Treatment: Urticaria and Angioedema

• H₁ antihistamines may be helpful: e.g., chlorpheniramine up to 24 mg PO daily; diphenhydramine 25-50 mg PO qid; hydroxyzine 40-200 mg PO daily; cyproheptadine 8-32 mg PO daily; or the low or nonsedating class, e.g., loratidine 10 mg PO daily; desloratidine 5 mg PO daily; fexofenadine up to 180 mg PO daily; cetirizine 5-10 mg PO daily; levocetirizine 5 mg PO daily.
• H₂ antihistamines: e.g., ranitidine 150 mg PO bid may add benefit.
• Doxepin, a tricyclic compound with H₁ and H₂ receptor antagonist activity, has been used.
• Leukotriene receptor antagonists can be add-on therapy: e.g., montelukast 10 mg daily or zafirlukast 20 mg bid.
• Topical glucocorticoids are of no value in the management of urticaria and/or angioedema. Systemic glucocorticoids should not be used in the treatment of idiopathic, allergen-induced, or physical urticaria because of their long-term toxicity.