Fast Five Quiz: Refresh Your Knowledge on Key Aspects of Acute Urticaria

William James, MD


March 27, 2018

Most patients with urticaria can be treated with oral H1 antihistamines. Modern second-generation antihistamines are the first choice. Increasing the dose up to fourfold is permitted in patients who do not respond sufficiently to the standard dosing. For refractory cases, use a combination of H1 and H2 antihistamines. H2 antagonists are not effective when used as single agents for urticaria; however, the combination of an H1 antagonist with an H2 antagonist has been shown to be more effective than an H1 antagonist alone.

According to the management guidelines from the European Academy of Allergy and Clinical Immunology, the Global Allergy and Asthma European Network, the European Dermatology Forum, and the World Allergy Organization, first-generation sedating antihistamines should no longer be used as the first-choice therapy except where second-generation antihistamines are not available or where their benefits outweigh their risks. The guideline advises against using older, sedating first-generation antihistamines in patients with urticaria who have no special indications.

In some instances of acute or chronic urticaria, antihistamines may fail, even at high doses, or adverse effects may be problematic. In addition, mediators other than histamine may be involved. In such situations, corticosteroids can be highly effective. Corticosteroids may also be used in urticarial vasculitis, which usually does not respond to antihistamines.

For more on the treatment of urticaria, read here.

Editor's Recommendations


Comments on Medscape are moderated and should be professional in tone and on topic. You must declare any conflicts of interest related to your comments and responses. Please see our Commenting Guide for further information. We reserve the right to remove posts at our sole discretion.