For emergency problems due to angioedema of the throat or tongue, a patient will need to take an antihistamine, possibly prednisone and if the patient feels faint or has difficulty breathing, they need Epinephrine also.
Patients that have life threatening reactions should carry Epinephrine with them. Products called Epipen® and Epipen Jr. or Auvi-Q® and Auvi-Q Jr. are auto injectable forms of epinephrine.
Urticaria and angioedema are a result of various mediators. White blood cells contain substances that are called mediators. Mediators include histamine, prostaglandins, and bradykinins. We have all felt the effects of histamine after a mosquito bite. The area gets red, itchy and some swelling may appear. We have few medicines that affect all the mediators, but we can address histamine, which is one of the main mediators. We use antihistamines to treat angioedema and urticaria. Some patients require high doses of antihistamines and even combinations of various antihistamines.
If the hives are intense and itchy an antihistamine should be taken and at times prednisone will also be prescribed. Creams and ointments really won’t help reduce the urticaria or angioedema. In fact, placing ice on the area, rubbing or scratching can make it worse.
Prednisone is a steroid medication that reduces allergic reactions, and can help with angioedema and urticaria. However, there are many side effects associated with taking an oral steroid frequently. Weight gain, increased appetite, water retention, elevated blood sugar, and even an alteration in the blood supply to the hip, which can lead to necrosis of the hip joint. Prednisone is very effective, but must be used sparingly.
If urticaria or angioedema occurs with frequency, it is important to rule out any systemic disease and discuss this with your primary care physician. It is important to undergo a physical examination that may include blood work if the urticaria and angioedema are difficult to control.
An allergist can help with the management and treatment of urticaria and angioedema. If the urticaria and angioedema are difficult to control, special medications may be needed. These medications must be monitored on a regular basis.
Our Urticaria Care Plan is handed to patients who have been diagnosed with idiopathic urticaria and angioedema. These patients are normally instructed to take a daily antihistamine of their choice such as Loratadine, Ceterizine or Fexafenidine as a preventative to help keep hives and swelling under control. In the event that they experience an episode of hives, itching or swelling, they are to start a dose of Prednisone and Benadryl. Again, Prednisone dosage ranges from 3/4 tsp – 1 1/2 tsp in liquid form for a younger child according to weight, and 20mg or 4 (5mg) tablets for an older child. Adults typically will need 30 mg and one or two Benadryl tablets at the onset to stop the attack. If swelling or hives persist after 4 hours, the patient may take another dose of Prednisone and Benadryl. We generally tell our patients that they may take 2 doses of Prednisone daily for up to 3 days in a row.
To treat chronic urticaria (urticaria that lasts longer than 6 weeks) we follow the practice parameters for allergy immunology:
1. Daily antihistamines two to three doses per day. Such as Loratadine, Fexofenadine, or Ceterizine.
2. If not controlled add Dapsone 25 to 100 mg per day
3. If not controlled add Xolair. Xolair is an anti-IgE biologic that will require insurance approval. This is an injectable. You would receive two injections once a month, and in a high percentage of patients this reduces or stops the itching. In our practice we have many patients receiving Xolair and many have shown a significant drop in their symptoms.
Download a copy of our Urticaria Care Plan.
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