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Urticaria - Management
Which antihistamine should I use to treat urticaria?

  • Cetirizine, fexofenadine, or loratadine (once-daily non-sedating antihistamines) are recommended for the treatment of urticaria.
  • If an additional sedating antihistamine is needed for night-time use, if the itch is interfering with sleep, chlorphenamine or hydroxyzine are recommended.
Clarification / Additional information
  • Non-sedating antihistamines are routinely increased beyond the recommended licensed dose in secondary care to control symptoms. It is not advisable to increase above the maximum licensed dose unless the healthcare professional has experience in doing so, or before seeking specialist advice.
Basis for recommendation
  • Antihistamines (H1-receptor blockers) are the only drugs licensed for use in urticaria.
  • Although the efficacy of antihistamines has only been demonstrated for chronic urticaria, there is a consensus that they are also effective for acute urticaria [Grattan et al, 2001; Zuberbier et al, 2006]:
  • Non-sedating antihistamines should therefore be used initially to control daytime symptoms.
  • Sedating antihistamines are not recommended for daytime use because the drowsiness they cause can affect a person's ability to drive or perform other skilled tasks [Grattan et al, 2001; Zuberbier et al, 2006]. However, the addition of a sedating antihistamine at night to a non-sedating (daytime) antihistamine may help people who are unable to sleep due to itching, and is considered to be safe [Grattan et al, 2001].
  • Desloratadine (a metabolite of loratadine) and levocetirizine (an isomer of cetirizine) are more recently marketed products, but there is little evidence to confirm whether they confer any additional benefit over the more established non-sedating antihistamines [MeReC, 2004].
  • Mizolastine has been implicated in causing an abnormal prolongation of the QT interval and is therefore not recommended as a first-line treatment.
  • Acrivastine is not recommended as it has a short half-life and needs to be taken three times a day.

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