The first-line pharmacotherapy is second-generation H antihistamines, leukotriene receptor antagonists, high-potency antihistamines, and brief corticosteroid bursts may be used as adjunctive treatment.
In refractory chronic urticaria, patients can be referred to subspecialists for additional treatments, such as omalizumab or cyclosporine.
More than one-half of patients with chronic urticaria will have resolution or improvement of symptoms within a year.
Urticaria is a common dermatologic condition that typically presents with intensely pruritic, well-circumscribed, raised wheals ranging from several millimeters to several centimeters or larger in size.
A = consistent, good-quality patient-oriented evidence; B = inconsistent or limited-quality patient-oriented evidence; C = consensus, disease-oriented evidence, usual practice, expert opinion, or case series.
For information about the SORT evidence rating system, go to https://org/afpsort PAUL SCHAEFER, MD, Ph D, is vice chair and associate professor in the Department of Family Medicine and assistant dean for student affairs at the University of Toledo (Ohio) College of Medicine and Life Sciences.
In 1998, in an unprecedented action, the American insurance company Anthem petitioned the FDA to allow loratadine and two other antihistamines to be made available over the counter (OTC) while it was still under patent; the FDA granted the request, which was not binding on manufacturers.
As of 2017 loratadine was available under many brand names and dosage forms worldwide, including several combination drug formulations with pseudoephedrine, paracetamol, betamethasone, ambroxol, salbutamol, phenylephrine, and dexamethasone.
Schering also developed desloratadine (Clarinex/Aerius), which is an active metabolite of loratadine.Address correspondence to Paul Schaefer, MD, Ph D, University of Toledo Health Sciences Campus, MS 1179, 2240 Dowling Hall, 3000 Arlington Ave., Toledo, OH 43614 (e-mail: [email protected]). The definition, diagnostic testing, and management of chronic inducible urticarias - The EAACI/GA(2) LEN/EDF/UNEV consensus recommendations 2016 update and revision. Reprints are not available from the author Zuberbier T, Aberer W, Asero R, et al.; European Academy of Allergy and Clinical Immunology; Global Allergy and Asthma European Network; European Dermatology Forum; World Allergy Organization. Only a limited nonspecific laboratory workup should be considered unless elements of the history or physical examination suggest specific underlying conditions.
The mainstay of treatment is avoidance of triggers, if identified. Urticaria can occur with angioedema, which is localized nonpitting edema of the subcutaneous or interstitial tissue that may be painful and warm. The intense pruritus can cause significant impairment in daily functioning and disrupt sleep.1 Typically otherwise benign and self-limited, urticaria can be a symptom of life-threatening anaphylaxis or, rarely, indicate significant underlying disease. Loratadine's peak effect occurs after one to two hours, and its biological half-life is on average 8 hours (range 3 to 20 hours) with desloratadine's half-life being 27 hours (range 9 to 92 hours), accounting for its long-lasting effect.