dry mouth, dizziness and gastrointestinal disturbances. Photosensitivity reactions, urticaria and Stevens-Johnson syndrome have been described. The elderly are more prone to mental confusion, cardiac abnormalities and problems due to inappropriate ADH secretion. 

Although the antihistamines are not useful as primary agents in the treatment of asthma, a number of studies have shown that the second-generation compounds are effective as adjunctive therapies in asthmatic patients with concomitant rhinitis, urticaria, or dermatitis. Cetirizine has been used to prevent the progression from atopic dermatitis to asthma in young children. 

Hydroxychloroquine is approved for the treatment of both systemic and cutaneous lupus erythematosus. Both chloroquine and quinacrine (Atabrine) are also effective in this skin disease. Low-dose chloroquine is used for the therapy of porphyria cutanea tarda in patients in whom phlebotomy has failed or is contraindicated. Other skin diseases in which the drugs are useful (after sunscreens and avoidance of sun exposure) include polymorphous light eruption and solar urticaria. 

Miconazole (Monistat) is a broad-spectrum imidazole antifungal agent used in the topical treatment of cutaneous dermatophyte infections and mucous membrane Candida infections, such as vaginitis. Minimal absorption occurs from skin or mucous membrane surfaces. Local irritation to skin and mucous membranes can occur with topical use headaches, urticaria, and abdominal cramping have been reported with treatment for vagiiutis. 

Unlabeled Uses Prevention of aspiration pneumonia treatment of acute urticaria, chronic warts, upper GI bleeding... 

I Unlabeled Uses Treatment of neurogenic pain, panic disorder prevention of vascular headache, pruritus in idiopathic urticaria... 

A variety of relatively uncommon dermatological side effects have been noted to be associated with antipsychotic agents. These include maculopapular rashes, urticaria, and erythema multiforme (Arana, 2000). Photosensitivity and skin pigmentation can also occur during treatment with these drugs. Although skin pigmentation has been most frequently reported with chlorpromazine, this can occur with thioridazine and trifluoperazine (Harth and Rapoport, 1996). In addition, treatment-induced alopecia has been reported for haloperidol, olanzapine, and risperidone (Mercke et ah, 2000). 

Cetirizine is indicated for the symptomatic treatment of perennial allergic rhinitis, seasonal allergic rhinitis, chronic idiopathic urticaria, conjunctivitis and pruritus in adults and children above two years of age. 

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