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MY APPROACH to the Diagnosis and Treatment of Urticaria (Hives) | PracticeUpdate.

  Fortunately, the basic science underlying hiving has led to increasingly useful drugs helping to the point that physicians can help the vast majority of patients. ❿  

For Hives, A New Study Suggests Many Can Skip The Steroids | WBUR News -

  "Prednisone is never going to help immediately," she explained, and it doesn't really help with the itching, which was the focus of the. "I took prednisone for approximately 15 days, starting at 6 tablets per day, then tapering the dose down. I was on Benadryl for a few days for severe hives due.     ❾-50%}

 

Got hives? Hold the steroids -- ScienceDaily

    Consider doxepin mg at bedtime.

For further information: Steve Arnoff sarnoff acep. American College of Emergency Physicians. About Us. Got Hives? Hold the Steroids May 3, Related Articles. Five Questions with Dr. Claudette Rodriguez. Most of the hives appear within 1 hour after exposure. In patients with urticaria that last longer than 24 hours, a skin biopsy may be helpful to exclude urticarial vasculitis, urticarial pemphigoid, and other conditions that might mimic hives.

The best treatment for hives and angioedema is to identify and remove the trigger whether that be a drug, food, or physical factor. Antihistamines targeting H1 are the mainstay of treatment and include older drugs such as diphenhydramine and hydroxyzine mg at bedtime are useful, but can be quite sedating; hence, their use at bedtime. Some special tips:. Push the dose. Except in patients with a history of heart arrhythmias, concomitant drugs that elevate the Q-T interval, the non-sedating antihistamines can be given safely at double the FDA approved dose.

If you have any question about this, consult with the patient's primary care physician! Consider combining antihistamines from different classes. Taking a non-sedating antihistamine in the morning and a sedating antihistamine at bedtime can help many patients.

Consider doxepin mg at bedtime. This is the strongest anti-histamine known to mankind and often helps when other drugs do not. It can be quite sedating, however. Although most experts believe topical steroids are not useful, I have found that patients with dermatographism can use intermittent topical steroids to acute hives along with cold compresses for quick relief of itching to help them avoid scratching that aggravates their condition.

Of course, careful consideration must be given to underlying diabetes, high blood pressure, and a multitude of other steroid side effects. Warn the patient that you will not be using prednisone long-term even if the prednisone works great! Property Value Status. We have detected that you are using an Ad Blocker.

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With the addition of prednisone, the relief scores were actually worse. Thirty percent of patients in the prednisone group and 24 percent in the placebo group reported relapses. Acute urticaria, or hives, is a fairly common presentation in the emergency department. Itching is frequently associated with hives and can interfere with daily activities and sleep.

International guidelines published in stated that a short course of oral corticosteroids may be helpful to reduce disease duration for acute hives. Prednisone is commonly prescribed in the emergency department to treat them, along with antihistamines.

Even if short-term treatment with corticosteroids does not cause clinically significant toxicity, recurrent or long-term treatment may have deleterious effects. Annals of Emergency Medicine is one of the peer-reviewed scientific journal for the American College of Emergency Physicians ACEPthe national medical society representing emergency medicine. Annals of Emergency Medicine is the largest and most frequently cited circulation peer-reviewed journal in emergency medicine and publishes original research, clinical reports, opinion, and educational information related to the practice, teaching, and research of emergency medicine.

For further information: Steve Arnoff sarnoff acep. American College of Emergency Physicians. About Us. Got Hives? Hold the Steroids May 3, Related Articles. Five Questions with Dr. Claudette Rodriguez.

"Prednisone is never going to help immediately," she explained, and it doesn't really help with the itching, which was the focus of the. "I took prednisone for approximately 15 days, starting at 6 tablets per day, then tapering the dose down. I was on Benadryl for a few days for severe hives due. Doctors often prescribe an oral corticosteroid, like prednisone, along with an antihistamine to treat mild itchy rashes. The body rapidly absorbs prednisone. An immediate-release tablet reaches peak concentrations in about 1 to 2 hours. It is possible to feel. If your hives won't go away, what can you do to get rid of them? When antihistamines and steroids don't work, there are a few more. So for patients who may have a bigger presentation, the steroids can be helpful in that way.

The diagnosis and treatment of urticaria hives can be very rewarding, and quite frustrating! Fortunately, the basic science underlying hiving has led to increasingly useful drugs helping to the point that physicians can help the vast majority of patients.

Hives wheals appear as swollen, pale or red, mm papules and larger wheals that can be confluent. They appear rapidly and resolve within 24 hours, with hives coming up in new areas over time. The vast majority of hives are associated with itching and dermatographism stroking the skin leaves a linear wheal Hives can appear anywhere on the body and are sometimes associated with angioedema deep localized swelling, usually on the lips, hands, feet, or genitals.

In very rare cases, swelling of the throat or wheezing leads to respiratory compromise. In some cases the GI tract is involved, causing vomiting and diarrhea. Histamine release is at the center of the mechanism of hives and angioedema.

This causes blood plasma to leak from small vessels. Of course, bradykinin, kallikrein, and other vasoactive substances released from mast cells and basophils are also components of a very complex mechanism.

The trigger for histamine release is often allergic foods, insect bites, medications , but sometimes physical factors cause histamine release, including sunlight, pressure, cold, and scratching.

For patients with urticaria that has lasted just a few weeks, no work-up is indicated beyond a good history. The majority of patients will have their hives controlled with treatment, and their hives will resolve if the cause is identified by history food, latex, medication [most often aspirin, non-steroidal anti-inflammatory drugs, penicillin, sulfa, and ACE inhibitors], inhaled allergens [eg, pet dander, pollen], physical causes, etc and eliminated or the hives may disappear on their own even when no cause can be found.

In fact, no cause is found in the vast majority of patients. In patients with urticaria that persists longer than 6 weeks, a referral to primary care for a physical examination and blood work searching for signs of an occult infection, including hepatitis, intestinal parasite, autoimmune disease, or internal malignancy, is indicated.

Physical urticaria consists of hives caused by direct physical stimulation of the skin, for example, cold, heat, sun exposure, vibration, pressure, sweating , and exercise. The hives usually occur right where the skin was stimulated and rarely appear elsewhere. Most of the hives appear within 1 hour after exposure. In patients with urticaria that last longer than 24 hours, a skin biopsy may be helpful to exclude urticarial vasculitis, urticarial pemphigoid, and other conditions that might mimic hives.

The best treatment for hives and angioedema is to identify and remove the trigger whether that be a drug, food, or physical factor. Antihistamines targeting H1 are the mainstay of treatment and include older drugs such as diphenhydramine and hydroxyzine mg at bedtime are useful, but can be quite sedating; hence, their use at bedtime.

Some special tips:. Push the dose. Except in patients with a history of heart arrhythmias, concomitant drugs that elevate the Q-T interval, the non-sedating antihistamines can be given safely at double the FDA approved dose.

If you have any question about this, consult with the patient's primary care physician! Consider combining antihistamines from different classes. Taking a non-sedating antihistamine in the morning and a sedating antihistamine at bedtime can help many patients. Consider doxepin mg at bedtime. This is the strongest anti-histamine known to mankind and often helps when other drugs do not.

It can be quite sedating, however. Although most experts believe topical steroids are not useful, I have found that patients with dermatographism can use intermittent topical steroids to acute hives along with cold compresses for quick relief of itching to help them avoid scratching that aggravates their condition.

Of course, careful consideration must be given to underlying diabetes, high blood pressure, and a multitude of other steroid side effects. Warn the patient that you will not be using prednisone long-term even if the prednisone works great! Property Value Status. We have detected that you are using an Ad Blocker. PracticeUpdate is free to end users but we rely on advertising to fund our site.

Please consider supporting PracticeUpdate by whitelisting us in your ad blocker. We have sent a message to the email address you have provided,. If this email is not correct, please update your settings with your correct address. The email address you provided during registration, , does not appear to be valid.

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