Contact Urticaria Syndrome Medication

Updated: Jan 30, 2020
  • Author: Shweta Shukla, MD; Chief Editor: Dirk M Elston, MD  more...
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Medication Summary

Depending on the ubiquity of the allergen, patients with immunologic contact urticaria may be advised to carry antihistamines and self-administered epinephrine. Antihistamines used in the treatment of contact urticaria include the H1-receptor blockers diphenhydramine, hydroxyzine, loratadine, and desloratadine, a loratadine metabolite. Epinephrine, a vasopressor, is used in the treatment of anaphylactoid reactions (stage 4 contact urticaria syndrome). NSAIDs are the first-line treatment for nonimmunologic urticaria.


Antihistamines, First Generation

Class Summary

First-generation antihistamines compete with histamine at the tissue-receptor level, preventing it from mediating its proinflammatory effects.

Diphenhydramine (Benadryl, Diphenhist, Allerdryl)

Diphenhydramine is for symptomatic relief of urticaria symptoms caused by the release of histamine in allergic reactions.

Hydroxyzine (Vistaril)

Hydroxyzine antagonizes H1 receptors in the periphery. It may suppress histamine activity in the subcortical region of the central nervous system.


Antihistamines, Second Generation

Class Summary

Second-generation antihistamines, also known as less-sedating or low-sedation antihistamines, produce less sedation than traditional H1 blockers because they are less lipid-soluble and only cross the blood-brain barrier in small amounts. They also have longer half-lives, allowing less frequent dosing.

Fexofenadine (Allegra)

Fexofenadine competes with histamine for H1 receptors in the GI tract, blood vessels, and the respiratory tract, reducing hypersensitivity reactions. It does not sedate. Fexofenadine is available as a 30-, 60-, or 180-mg tablet. The Allegra ODT tablet is formulated for disintegration in the mouth immediately after administration. Each orally disintegrating tablet contains 30 mg of fexofenadine hydrochloride. The Allegra oral suspension contains 6 mg/mL of fexofenadine hydrochloride (30 mg/5 mL).

Loratadine (Claritin)

Loratadine selectively inhibits peripheral histamine H1 receptors.

Desloratadine (Clarinex)

Desloratadine is a long-acting tricyclic histamine antagonist that is selective for H1 receptors. This agent is a major metabolite of loratadine, which after ingestion is extensively metabolized to active metabolite 3-hydroxydesloratadine.

Levocetirizine (Xyzal)

Levocetirizine is an H1-receptor antagonist, an active enantiomer of cetirizine. It is a second-generation prescription antihistamine.



Class Summary

Corticosteroids have anti-inflammatory properties and cause profound and varied metabolic effects. These agents modify the body's immune response to diverse stimuli. In patients with generalized urticaria or asthma, systemic glucocorticoids can be highly effective. However, epinephrine and H1 antihistamines are the high-priority and first-line agents in anaphylaxis.

Methylprednisolone (Medrol, Medrol Dosepak, DepoMedrol, SoluMedrol)

Methylprednisolone may decrease inflammation by reversing increased capillary permeability and suppressing PMN activity. It is ndicated for severe, prolonged, or anaphylactic reactions. It decreases late immune-mediated complications.

Prednisone (Deltasone, Rayos, Prednisone Intensol, Sterapred, Sterapred DS)

Prednisone is indicated for severe, prolonged, or anaphylactic reactions. It decreases late immune-mediated complications. It must be metabolized to the active metabolite prednisolone for effect. Conversion may be impaired in liver disease.


Alpha/Beta Adrenergic Agonists

Class Summary

These agents are used in the emergency management of systemic allergic reactions or anaphylaxis (eg, urticaria, angioedema, bronchospasm, cardiovascular collapse). The effects are immediate and dramatic. The appropriate use of this class of medication can be lifesaving, especially in the emergency management of anaphylaxis.

Epinephrine (EpiPen, Adrenaline, Twinject)

Epinephrine has alpha-agonist effects that include increased peripheral vascular resistance, reversed peripheral vasodilatation, systemic hypotension, and vascular permeability. Beta-agonist effects of epinephrine include bronchodilatation, chronotropic cardiac activity, and positive inotropic effects.



Class Summary

These medications inhibit various cyclooxygenase enzymes. These enzymes are involved in producing prostaglandins, which promote fever, pain, and inflammation. They are also involved in platelet function and clotting. Thus, blocking these enzymes results in a reduction of inflammation as well as impaired blood clotting. Adverse effects include stomach ulcers and kidney damage.

Ibuprofen (Advil, Motrin, PediaCare Children's Pain Reliever/Fever Reducer IB)

Ibuprofen is an NSAID with analgesic, anti-inflammatory, and antipyretic properties. It inhibits inflammatory reactions and pain by decreasing prostaglandin synthesis.

Naproxen (Naprox Sodium, Aleve, Anaprox)

Naproxen inhibits inflammatory reactions and pain by decreasing the activity of cyclooxygenase, which results in a decrease of prostaglandin synthesis.