Treatment of urticaria: Medication and topical treatment and home remedies

Treatment of urticaria is individual.

It should be based on the elimination of the causes and symptomatic treatment (antihistamines, corticosteroids), which eliminate itching and swelling.

A prerequisite for the successful treatment of urticaria is good cooperation between the doctor and the patient.

Treatment of urticaria consists of three steps:

a. Patient education

As part of the patient's education, the doctor should educate him about the nature of the disease.

b. Elimination of provoking factors

Elimination of the provoking allergen is only possible if the provoking factor is known (physical factor, food additives, latex, medications).

c. Treatment

Treatment of urticaria is chosen by the doctor in the event that the manifestations of the disease persist even after the elimination of the provoking factors.

Treatment depends on the type of urticaria.

Antihistamines

The trend of increasing allergic diseases is reflected in the consumption of histamine-blocking drugs.

Such drugs are called antihistamines or antagonists – H₁ receptors. 

Antihistamines are used for the prophylaxis and treatment of diseases on an allergic basis. In the case of urticaria, antihistamines reduce the number and size of rashes. They suppress itching and edema.

Antihistamines of the 1st generation

The first antihistamines appeared on the market in the 1940s. Drugs belonging to this group are most commonly used orally or topically (ointments, creams, eye ointments and eye drops).

V súčasnosti sa z tejto skupiny antihistaminík najčastejšie využívajú tieto liečivá:

• Bisulepin

It blocks the action of histamine, one of the substances released in the body during a hypersensitivity reaction.

Bisulepin is used to relieve the discomfort of hypersensitivity manifestations, allergic rhinitis and conjunctivitis, acute allergic conditions and allergic reactions (after insect bites, after medication, after food, etc.), as well as in the treatment of urticaria.

The dosage of bisulepin is individual. In the beginning, it is advisable to give higher doses. Once the effect is achieved, lower doses can usually be sufficient.

• Ketotifen

It is an anti-allergic drug that suppresses the inflammatory response by which the body reacts to certain substances. It is used to prevent and treat certain allergic diseases such as urticaria, dermatitis, allergic rhinitis and conjunctivitis.

The dosage of ketotifen in adult patients is 1 tablet 2 x daily. In patients sensitive to the sedative effect of ketotifen, a slow increase in dose is recommended in the 1st week of treatment. 

Initially 1/2 tablet 2x daily and then increase the dose until the full therapeutic dose is reached. If necessary, the daily dose may be increased to 2 tablets 2x daily.

The maximum daily dose is 4 tablets.

Side effects of the 1st generation antihistamines

• sedative effect - a decrease in attention, ability to concentrate and daytime sleepiness
• photosensitivity
• dry mouth
• visual disturbances - blurred vision
• urinary retention
• nervousness
• uncontrollable hand trembling

The elderly may experience drowsiness, dizziness, euphoria, confusion, insomnia and excessive nervousness.

Risk factors in the development of decline include:

• administration of alcohol
• use of psychopharmaceuticals

Antihistamines of the 2nd generation

Generation 2 antihistamines provide the same therapeutic effect as the previous group of drugs, but have significantly fewer side effects.

In practice, they are popular because they do not have a sedative effect. The quality of life of patients is without limitations. They can carry out work that requires full attention (driving, operating machinery, etc.).

Nevertheless, sedative side effects occur in some patients and are significant even at low frequency, especially in high-risk occupations. For this reason, in Japan, the use of any antihistamines, even in topical form, is not permissible in the air force or the military.

Second-generation antihistamines inhibit the degranulation of mast cells, eosinophils and neutrophils, inhibit granulocyte chemotaxis and have anti-inflammatory effects. Generation II antihistamines are considered the 1st-line drugs of choice for almost all forms of urticaria.

Antihistamines and pregnancy

The use of antihistamines in pregnancy is only possible in cases where the benefits outweigh the potential risks.

First-generation antihistamines are not recommended for use during pregnancy, especially in the first trimester, without consideration of the beneficial therapeutic effect on the mother and the potential risk to the fetus.

Given the results of scientific studies, 2nd generation antihistamines are preferred.

How do I know if I've overdosed?

An overdose of an antihistamine may manifest in the following way:

• dry mucous membranes
• increased body temperature
• reddening of the skin
• urinary retention
• reduced intestinal motility
• tachycardia
• lethargy
• excessive sleeping (hypersomnolence)
• coma

In infants and younger children, an overdose may manifest in the following way:

• irritability
• hyperactivity
• insomnia
• visual hallucinations
• cerebral spasms

Corticosteroids

Corticosteroid treatment is used for the most severe forms of urticaria and angioedema.

In practice, synthetically prepared glucocorticoids are used. They attenuate or inhibit the immune and inflammatory response caused by various stimuli such as mechanical, chemical, infectious or immunological factors and radiation.

The effects of glucocorticoids are:

• anti-allergic
• anti-inflammatory
• anti-proliferative
• analgesic

Corticosteroids are available in injectable and tablet form. They are also available as eye drops, nasal spray, gel or cream for topical use.

Side effects of corticosteroids include:

• bacteraemia
• cardiac and renal decompensation
• hypokalaemia
• peptic ulceration
• osteoporosis
• steroid diabetes mellitus
• stretch marks
• steroid acne
• pigmentation

When should corticosteroids not be given?

• Cushing's disease
• stomach and intestinal surgery
• severe diabetes mellitus
• gastric ulcer disease
• psychosis
• viral and bacterial infections
• pregnancy

Triple combination

Another option is the so-called combined treatment.

In this treatment, the following are administered simultaneously:

• antibiotics (tetracyklin)
• antifungals - against candida in the digestive tract (for 5 days)
• antihistamines - prolonged administration of antihistamines

Hives and probiotics?

At the same time, the intestinal flora is modified by the administration of probiotics.

The digestive tract has many functions. In addition to its digestive and excretory functions, it also has an immunological function. Microorganisms present in the digestive tract promote immune responses by various mechanisms:

• suppress the development of intestinal inflammation.
• support the function of lymphoid tissue, which produces secretory antibodies.
• prevent the establishment of pathogens.

Topical treatment of urticaria

To relieve itching and irritation, topical antihistamines (dimetindene, diphenhydramine) and topical corticosteroids (hydrocortisone) are recommended in practice.

When applying them, we must protect the skin from sunlight and cannot apply them to large areas. Emollients containing betaglucan, zinc, copper, hyaluronate, which regenerate the skin and relieve itching, have a positive effect on skin regeneration.

What are the home recipes for the treatment of urticaria?

Salty compresses

A salty compress should relieve itching.

For this recipe we need a liter of water and three tablespoons of salt.

Mix the salt in the water.

Soak a handkerchief or towel in the resulting solution.

Place the handkerchief on the affected area for at least ten minutes.